Medical assignment analysing AMH as a marker of PCOS

Question

Task: A high-level review of the literature investigating a current concept in endocrinological/tumour marker-related laboratory medicine. The medical assignment will cover the current best practice in analytical strategies along with a summary of research in the area and emerging possibilities to enhance the service to and welfare of patients.

Answer

Introduction:
Polycystic ovary syndrome is accounted as one of the most commonly occurring endocrine disorders in women. It has also been identified as the leading cause of infertility among younger women and thus has dragged significant attention as a major health concern globally. Despite being one of the leading causes of infertility in women, it has not been accounted as a public health concern in relation to endocrinopathy (Ran, Yi & Li, 2021). According to worldwide statistics mentioned in the medical assignment, it has been found that approximately 4% to 20% of the female population are witnessing the severity of the condition. Polycystic ovary syndrome or PCOS is known to present heterogeneous features which account for ovulatory dysfunction, hyperandrogenism as well as hirsutism. The health condition is accounted in the medical assignmentto have a peri pubertal onset with confusing factors associated with its prevalence, early diagnosis, signs and symptoms, treatment, psychological issues as well as management and prevention.

It has also been found in the medical assignmentthat women belonging to the age of childbearing are withstanding the complications of PCOS with a prevalence of approximately 5 to 10%. Several research studies have identified that the Anti-Müllerian hormone (AMH) level serves as a significant marker for the diagnosis of the condition (Dewailly&Laven, 2019). This particular hormone is produced within the ovary and thus increase in the production of AMH has been acknowledged to be related to the complications within the particular organ. The normal level of AMH in a female with a healthy ovary is accounted to be within 1.0 ng/mL to 3.0 ng/mL while in the case of females belonging to the age group of 20–29 years with PCOS the level increases up to 8.16 ng/ml and 5.89 ng/ml within those of 30 to 39 years of age (Capuzzo& La Marca, 2021). Focusing on the above statistic as well as pieces of evidence suggesting the role of AMH as a marker for the diagnosis of PCOS, the following medical assignmentwill critically analyze the appropriate pieces of evidence relevant to the research topic.

Main body of the medical assignment:
Polycystic ovarian syndrome or PCOS as discussed earlier has been accounted to be the concerning reason behind ovulatory infertility in women and the statistics highlight that approximately 21% of the women witnesses the complication during their reproductive age. The particular disorder has been acknowledged in the medical assignmentand characterized based on a wide range of signs and symptoms which are primarily associated with ovulatory disruptions, metabolic abnormalities, androgen access as well as polycystic ovarian morphology (Deswal et al., 2020). It has also been assessed in the medical assignmentthat these particular signs and symptoms do not appropriately and accurately serve in the process of analysis which further leads to a challenging situation in the process of PCOS diagnosis. Clinical presentation representing the onset of polycystic ovarian syndrome includes complications such as irregular, absence of a menstrual cycle, increased hair growth within the skin and face which is also called hirsutism as well as increased acne. Due to having signs and symptoms similar to other health complications, as well as a complication in diagnosis, sustaining accurate prevalence of PCOS within the worldwide population has been a major concern. Thus, the prevalence has been estimated in the medical assignmentto range between 2.2% to 26% throughout the worldwide population. Pieces of evidence in the medical assignmenthave supported the fact that polycystic ovary sustains major abnormality in the number of growing follicles which at a certain stage serves in the increased serum level of AMH. It has been identified that women suffering from polycystic ovarian syndrome consist of two to four-fold higher serum AMH levels when compared to those with normal functional ovaries (Tokmak et al., 2015). It indicates that the production of the particular hormone in vitro by the granulosa cells becomes significantly higher in the case of individuals with the polycystic ovarian syndrome at a stage when they become anovulatory. Thus, in the field of PCOS diagnosis, agreement on the assessment of polycystic ovary using serum AMH assay Has been considered and acknowledged (Deswal et al., 2020). Also, the particular assay using AMH serves in identifying and tracking ovulatory dysfunction with the help of increasing the AMH/AFC ratio within suffering individuals.

