Evaluation of Biochemical Serum Markers for the Diagnosis of Polycystic Ovary Syndrome (PCOS) in Obese Women in Kazakhstan: Is Anti-Müllerian Hormone a Potential Marker?

Abstract

Background: Polycystic Ovarian Syndrome (PCOS) is a common endocrine condition that affects 8-13% of women of reproductive age. In Kazakhstan, the prevalence of this syndrome is particularly high compared with other countries and the global average. Currently, the diagnosis of PCOS is based on internationally established Rotterdam criteria, using hyperandrogenism as a key parameter. These criteria are applied to diagnose PCOS in all female patients, although obese patients may have excess testosterone produced by adipose tissue. To avoid possible misdiagnosis, an additional criterion, especially for the diagnosis of PCOS in obese women, could be considered. The aim of this study was to identify whether anti-Müllerian hormone (AMH) or other biochemical criteria can be used for this purpose. Methods: A total of 138 women were recruited for this study and grouped into control (n = 46), obese subjects without PCOS (n = 67), and obese patients with PCOS (n = 25). The health status, anthropometric parameters, and serum indicators for glucose, glycosylated hemoglobin, and hormone levels were examined for all subjects. Statistical data were analyzed using GraphPad Prism 10 software for interpretation of the data. Results: Serum AMH, testosterone, and LH were positively correlated in obese PCOS patients, while AMH and FSH were negatively correlated. Compared with other biochemical indicators, the serum AMH and testosterone levels in obese PCOS patients were significantly higher than those in non-PCOS patients (regardless of obesity), and AMH was also positively correlated with testosterone. Conclusions: AMH appears to be a reliable criterion in addition to testosterone for the diagnosis of PCOS in obese women.

Keywords: anti-Müllerian hormone (AMH); biomarker; hyperandrogenism; obesity; polycystic ovary syndrome (PCOS).

Figure 1

Flow chart representing the selection of subjects for the control group (n = 46), obese women without polycystic ovary syndrome (no PCOS: n = 67), and obese patients with polycystic ovary syndrome (PCOS: n = 25).

Figure 2

Comparison between control group (n = 46) and study groups (obese group with or without PCOS (PCOS: n = 25; no PCOS: n = 67)) in terms of age and body mass index (BMI). (A) Age; (B) BMI. Kruskal–Wallis nonparametric test and post hoc Dunn’s test. **** p < 0.0001. Median and IQR.

Figure 3

Comparison between control group (n = 46) and study groups (obese group with or without PCOS (PCOS: n = 25; no PCOS: n = 67) in terms of serum levels of hormones. (A) Serum anti-Müllerian hormone (AMH) protein concentration; (B) serum testosterone protein concentration; (C) serum follicle-stimulating hormone (FSH) level of enzymatic activity; (D) serum luteinizing hormone (LH) level of enzymatic activity; (E) serum thyroid-stimulating hormone (TSH) level of enzymatic activity; (F) serum estradiol protein concentration; (G) serum progesterone protein concentration; (H) serum prolactin protein concentration; (I) serum insulin level of enzymatic activity; (J) serum adiponectin protein concentration; (K) serum resistin protein concentration. Kruskal–Wallis nonparametric test and post hoc Dunn’s test. * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001. Median and IQR.

Figure 4

ROC analysis of AMH specificity and sensitivity as a biomarker for PCOS diagnosis. Black circles indicate the pair of [sensitivity%] and [100% − specificity%] for each value of AMH level in the blood serum of obese women with or without PCOS.

Figure 5

Comparison between control group (n = 46) and study groups (obese group with or without PCOS (PCOS: n = 25; no PCOS: n = 67)) in terms of serum metabolites. (A) Serum glucose level; (B) serum glycated hemoglobin level; (C) serum cholesterol level; (D) serum high-density lipoprotein (HDL) level; (E) serum low-density lipoprotein (LDL) level; (F) serum triacylglycerol level. Kruskal–Wallis nonparametric test and post hoc Dunn’s test. *** p < 0.001, **** p < 0.0001. Median and IQR.

Figure 6

Correlation coefficients from Spearman correlation analysis of AMH and hormonal parameters including testosterone, FSH, LH, TSH, estradiol, progesterone, prolactin, and insulin for patients from the control group (no obesity, no PCOS; n = 46), obese patients without polycystic ovary syndrome (no PCOS; n = 67), and obese patients with polycystic ovary syndrome (PCOS; n = 25). * p < 0.05, ** p < 0.01. FSH, follicle-stimulating hormone; LH, luteinizing hormone; PCOS, polycystic ovary syndrome; TSH, thyroid-stimulating hormone.