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Insulin resistance does not influence anti-Müllerian hormone levels in PCOS
Women with polycystic ovary syndrome had similar anti-Müllerian hormone levels regardless of whether they also had insulin resistance, according to findings published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
“Insulin resistance and serum [anti-Müllerian hormone] levels play a role in the clinical assessment and interventions of PCOS,” Sezai Sahmay, MD, professor in the department of obstetrics and gynecology at Istanbul University Cerrahpasa School of Medicine, Turkey, and colleagues wrote in the study background. “Insulin resistance is associated with hyperandrogenism, and it has been suggested that [insulin resistance] might also be associated with serum [anti-Müllerian hormone] levels. However, evidence regarding the association between elevated [anti-Müllerian hormone] levels and [insulin resistance] as well as other metabolic manifestations of PCOS is conflicting.”
In a cross-sectional study, Sahmay and colleagues analyzed data from 293 women younger than 40 years admitted to the reproductive endocrinology and in vitro fertilization unit of Istanbul University Cerrahpasa Faculty of Medicine between 2012 and 2016 with a diagnosis of PCOS according to Rotterdam criteria. Included women underwent an exam and ultrasound and provided fasting blood sample during 3 to 5 days of a spontaneous menstrual cycle to assess polycystic ovarian morphology, ovarian volume, fasting glucose, serum insulin and hormone profile, including follicle-stimulating hormone level, luteinizing hormone, total testosterone, free testosterone, dehydroepiandrosterone sulfate, 17-OH-progesterone, thyroid-stimulating hormone and anti-Müllerian hormone. Insulin resistance was measured via homeostatic model assessment of insulin resistance (HOMA-IR). Primary outcome was anti-Müllerian hormone levels in women with and without insulin resistance; secondary outcomes included HOMA-IR, BMI and anti-Müllerian hormone values across different PCOS phenotypes. Researchers used linear regression analysis to determine the role of factors on HOMA-IR.
Within the cohort, 45% of women had insulin resistance as determined by HOMA-IR, according to researchers. They found that serum anti-Müllerian hormone levels were not different between women with and without insulin resistance; however, women with insulin resistance were more likely to higher BMI and serum free testosterone levels, as well as a longer menstrual cycle length.
When women were stratified by anti-Müllerian hormone level percentiles (< 25%; 25% to 75%; > 75%), median HOMA-IR values did not differ between groups, according to researchers. However, in each anti-Müllerian hormone percentile group, BMI values were higher in women with insulin resistance vs. those without insulin resistance.
In analyzing secondary outcomes, researchers stratified women by four main PCOS phenotypes: PCOS with polycystic ovarian morphology, hyperandrogenism and oligomenorrhea (type 1); PCOS with only polycystic ovarian morphology and oligomenorrhea (type 2); PCOS with only polycystic ovarian morphology and hyperandrogenism (type 3); and PCOS with only hyperandrogenism and oligomenorrhea (type 4). Among women with PCOS and insulin resistance, 71% had the type 1 phenotype, 5% had the type 2 phenotype, 18% had the type 3 phenotype and 6% had type 4 phenotype, according to researchers.
“This finding aligns with the longer cycle lengths and higher free testosterone levels observed in our population with [insulin resistance],” the researchers wrote. “Serum [anti-Müllerian hormone] levels were found to be highest in women with all features.”
The researchers noted that insulin resistance should be investigated in women with PCOS and a BMI of at least 25 kg/m², independent of PCOS phenotype of anti-Müllerian hormone level. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.