Anti Mullerian hormone or AMH is identified to be associated with the TGF- family and the production of the hormone is carried out by the granulosa cells of both the enthral and pre antral follicles within an ovary. The anti-Mullerian hormone mentioned in the medical assignmentis known to have a limited goal within the physiological process of the ovary which includes the prevention of the recruitment of non-dominant follicles as well as inhibition of the development of follicular cells at an early stage (Bell et al., 2022).Anti Mullerian hormone is known to be a dimeric glycoprotein and is a member of the transforming growth factor beta or the TGF- family. This particular hormone mentioned in the medical assignmentis also present within the male population where it is secreted by the Sertoli cells present within the testes which further leads to regression of the Mullerian duct within the body. In the case of females, the serum level of the hormone indicates the growth of the follicles and thus increase in the level indicates ovarian reserve. AMH has been designated as the key regulator of the entire function of the ovary as well as a local growth factor which acts within the differentiation at the cellular level. Research studies have identified that the anti-Mullerian hormone serves in decreasing the aromatase expression stimulated byfollicle-stimulating hormone (FSH) (Dewailly et al., 2020). It also functions by reducing the expression ofFSH receptor messenger RNA (mRNA) with correlates with the modulation of the responses towards gonadotrophin by the ovarian follicles.Focusing on the nature and function of the hormone in the medical assignment, healthcare professionals have been using the Anti-Mullerian Hormone Testas a means to assess the serum level of the hormone as well as associated health complications. With the help of the particular test, professionals measure the significant amount of anti-Mullerian hormone present in an individual's blood (Dilaver et al., 2019). It is used to evaluate ovarian health, fertility and infertility as well as an ovarian reserve but is also accounted for the significant identification of the development of the polycystic ovarian syndrome.

It has been also assessed in the medical assignmentthrough the wide range of research studies and analyses that there is a significant role of anti-Müllerian hormone in female fertility and infertility. Anti Mullerian hormone level in plasma is known to reflect the ongoing noncyclic growth of the smaller follicles within the ovary. It functions by reflecting the accurate size of the primordial follicle pool interesting stage which significantly serves as a marker for the identification of ovarian reserve (Abbara et al., 2019). The hormone is acknowledged in the medical assignmentto be one of the best endocrine markers used in the assessment process of declination in the ovarian pool in terms of age within a healthy individual. With this particular nature of the hormone, it is acknowledged to have the potential ability to evaluate and hypothesize the upcoming lifespan of the reproductive system in women. One of the significant roles identified for the measurement of anti-Mullerian hormone is prior in vitro fertilization as it serves in predicting the response of an ovary which can either be hyper-responsive or hyper-responsive (Yue et al., 2018). Thus, AMH is used as a significant aspect of the ovarian pathological process which highly accounts for polycystic ovarian syndrome, premature ovarian failure as well as granulosa cell tumours. It helps in measuring as well as evaluating the abnormality functioning within the ovarian cells as well as the chances of fertility and infertility within and woman associated with age or pathological conditions. As stated earlier in themedical assignment, ovarian pathological researchers have considered anti-Mullerian hormones as a significant marker for fertility, infertility as well as other ovarian pathological complications such as polycystic ovarian syndrome and cancer (Ramezani Tehrani et al., 2021). This particular hormone being a member of the TGF - family is produced from the preantral as well as antral follicles of the granulosa cells. Medical assignmentResearch studies have also demonstrated that serum anti-Mullerian hormone level is closely associated with antral follicle count or AFC in the case of a woman with infertility (Abbara et al., 2019). Also, the association between these two particular hormones and antral follicle count is effective when compared to any other hormonal markers identified and available. With this particular association in the medical assignment, it has been assisting that the serum level of the anti-Mullerian hormone serves in reflecting the number of smaller follicle cells growing as well as the reduction in the level of the hormone through the reproductive phase. Thus, it has been found in the medical assignmentthat in an initial diagnosis or laboratory testing for fertility, this particular serum level for the hormone is used as a prime source. In relation to identifying the role of anti-mullerian hormone as a marker for PCOS diagnosis wide range of mechanisms have been discussed and tested. With this medical assignment, it has been found that the AFC substantially increases within an individual with a polycystic ovarian syndrome which serves as a characteristic of the condition. With this increase in the AFC, a significant increase in the level of anti-Mullerian hormone is also identified with service in correlation with the AFC. It has also been found in the medical assignmentthat apart from an increase in follicle numbers within an ovary, an increased production of anti-Mullerian hormone by individual follicles also serves in increasing the hormone concentration within the blood. It has also been identified through several research studies that hyperinsulinemia, as well as hyperandrogenism, has a significant impact on increasing the anti-Mullerian hormone level within individuals suffering from polycystic ovarian syndrome.

