Study of Serum Anti-Mullerian Hormone in the Diagnosis of Ovarian Reserve Function in Patients with Premature Ovarian Insufficiency

Abstract

Objective. To explore the diagnostic value of serum anti-Mullerian hormone (AMH) for patients with premature ovarian insufficiency (POI) and premature ovarian failure (POF). Methods. Totally, 125 women with menstrual disorder treated in the Obstetrics and Gynecology Department of Ningbo Women & Children Hospital between January 2020 and December 2021 were enrolled. Among them, based on the follicle-stimulating hormone (FSH) level, 54 patients ( $25\text{IU}/\text{L}<\text{FSH}\le 40\text{IU}/\text{L}$ ) were assigned to the POI group, and 71 patients ( $\text{FSH}>40\text{IU}/\text{L}$ ) were assigned to the POF group. In addition, 72 individuals who went physical examination in the hospital and showed normal menstrual cycle were selected as the control (CON) group. Serum AMH in each group was quantified via enzyme-linked immunosorbent assay (ELISA) and Beckman Coulter Access active immunoassay analyzer, and the levels of serum neutral hormones [luteinizing hormone (LH), FSH, as well as estradiol (E2)] in each group were detected through the electrochemiluminescence method. The difference between AMH level acquired by the latest automatic method and that acquired by the traditional manual ELISA was compared, and the correlation of serum AMH with sex hormones was analyzed. In addition, receiver-operating characteristic (ROC) curves were drawn for determining the diagnostic value of serum AHM for POI ad POF. Results. Beckman Coulter Access quantified AMH more accurately and fastly (Beckman Coulter Access: 35 minutes; manual quantification: 3-4 hours) and was more sensitive than ELISA, with a requirement to less serum. The levels of serum AMH and E2 in the POF group were $0.04\pm 0.10$  ng/mL and $35.16\pm 53.06$  ng/mL, respectively, which were notably lower than those in the POI group (( $0.69\pm 1.46$ ) ng/mL and ( $3.96\pm 2.82$ ) ng/mL) and CON group (( $76.31\pm 97.84$ ) ng/mL and ( $113.19\pm 114.84$ ) ng/mL). The LH and FSH levels in the POF group were $37.86\pm 19.44$  IU/L and $75.05\pm 35.31$  IU/L, which were higher than those in POI group (( $22.66\pm 26.15$ ) IU/L and ( $11.30\pm 17.05$ ) IU/L) and the CON group (( $29.81\pm 4.45$ ) IU/L and ( $6.78\pm 3.45$ ) IU/L) ( $P<0.05$ ). The POI group showed a notably lower serum AMH level and notably higher LH and FSH levels than the CON group ( $P<0.05$ ), and the POI group was similar to the CON group in the E2 level ( $P>0.05$ ). Serum AMH showed a positive correlation with E2 ( $r=0.291$ , $P<0.05$ ) and a negative association with both FSH ( $r=-0.476$ , $P<0.05$ ) and LH ( $r=-0.143$ , $P<0.1$ ). The optimal cut-off value of serum AMH in predicting POI was 0.83 ng/mL, and the corresponding sensitivity and specificity were 95.8% and 85.2%. The optimal cut-off of serum AMH in predicting POF was 0.075 ng/mL, and the corresponding sensitivity and specificity were 81.7% and 94.4%. The area under ROC curve (AUC) of serum AMH + FSH in the diagnosis of POF was close to 1. Conclusion. Beckman Coulter Access AMH test is the latest automatic electrochemiluminescence sandwich immunoassay, with higher sensitivity and reproducibility than traditional manual ELISA and with ability to produce repeatable results. With the decline of ovarian function, the serum AMH of POI patients decreases gradually, and the serum AMH of POF patients decreases obviously, so serum AMH level has great value in predicting POI and POF and can be used as a sensitive index for early diagnosis of the two. Serum AMH combined with FSH can lift the diagnostic efficiency of POF.