Does metformin treatment change the ovarian reserve parameter , AMH, in PCOS?

What is it about?

We investigated the relation of AMH, PCOS and metformin using blood samples from a biobank originating from a randomized, controlled cross-over study of a relatively large cohort. The main purpose was to determine the effect of metformin on AMH by estimating the difference between AMH levels before and after treatment with metformin relative to placebo during 6 months. Secondarily, we assessed the influence of the body mass index (BMI) and the correlation of AMH to other clinical and biochemical markers in PCOS.

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Why is it important?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women and a major cause of female infertility. The prevalence is about one in 15 women of reproductive age. In PCOS both serum levels and intra-ovarian levels of anti-Mullerian hormone (AMH) are above normal, reflecting a larger number of growing follicles and higher production of AMH by the follicle and granulosa cells. Metformin, a biguanide insulin sensitizer, improves ovulatory function and hence clinical pregnancy rates in women with PCOS, as well as reducing androgen levels and attenuating hyperinsulinemia. It is essential to establish the impact of metformin on AMH to qualify the interpretation of AMH test results in women who are on metformin treatment. This would expand understanding of the mechanisms by which AMH plays a role in PCOS. A number of studies have examined this association, but collectively the conclusions are ambiguous. Mostly a difference in AMH after metformin treatment of women with hyperandrogenemic PCOS has not been found, but a few studies report a significant decrease in AMH.

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