Anti-müllerian hormone as a diagnostic biomarker for polycystic ovary syndrome and polycystic ovarian morphology: a systematic review and meta-analysis.
Level 2 - randomized trial
Systematic review and meta-analysis of observational diagnostic accuracy studies.
PubMed 38944177 · doi:10.1016/j.fertnstert.2024.05.163
What was done
This systematic review and meta-analysis evaluated the diagnostic accuracy of anti-Müllerian hormone (AMH) for polycystic ovary syndrome (PCOS) in adults and adolescents, as well as for polycystic ovarian morphology (PCOM) in adults, supporting the 2023 international PCOS guideline. Searches across six databases through July 31, 2023, identified human studies reporting sensitivity, specificity, or area under the curve. Risk of bias was evaluated using QUADAS. Pooled diagnostic sensitivity and specificity were calculated using random-effects models.
What was found
Eighty-two studies were included across three sub-analyses: - Adult PCOS diagnosis (n = 68 studies): Pooled sensitivity of 0.79 (95% CI, 0.76–0.82; I² = 86%) and pooled specificity of 0.87 (95% CI, 0.84–0.89; I² = 91%). - Adolescent PCOS diagnosis (n = 11 studies): Pooled sensitivity of 0.66 (95% CI, 0.58–0.73; I² = 74%) and pooled specificity of 0.78 (95% CI, 0.71–0.83; I² = 45%). - Adult PCOM detection (n = 7 studies): Pooled sensitivity of 0.79 (95% CI, 0.72–0.85; I² = 94%) and pooled specificity of 0.87 (95% CI, 0.78–0.93; I² = 94%).
Why it matters
These findings support the 2023 international guideline update incorporating AMH as an alternative marker for defining PCOM in adult diagnostic algorithms. However, AMH cannot serve as a standalone diagnostic test for PCOS and is not reliable for identifying PCOM in adolescents.
Limits
Statistical heterogeneity was substantial across adult analyses (I² between 86% and 94%). The abstract notes that diverse assay platforms, population characteristics, age, and BMI introduce considerable variation, preventing the establishment of a single universal international cut-off value. Adolescent data were limited to 11 studies with lower diagnostic accuracy.