Anti-Müllerian Hormone in Polycystic Ovary Syndrome: Towards a Specific Diagnostic Threshold in the Tunisian Population

Objective Polycystic ovary syndrome (PCOS) is the leading cause of infertility in women of reproductive age. Its diagnosis can be challenging due to the heterogeneity of presentation, the lack of a single definitive test, and the need to rule out other conditions. The diagnostic criteria are difficult to apply consistently across different individuals and ethnic groups. The study aimed to define a threshold of anti-Müllerian hormone (AMH), which would be predictive of PCOS in the Tunisian population. Methods A case-control study was conducted, including 31 women diagnosed with PCOS according to the Rotterdam criteria, and 31 age- and body mass index-matched women without PCOS. All participants underwent medical evaluations, including gynecologic history, physical examination, ovarian ultrasound, and measurements of serum AMH and testosterone concentrations. Results Serum AMH concentrations were noticeably higher in women with than those without PCOS [median (25th-75th percentile), 6.92 (4.60-10.0) ng/mL versus 1.90 (1.33-2.85) ng/mL; P < 0.001]. A serum AMH concentration of 3.41 ng/mL differentiated women with PCOS from control women with excellent accuracy (median area under the curve, 0.977; sensitivity, 97%; and specificity, 90%). AMH levels were positively correlated with the number of antral follicles (Spearman's r=0.846; P < 0.001), ovarian volume (Spearman's r=0.769; P < 0.001), and testosterone levels (Spearman's r=0.654; P < 0.001). PCOS phenotype A was associated with the highest AMH levels. Conclusion The study suggests that serum AMH is relevant for the diagnosis of PCOS. Based on the findings, we propose a serum AMH cutoff value of 3.41 ng/mL for the diagnosis of PCOS in Tunisian hyperandrogenic adult women.