Anti-Müllerian hormone as a supplementary test in women not meeting ultrasonographic polycystic ovary morphology criteria.

RESEARCH QUESTION: Is supplementary anti-Müllerian hormone (AMH) testing of diagnostic value in symptomatic women who fail to meet the updated ultrasonographic (USG) polycystic ovary morphology (PCOM) criteria? DESIGN: Cross-sectional study analysing 213 women with irregular menstruation or hyperandrogenism who met the original Rotterdam PCOM criteria. Although 95 met the updated USG-PCOM criteria and were diagnosed with polycystic ovary syndrome (PCOS), the remaining 118 failed to meet the updated USG criteria and served as the main analysis group. RESULTS: Among the 118 women, 75.4% (n = 89) met the optimal age-group-specific and AMH cut-off for Korean women, and their geometric mean AMH concentration was 9.8 ng/ml. These 89 individuals demonstrated significantly higher waist circumference, blood pressure, haemoglobin A1c concentrations and worse lipid profiles than 267 matched controls. Their metabolic and androgenic patterns were comparable to the 95 women diagnosed with PCOS via USG-PCOM, of whom 93.7% (n = 89) also fulfilled the AMH-based PCOM criteria. CONCLUSIONS: Although concurrent use of AMH and USG is discouraged to prevent overdiagnosis, supplementary AMH testing is valuable for symptomatic women who fail to meet the updated USG-PCOM criteria. When AMH defines PCOM, these women can be diagnosed with PCOS, exhibiting clinical and metabolic features similar to USG-confirmed PCOS and distinct from controls. Additional AMH testing is unnecessary when USG-PCOM is already evident, as AMH elevation is predominantly present; however, it should be considered in USG-negative symptomatic women. Identifying these patients enables earlier metabolic intervention, potentially outweighing overdiagnosis risks.