Antimullerian Hormone Levels by Phenotypes in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Structured abstractO_ST_ABSObjectiveC_ST_ABSThis study aims to evaluate antimullerian hormone (AMH) levels across Polycystic Ovary Syndrome (PCOS) phenotypes (A, B, C, D) based on the Rotterdam diagnostic criteria. Data SourcesA systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, ScienceDirect, and Web of Science were searched for studies published between January 2009 and June 2024. Study Eligibility CriteriaStudies reporting AMH levels stratified by PCOS phenotypes based on the Rotterdam criteria, along with population characteristics and AMH measurement methods, were included. Animal studies, reviews, case reports, opinion articles, letters to the editor, other non-original research. and those lacking complete phenotype stratification were excluded. Study Appraisal and Synthesis MethodsStudy quality was assessed using the ROBINS-E tool. Primary outcomes included mean AMH levels across phenotypes, analyzed as tAMH (without assay differentiation) and bcAMH (Beckman Coulter Gen II assay). Secondary outcomes included age and BMI by phenotype. Random-effects meta-analysis was used to calculate mean levels and standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I{superscript 2} statistic. ResultsForty-nine studies involving 15,535 subjects revealed that AMH levels vary significantly by phenotype, being highest in A, followed by D, C, and B. For phenotype A: tAMH=9.87 ng/mL (SMD 2.97, CI 9.29-10.48); bcAMH=11.49 ng/mL (SMD 3.06, CI 10.47-12.61). For phenotype B: tAMH=5.71 ng/mL (SMD 0.98, CI 4.96-6.57); bcAMH=6.25 ng/mL (SMD 1.36, CI 5.20-7.51). There were no significant differences in age or BMI among phenotypes. High heterogeneity suggests additional factors influence AMH levels beyond phenotypic categories. ConclusionsAMH levels are elevated in PCOS and vary across phenotypes, underscoring their potential to improve PCOS subtype characterization and guide management strategies. The findings highlight the need for standardizing AMH measurement techniques for consistent clinical application.