title: Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic ovarian syndrome phenotypes and assisted reproductive technology outcomes.
abstract: OBJECTIVE
  Serum Antimüllerian hormone (AMH) levels are elevated in polycystic ovarian syndrome and have been shown to be useful in its diagnosis. However, the clinical significance of extremely high AMH levels is understudied. We aimed to characterize a population of women with elevated AMH (>5 ng/mL).
  
  
  METHODS
  This was a retrospective cohort study of 134 women presenting to our fertility clinic for infertility evaluation and treatment who were found to have random serum AMH over 5 ng/mL. Women were divided into 3 groups according to AMH: 5-10 ng/mL, >10-14 ng/mL, and >14 ng/mL. Endocrine characteristics, polycystic ovarian syndrome (PCOS) phenotypes, fertilization rate, implantation rate, clinical pregnancy, and multiple pregnancy rates were compared between groups.
  
  
  RESULTS
  AMH ranged between 5 to 48 ng/mL. Greater than 97% of women with ultrahigh AMH (>10 ng/mL) had PCOS. In addition, women with AMH >10 ng/mL had greater prevalence of polycystic ovarian morphology and oligoamenorrhea than women with AMH 5-10 ng/mL. Moreover, serum AMH correlated positively with luteinizing hormone, total testosterone, and dehydroepiandrosterone sulfate. Furthermore, AMH showed strong predictive ability for the presence of amenorrhea (area under the curve, 0.87; 95% confidence interval, 0.80-0.92; P < .0001). Despite similar age and mean number of transferred embryos, women with AMH >10 ng/mL showed higher rates of ovarian hyperstimulation syndrome and clinical pregnancy rates compared with women with AMH 5-10 ng/mL.
  
  
  CONCLUSIONS
  These data characterize a population of women with elevated AMH levels, demonstrating that the vast majority of women with AMH >10 ng/mL have PCOS. Increased AMH levels correlated with PCOS severity and are associated with greater ovarian stimulation and higher clinical pregnancy rates following assisted reproductive technology.
authors.affiliation: Genesis Fertility and Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY. Electronic address: resheft@gmail.com.
authors.forename: Reshef
authors.initials: R
authors.lastname: Tal
authors.affiliation: Genesis Fertility and Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: David B
authors.initials: DB
authors.lastname: Seifer
authors.affiliation: Genesis Fertility and Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Moisey
authors.initials: M
authors.lastname: Khanimov
authors.affiliation: Genesis Fertility and Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Malter
authors.affiliation: Genesis Fertility and Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Grazi
authors.affiliation: Clinical Research Division, Reprosource, Inc, Woburn, MA.
authors.forename: Ben
authors.initials: B
authors.lastname: Leader
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000209:etiology; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D010062:Ovulation Induction; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D011247:Pregnancy; D018873:Pregnancy Rate; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone
keywords: antimüllerian hormone (AMH); assisted reproductive technology (ART); outcomes; polycystic ovarian syndrome (PCOS); ultrahigh AMH