Anti Mullerian hormone is known to be secreted from the growing antral follicles and often has a signal as a substitute marker used for counting the antral follicle. Medical assignmentResearch also suggests that this particular hormone serves a paracrine role in the inhibition of aromatase activity induced by FSH within the granulosa cells and thus serves by aiding the development of dominant follicles (Abbara et al., 2019). It has been highlighted in themedical assignmentthat the anti-Mullerian hormone has a significant and supposed role in the pathogenesis of polycystic ovarian syndrome where it serves as an endocrine signal functioning in the increased pulsatility of GnRH. In the case of an individual with increased AMH hormone, the GnRH pulsatility increases proportionately with the increase of the hormone as well as it signifies the LH predominant level of follicular phase gonadotropin. Further, in relation to this particular evidence in themedical assignment, it has been found that women witnessing menstrual disturbance or abnormal mensuration cycle have a significantly increased secretion level ofLH-predominant gonadotropin (Le et al., 2019). The polycystic ovary morphology generally relies on appearance as well as the condition of the follicles located peripherally surrounding a central stoma and thus it fairly accounts for the number of follicles in each ovary regardless of the normal distribution. Also,pieces of evidence have suggested that an increased rate of anti-Mullerian hormone as well as AFC followed by abnormal menstrual cycle or disturbance is highly identified in women with polycystic ovarian morphology within both ovaries than those with one ovary witnessing polycystic ovarian syndrome (Abbara et al., 2019). Hence significant and molecular pieces of evidence based on the hormone and its function as a marker for ovarian pathology as well as associated menstrual complications have been obtained which ensures its role as a necessary biomarker for PCOS.

Conclusion and Discussion:
After completion of the critical evaluation of pieces of evidence and information available in the medical assignment, that signifies the significant role of anti-mullerian hormone as a marker for polycystic ovarian syndrome, a wide range of understanding has been obtained. Just to conclude the medical assignmentit can be stated that the anti-Mullerian hormone can serve as a significant and effective predictor for conditions leading to menstrual disturbance such as polycystic ovarian syndrome. It also evaluates the significant role of an increased level of anti-Mullerian hormone in developing the risk of mensural complication. Also,evidence highlight that the anti-Mullerian hormone serves as a significant and better indicator for menstrual disturbance or polycystic ovarian syndrome when compared to AFC. It has also been identified in the medical assignmentthat a combination of both AFC and AMH serves as a better indicator or marker for the diagnosis and identification of polycystic ovarian syndrome condition. Thus from different medical assignmentresearch articles, it has been found that women suffering from polycystic ovarian syndrome or exhibiting major signs and symptoms of the condition has increased anti-Mullerian hormone when compared to those with normal ovary. Thus, it reflected its ability to serve as a potential marker in the diagnosis of polycystic ovarian syndrome in women. Evidence from the medical assignmentalso suggests that PCOS along with PCO morphology sustains an increased level of AMH when compared to those with only a single condition of either PCOS as well as PCO morphology or those with a normal health condition. Thus, on evaluation of each piece of evidence and findings sustained throughout the medical assignment, it has been found that AMH has a significantpotential to serve as a predictor for ovariancomplications as well as the development of the polycysticovarian syndrome. In order to understand the condition as well as the role of AMH as a marker, a much depth evaluation of the condition is necessary. Thechanging level of the hormone thus has been recognizedin the medical assignmentto be significant in the analysis of the pathological function of the ovary and associated health conditions.

