Correlation of Anti Mullerian Hormone with Homeostatic Model Assessment-Insulin Resistance in Polycystic Ovarian Syndrome and Normally Ovulating Women

Abstract

Introduction: Polycystic Ovarian Syndrome (PCOS) is the most common metabolic syndrome in women of reproductive age group with incidence of approximate 3.7% in Northern India. It is characterised by chronic anovulation, polycystic morphology of the ovaries and hyperandrogenism and predisposes women to Gestational Diabetes Mellitus (GDM), Type 2 Diabetes Mellitus, dyslipidemia, hypertension and coronary vascular disease later in life. Aim: To study correlation of Anti-mullerian Hormone (AMH) with fasting plasma glucose, serum fasting insulin, triglyceride and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) in PCOS and normally ovulating women. Materials and Methods: This was a hospital based observational study conducted in the Department of Gynaecology for a period of 1 year from 2017 to 2018. The study included 40 PCOS and 40 normally ovulating women of similar age. After taking consent, history and examination, ultrasonological evaluation of ovaries was done in order to identify PCOS and normally ovulating women. A fasting sample was tested for serum fasting insulin, fasting plasma glucose, triglyceride and HOMA-IR were calculated. A blood sample was tested for serum AMH, androgens (DHEAS, Testosterone), Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) levels on day 2 of menstrual cycle for all the women. Statistical analysis was done by using IBM SPSS version 25.0. Results: BMI, Serum AMH, fasting insulin, fasting plasma glucose, HOMA-IR, triglyceride, androgens (Testosterone and DHEAS) were high in PCOS women as compared to normally ovulating women (p-value <0.001, <0.001, 0.009, <0.001, 0.005, <0.001, <0.001 and 0.011, respectively). There was a significant positive correlation between AMH and Fasting insulin, HOMAIR and Triglycerides in PCOS group (p-value 0.01, 0.002 and <0.001 respectively) but the correlation between AMH and fasting blood glucose was not statistically significant (0.059). Conclusion: PCOS is associated with spectrum of metabolic abnormality like hyperandrogenism, insulin resistance, hyperlipidemia. The positive correlation of AMH with insulin and HOMA-IR indicates insulin resistance and risk of GDM and Type 2 diabetes mellitus in PCOS women with raised AMH. The positive correlation of AMH with triglyceride in PCOS women also indicates risk of hyperlipidemia and its complications like risk of cardiovascular diseases.

Keywords

• gestational diabetes mellitus
• hyperandrogenism
• hyperlipidemia
• menstrual cycle
• metabolic syndrome