ANTI-MÜLLERIAN HORMONE AS A DIAGNOSTIC MARKER OF POLYCYSTIC OVARY SYNDROME: A SYSTEMATIC REVIEW WITH META-ANALYSIS.

Abstract

Objective: To determine whether serum anti-Müllerian hormone measurement can be used as a diagnostic marker for polycystic ovary syndrome (PCOS) compared to serum androgen measurement and transvaginal/transabdominal ultrasound.

Data sources: A systematic literature review and meta-analysis were conducted. Electronic and manual searches were carried out in the Cochrane Library, Embase, LILACS, PubMed, Scopus, Web of Science, and Google Scholar databases.

Study eligibility criteria: Studies conducted in humans, published in any language up to August 2023 and addressing the following research question were included: "Can serum anti-Mullerian hormone levels be used as a diagnostic marker of PCOS in comparison to serum androgen levels and transvaginal/transabdominal ultrasound?". Furthermore, only articles that used the Rotterdam (2003) criteria, the National Institutes of Health of 1990 criteria, the Androgen Excess and PCOS Society criteria, or the Evidence-based Guidelines on PCOS from 2013, 2018, and 2023 for diagnosing women with PCOS were included.

Study appraisal and synthesis methods: Two independent reviewers selected the studies, and extracted and analyzed the data. The QUADAS-2 and GRADE tools were used to analyze the risk of bias and certainty of evidence.

Results: This systematic review included 45 studies. The studies exhibited a low risk of bias in the "Reference standard" and "Flow and time" domains but showed a moderate risk of bias in the "Patient selection" domain and a high risk of bias in the "Index test" domain. The meta-analysis of the case-control studies demonstrated a sensitivity of 81% and specificity of 82%, whereas the meta-analysis of the cross-sectional studies showed a sensitivity of 80% and specificity of 85%, both with 95% confidence intervals. The certainty of the evidence was rated as "low".

Conclusions: This systematic review showed that serum anti-Müllerian hormone levels can serve as a diagnostic marker for PCOS, when factors like age, test standardization, PCOS phenotypes, and body mass index are considered. Otherwise, the anti-Müllerian hormone should be used as an adjuvant to the PCOS diagnostic criteria established through consensus and/or guidelines. Additionally, serum concentrations reflected the severity of this syndrome.