References:
Abbara, A., Eng, P. C., Phylactou, M., Clarke, S. A., Hunjan, T., Roberts, R., ... &Dhillo, W. S. (2019). Anti-Müllerian hormone (AMH) in the diagnosis of menstrual disturbance due to polycystic ovarian syndrome. Frontiers in endocrinology, 10, 656.doi: 10.3389/fendo.2019.00656
Bell, R. J., Islam, R. M., Skiba, M. A., Herbert, D., Martinez Garcia, A., & Davis, S. R. (2022). Substituting serum anti-Müllerian hormone for polycystic ovary morphology increases the number of women diagnosed with polycystic ovary syndrome: a community-based cross-sectional study. Human Reproduction, 37(1), 109-118.https://doi.org/10.1093/humrep/deab232
Capuzzo, M., & La Marca, A. (2021). Use of AMH in the Differential Diagnosis of Anovulatory Disorders Including PCOS. Frontiers in Endocrinology, 11, 616766.https://doi.org/10.3389/fendo.2020.616766 Deswal, R., Narwal, V., Dang, A., &Pundir, C. S. (2020). The prevalence of polycystic ovary syndrome: a brief systematic review. Journal of Human Reproductive Sciences, 13(4), 261.doi: 10.4103/jhrs.JHRS_95_18
Dewailly, D., &Laven, J. (2019). AMH as the primary marker for fertility. European journal of endocrinology, 181(6), D45-D51. Retrieved from: https://eje.bioscientifica.com/downloadpdf/journals/eje/181/6/EJE-19-0373.xml
Dewailly, D., Barbotin, A. L., Dumont, A., Catteau-Jonard, S., & Robin, G. (2020). Role of anti-Müllerian hormone in the pathogenesis of polycystic ovary syndrome. Frontiers in Endocrinology, 11, 641.https://doi.org/10.3389/fendo.2020.00641
Dilaver, N., Pellatt, L., Jameson, E., Ogunjimi, M., Bano, G., Homburg, R., ... & Rice, S. (2019). The regulation and signalling of anti-Müllerian hormone in human granulosa cells: relevance to polycystic ovary syndrome. Human Reproduction, 34(12), 2467-2479.https://doi.org/10.1093/humrep/dez214 Le, M. T., Le, V. N. S., Le, D. D., Nguyen, V. Q. H., Chen, C., & Cao, N. T. (2019). Exploration of the role of anti Mullerian hormone and LH/FSH ratio in diagnosis of polycystic ovary syndrome. Clinical Endocrinology, 90(4), 579-585.https://doi.org/10.1111/cen.13934

Ramezani Tehrani, F., Rahmati, M., Mahboobifard, F., Firouzi, F., Hashemi, N., & Azizi, F. (2021). Age-specific cut-off levels of anti-Müllerian hormone can be used as diagnostic markers for polycystic ovary syndrome. Reproductive Biology and Endocrinology, 19(1), 1-10.https://doi.org/10.1186/s12958-021-00755-8
Ran, Y., Yi, Q., & Li, C. (2021). The relationship of anti-Mullerian hormone in polycystic ovary syndrome patients with different subgroups. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14, 1419.doi: 10.2147/DMSO.S299558
Tokmak, A., Timur, H., Aksoy, R. T., Çnar, M., &Ylmaz, N. (2015). Is anti-Mullerian hormone a good diagnostic marker for adolescent and young adult patients with Polycystic ovary syndrome. Turkish Journal of Obstetrics and Gynecology, 12(4), 199.doi: 10.4274/tjod.21549

Yue, C. Y., Lu, L. K. Y., Li, M., Zhang, Q. L., & Ying, C. M. (2018). Threshold value of anti-Mullerian hormone for the diagnosis of polycystic ovary syndrome in Chinese women. PLoS One, 13(8), e0203129.https://doi.org/10.1371/journal.pone.0203129