Context: The common characteristic of polycystic ovary syndrome (PCOS) is a disturbance in the selection of the dominant follicle, resulting in anovulation. In PCOS women, serum anti-Müllerian hormone (AMH) levels are elevated. Because AMH decreases FSH sensitivity in mice, the elevated AMH levels may contribute to the disturbed follicle selection in PCOS women. Objective: The objective of the study was to investigate the role of the AMH signaling pathway in the pathophysiology of PCOS using a genetic approach. Design: The association of the AMH Ile49Ser (rs10407022) and the AMH type II receptor -482 A>G (rs2002555) polymorphism with PCOS susceptibility and phenotype was studied in a large cohort of PCOS women. Setting/Subjects: A total of 331 women with PCOS, 32 normoovulatory controls, and 3635 population-based controls were included. Main Outcome Measures: Ovarian parameters, serum AMH, FSH, androgen, and estradiol levels were measured. Results: Genotype and allele frequencies for the AMH Ile49Ser and AMH type II receptor -482 A>G polymorphism were similar in PCOS women and controls. However, within the group of PCOS women, carriers of the AMH49Ser allele less often had polycystic ovaries (92.7 vs. 99.5%, P = 0.0004), lower follicle numbers (P = 0.03), and lower androgen levels, compared with noncarriers (P = 0.04). In addition, in vitro studies demonstrated that the bioactivity of the AMH49Ser protein is diminished, compared with the AMH49Ile protein (P < 0.0001). Conclusions: Genetic variants in the AMH and AMH type II receptor gene do not influence PCOS susceptibility. However, our results suggest that the AMH Ile49Ser polymorphism contributes to the severity of the PCOS phenotype. Copyright

dx.doi.org/10.1210/jc.2007-2205, hdl.handle.net/1765/29193
Journal of Clinical Endocrinology and Metabolism
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Erasmus MC: University Medical Center Rotterdam

Kevenaar, M.E, Laven, J.S.E, Lie Fong, S, Uitterlinden, A.G, de Jong, F.H, Themmen, A.P.N, & Visser, J.A. (2008). A functional anti-müllerian hormone gene polymorphism is associated with follicle number and androgen levels in polycystic ovary syndrome patients. Journal of Clinical Endocrinology and Metabolism, 93(4), 1310–1316. doi:10.1210/jc.2007-2205