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Is Elevated Anti-Mullerian Hormone an Indicator of Preterm Delivery for Women with Polycystic Ovary Syndrome?

J. Hsu, K. James, C. Bormann, P. Donahoe, D. Pepin, M. Sabatini

June 21, 2019
Bridget Houlihan

Polycystic ovary syndrome is a condition that affects around 27% of women, and can lead to complications including preterm delivery-- regardless of whether the pregnancy is the result of fertility treatment. This study was conducted to determine if the high levels of anti-Mullerian hormone were any indication of whether or not a woman would delivery preterm. In this article we’re going to discuss:

  • What is the relationship with AMH and PCOS?
  • What did the study determine?

What is the anti-Mullerian Hormone?

Anti-Mullerian hormone, or Mullerian-inhibiting substance (AMH/MIS), is the hormone which is produced around eight weeks after conception when a fetus is genetically male. The AMH is produced in the embryonic testes and causes the Mullerian reproductive system of a genetic female to disappear. The AMH allows the male embryo begin the development of the male reproductive system, such as the vas deferens, seminal vesicles, and the prostate gland.

This hormone is also important to the development of follicles in women, and can be used to measure how many follicles a woman has in her ovarian reserve. Although AMH levels peak around puberty, levels typically stay constant until menopause. Because this hormone is used to determine how a woman’s ovarian reserve is, it is also very helpful in determining how well she will respond to fertility treatment such as IVF.

A diagram of the ovary and fallopian tube, which are affected by PCOS and AMH
What are the outcomes of births when high levels of AMH are present? Image courtesy of Medical News Today.

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS) is a condition that affects the levels of specific hormones in women. These hormones produce higher than normal male hormones, and interfere with the normal process of the ovaries. PCOS is characterized by the development of cysts in the ovaries which contain immature eggs. These eggs are never ovulated to be fertilized. Although doctors do not know what exactly causes PCOS, they believe it is the result of overproduction of male hormones, which inhibit the female reproductive system. This will disrupt the menstrual cycle and can cause irregular periods.

Objective and Methods of the Study

Complications with childbirth can be a serious matter, so developing methods in order to study the factors that might determine the risk level of women is an important area of research. If doctors are aware of what can cause certain complications, they are better equipped to develop interventions. Because AMH is a known indicator of the ovarian reserve and follicle production, the researchers of this study sought to determine if the levels of this hormone had any effect on pregnancy outcomes.

Specifically, they looked at the chances of preterm delivery with women with PCOS and extremely high levels of AMH. The researchers also sought to determine the risk of Cesarean delivery with extremely low AMH levels. This study was conducted utilizing the information in the eIVF database and looked at women who became pregnant as a result of IVF treatment between 2012 and 2016.

Two outcomes were anticipated-- either a preterm birth or a Caesarean delivery. Due to the fact that AMH levels can be highly dependent upon the infertility diagnosis, the study specifically chose to look at preterm risk in women who also have polycystic ovary syndrome. The Caesarean delivery outcome looked at women who had a diminished ovarian reserve (DOR) diagnosis.

A pregnant woman with PCOS wearing a plaid shirt and leggings sits under a flowering tree on burnt orange grass.
The data gathered through this study correlates high levels of AMH with preterm births in women with PCOS.

Results and Conclusion

The results of this study showed that the women with polycystic ovary syndrome who delivered preterm had much higher levels of AMH. In fact, their median levels were at 18 ng/mL, compared to the women who delivered to term, whose median level was 6.8 ng/mL. Women who had the highest levels of AMH tended to overwhelmingly deliver prematurely. In the 75th percentile with 13 ng/mL and above, 67% of women with high AMH delivered preterm, while only 11% delivered to term. As the AMH levels increased, women in the 90th percentile with 20 ng/ML and above, all the deliveries were preterm.

Interestingly, AMH caused no effect in the delivery of women without PCOS. The researchers also observed no correlation between AMH levels and the outcome of a Caesarean delivery.

As the statistics show, there is a strong correlation between women who have polycystic ovary syndrome and the risk of delivering preterm. The higher the level of AMH, the greater the chance that delivery will be premature. This is helpful for physicians to be aware of, so they can make their patients aware of the risk associated with high levels of this hormone.

Further study into the reasons behind elevated AMH levels is necessary, and would prove helpful to determine the risk level of preterm labor in women who specifically underwent IVF treatment.


"Müllerian-Inhibiting Substance/Anti-Müllerian Hormone as a Predictor of Preterm Birth in Polycystic Ovary Syndrome"

The Journal of Clinical Endocrinology & Metabolism, Volume 103, Issue 11, November 2018, Pages 4187–4196


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