title: The phenotypic diversity in per-follicle anti-Müllerian hormone production in polycystic ovary syndrome.
abstract: OBJECTIVE
  Is intrinsic dysregulation of granulosa cells (GC) and consequent increases in the per-follicle production of anti-Müllerian hormone (AMH), correlated with the phenotypic presentation of women with polycystic ovaries?
  
  
  CONCLUSIONS
  Involvement of intrinsic GC dysregulation in oligo-anovulation associated with polycystic ovary syndrome (PCOS) is likely because among women with PCOS, those with oligo-amenorrhea have higher per-follicle AMH production than those who ovulate normally, irrespective of their androgen and/or metabolic status.
  
  
  BACKGROUND
  Women with PCOS have higher serum AMH level than non-PCOS women due to an increased follicle number and excessive AMH production per follicle, the latter reflecting a putative GC dysfunction that may vary between PCOS phenotypes.
  
  
  METHODS
  This is a retrospective analysis of data collected from 1021 women undergoing infertility evaluation from March 2011 to October 2013.
  
  
  METHODS
  The study included women with polycystic ovarian morphology (PCOM) who met the Rotterdam criteria for PCOS (n = 272), women with PCOM only (n = 168) and controls (n = 581).
  
  
  RESULTS
  We used serum AMH to antral follicle count (AFC) ratio (AMH/AFC) as a marker of per-follicle AMH production and checked whether this ratio was associated with the PCOS phenotype and to the menstrual, androgen and metabolic status in women with PCOS, women with PCOM only and in controls. AMH/AFC was significantly higher in oligo-amenorrheic women with PCOS than in eumenorrheic women with PCOS or PCOM (P < 0.001) but also in the latter group compared with controls (P < 0.001) regardless of androgen status. Stepwise discriminant analysis yielded a significant score for the menstrual status with a discriminant power of 26.5% (P < 0.001). This score included AFC, AMH/AFC, waist circumference and LH with partial R(2) of 0.172, 0.042, 0.024 and 0.023, respectively.
  
  
  CONCLUSIONS
  The AMH to AFC ratio as a surrogate marker for average AMH may be subject to error because follicles below the sensitivity limit of the ultrasonography used may also contribute to serum AMH concentration and secondly, AFC can be subjective.
  
  
  CONCLUSIONS
  The higher AMH/AFC in women with PCOM only than in controls suggests that isolated PCOM may represent a PCOS-like phenotype in which an inherent dysfunction of GC exists but is too mild to affect the ovulatory process.
  
  
  BACKGROUND
  No funding was obtained for this study. There are no conflicts of interest to be declared.
  
  
  BACKGROUND
  Non-applicable.
authors.affiliation: Division of Reproductive Medicine, Podobnik Maternity and Gynecology Hospital, Sveti Duh 112, 10000 Zagreb, Croatia alebic11@gmail.com.
authors.forename: M Š
authors.initials: MŠ
authors.lastname: Alebić
authors.affiliation: Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia.
authors.forename: N
authors.initials: N
authors.lastname: Stojanović
authors.affiliation: Unité de Biostatistiques, EA2694, Université Lille Nord de France, 59000 Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, C.H.R.U., 59037 Lille, France.
authors.forename: D
authors.initials: D
authors.lastname: Dewailly
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D006107:Granulosa Cells / Q000378:metabolism*; D006801:Humans; D008597:Menstrual Cycle / Q000378:metabolism; D006080:Ovarian Follicle / Q000378:metabolism*; D011085:Polycystic Ovary Syndrome / Q000378:metabolism*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone
keywords: PCOS; anovulation; anti-Müllerian hormone; hyperandrogenism; polycystic ovary