Abstract
Background: The most prevalent endocrine disorder in women of reproductive age, and the major cause of infertility caused by anovulatory, is polycystic ovary syndrome (PCOS). Anti-Mullerian hormone (AMH) and insulin resistance are also considered crucial pathophysiological traits of PCOS, and their roles as the biomarkers of infertility are not yet fully understood.
Design: A cross-sectional group cohort study designed to assess the AMH and insulin resistance (measured by HOMA-IR) levels in infertile and fertile PCOS patients, and to find out whether they can be used as predictive biomarkers of infertility in PCOS.
Methods: The case-control study was carried out in January 20, May first, 2025 in Samarra General Hospital, Iraq. One hundred and five women of reproductive age (18-40 years) were recruited and separated into three groups, PCOS patients with infertility (n=35), PCOS patients without infertility (n=35), and healthy fertile controls (n=35). The diagnosis of PCOS was done using Rotterdam criteria. The AMH serum levels, fasting glucose levels, fasting insulin levels, follicle-stimulating hormone (FSH) levels, luteinizing hormone (LH) levels, and testosterone levels were measured. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was used in the evaluation of insulin resistance. Body mass index (BMI) and waist circumference were anthropometric measurements. The identification of independent predictors of infertility relied on binary logistic regression.
Findings: PCOS infertile patients were found to have much higher AMH levels than PCOS infertile and healthy controls (8.94 ± 2.31 ng/mL vs. 6.82 ± 1.95 ng/mL vs. 3.45 ± 1.12 ng/mL, p=0.001). The PCOS patients with infertility (4.76 +/-1.84) had a significantly higher value in HOMA-IR than PCOS without infertility (3.21 +/-1.45), and controls (1.89 +/-0.67) (p<0.001). The LH/FSH was also found to be much greater in infertile patients with PCOS (2.84 ± 0.92) than in the other groups (p<0.001). The analysis of ROC curves showed that AMH level above 7.5 ng/mL (sensitivity 82.9, specificity 77.1, AUC=0.812) and HOMA-IR level above 3.8 (sensitivity 74.3, specificity 71.4, AUC=0.768) were the best cut-off points in predicting infertility in PCOS patients. The independent variables that AMH (OR=2.84, 95% CI: 1.62-4.98, p<0.001) and HOMA-IR (OR=2.13, 95% CI: 1.38-3.29, p=0.001) were confirmed as independent predictors of infertility in binary logistic regression. The AMH and HOMA-IR had a strong positive correlation in the infertile PCOS group (r=0.68, p<0.001).
Conclusion: AMH and insulin resistance levels are strongly connected to infertility among PCOS patients and this is an independent predictor of fertility. These biomarkers can be effective pointers of fertility prospects in PCOS and can be discussed as complements to overall fertility assessment in order to implement therapeutic measures.