Abstract:
Polycystic ovarian syndrome (PCOS) is the leading cause of female infertility due to
anovulation. Another condition that has a significant impact on ovarian health is
hypothyroidism. Both these conditions are widely prevalent. Hypothyroidism, as well as
PCOS bring about a similar effect on the ovary in terms of polycystic appearance, which is
why it is important to rule out hypothyroidism while planning workup of PCOS. The anti Mullerian hormone (AMH), also known as Mullerian-inhibiting hormone (MIH) is produced
by granulosa cells of the pre-antral and small antral follicles in women until menopause.
Production of AMH regulates folliculogenesis by inhibiting recruitment of follicles from the
resting pool, thus promoting growth of a single dominant follicle. AMH can help predict the
functional ovarian reserve since it is a product of the granulosa cells, which envelop each
egg and provide them energy. An AMH level of >3.8ng/mL is being considered to help in
the diagnosis of PCOS. However, hypothyroidism can alter the levels of AMH, and so it is
important to ascertain whether serum AMH levels are reliable in PCOS patients with
hypothyroidism. The objective of this study was to measure and compare the levels of AMH
in women of reproductive age that have been diagnosed with PCOS (by Rotterdam Criteria,
2003) alone, and those that have been diagnosed with PCOS as well as hypothyroidism
(TSH>4.2 mIU/L). In this case-control study, carried out at the National Medical Centre
(NMC) hospital in Karachi, subjects were divided into two groups. Cases, consisting of 42
subjects; these were subjects diagnosed with both conditions, PCOS as well as
hypothyroidism. Controls; 42 subjects diagnosed with PCOS alone. Serum TSH, Fasting
Insulin, AMH, and BMI were measured in both groups. Age, and duration of infertility was
recorded in both groups. Statistical analysis was done using SPSS software version 26. The
results showed a statistically insignificant difference between AMH levels (4.39 ± 2.05 in
cases vs. 4.19 ± 1.86 in controls) in both groups. Fasting insulin (16.17 ± 8.91 in case vs.
14.26 ± 6 controls) , BMI (28.14 ± 5.12 in cases vs. 29.39 ± 6.09 in controls), and duration
of infertility (4.62 ± 3.87 in cases vs. 3.86 ± 3.04 in controls) was similar in both groups. The
results of this study support use of AMH as a diagnostic marker in PCOS, even in patients
suffering from hypothyroidism.
