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Hum. Reprod. Advance Access originally published online on June 10, 2008
Human Reproduction 2008 23(9):2122-2126; doi:10.1093/humrep/den185
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Anti-Mullerian hormone is increased in follicular fluid from unstimulated ovaries in women with polycystic ovary syndrome

M. Das1,2, D.J. Gillott1,2, E. Saridogan1,2 and O. Djahanbakhch1,2,3

1 Academic Department of Obstetrics and Gynaecology, Barts and The London, The Royal London Hospital, School of Medicine, University of London, Whitechapel, London E1 1BB, UK 2 Newham University Hospital, London, UK

3 Correspondence address. Tel: +44-2073638069; Fax: +44-2073638775; E-mail:o.b.djahanbakhch{at}qmul.ac.uk

BACKGROUND: Anti-Mullerian hormone (AMH) may have a role in disordered folliculogenesis in polycystic ovary syndrome (PCOS). Though there have been several investigations into circulating AMH levels in patients with PCOS, no previous studies have compared AMH concentrations in the follicular fluid of unstimulated ovaries in women with PCOS with that of normally ovulating women.

METHODS: Follicular fluid was aspirated from 4–8-mm follicles of unstimulated ovaries during routine laparoscopy or laparotomy from women with anovulatory PCOS (n = 11) and those with regular ovulatory cycles (n = 8). Follicular AMH was compared in the two groups. Serum samples were analysed for AMH and endocrine profile.

RESULTS: Follicular fluid AMH levels were significantly higher (P < 0.0001) in women with anovulatory PCOS (median: 466.2 ng/ml) compared with normal-ovulatory controls (median: 78.0 ng/ml). Mean follicular fluid AMH levels in PCOS patients were 60 times higher than in the serum. Moreover, there was a significant correlation between the follicular fluid and serum concentrations of AMH in the PCOS group (r = 0.86; P = 0.007) but not in controls.

CONCLUSIONS: Highly elevated AMH in follicular fluid from PCOS patients in contrast to age-matched normal controls suggests that increased circulating concentrations of AMH are partly due to the increased production of AMH by individual follicles and not simply attributable to the increased number of small antral follicles. This suggests an intrinsic abnormality in the ovarian follicles themselves in PCOS, which could contribute to disordered folliculogenesis.

Key words: polycystic ovary syndrome/anti-Mullerian hormone/follicular fluid/granulosa cell

Submitted on August 27, 2007; resubmitted on April 11, 2008; accepted on April 21, 2008.


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