The relationship between anti-Mu¨ llerian hormone, androgen
and insulin resistance on the number of antral follicles
in women with polycystic ovary syndrome
Mei-Jou Chen1,2, Wei-Shiung Yang2,3, Chi-Ling Chen2, Ming-Yih Wu1, Yu-Shih Yang1
and Hong-Nerng Ho1,4
1Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan;
2Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Internal
Medicine, National Taiwan University Hospital, Taipei, Taiwan
4Correspondence address. Tel: þ886-2-2356-2175; Fax: þ886-2-2341-8557; E-mail: hnho@ntu.edu.tw
BACKGROUND: Anti-Mu¨ llerian hormone (AMH) is a biomarker that predicts the number of antral follicles and is
involved in follicle arrest for women with polycystic ovary syndrome (PCOS). We investigated the association between
the characteristic hyperandrogenemia, insulin resistance (IR), AMH, and the morphology and size of ovaries for
women with PCOS. METHODS: A total of 99 Taiwanese women with PCOS who were willing to undergo vaginal
ultrasonography were enrolled in this cross-sectional study. RESULTS: The number of antral follicles and the
ovarian volume showed a significant correlation with AMH, total testosterone and the free androgen index, but not
with age, body mass index (BMI) or the homeostasis model assessment of insulin resistance (HOMA-IR). AMH
had a significant negative association with both BMI and HOMA-IR. Multiple stepwise regression analysis demonstrated
that AMH, BMI and total testosterone were independently related to the number of antral follicles.
AMH and total testosterone were the main determinants for ovarian volume in a stepwise regression model.
CONCLUSIONS: Our results suggest that not only the AMH level, but also obesity, IR and elevated androgen
levels may relate to the development of the large size of antral follicle pool and ovarian volume in women with
PCOS. Obesity and IR may enhance the follicular excess through the dysregulation of AMH or through the
pathway of hyperandrogenemia. These findings might partly explain why adequate body weight management and
improvement in IR can improve the ovulatory function for women with PCOS.
Keywords: polycystic ovary syndrome; anti-Mu¨llerian hormone; obesity; insulin resistance; antral follicle count