Background: Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities, specifically menstrual dysfunction and anovulation in conjunction with elevated pre-antral follicle number and arrested follicular maturation. Although anti-mullerian hormone (AMH), an inhibitor of follicle recruitment and maturation, is increased in women with PCOS, the usefulness of circulating AMH levels as a clinical predictor of menstrual response to weight loss in PCOS is not known.

Methods: Overweight women with PCOS (n=26, age 32.9±5.8 years, weight 98.9±20.8 kg, BMI 36.1±7.0 kg/m², mean±SD) followed an 8 week weight loss and 6 month weight maintenance program.

Results: Net reductions in weight (4.6±4.8 kg), waist circumference (6.0±5.3 cm), testosterone (0.3±0.6 nmol/L), fasting insulin (3.7±7.6 mU/L) and the homeostasis model assessment of insulin sensitivity (0.7±1.3) occurred for all subjects over the entire study duration. 15/26 (57.7%) subjects responded to the intervention with improvements in menstrual cyclicity (responders). Compared to non-responders, responders had lower AMH levels at baseline (23.6±12.0 versus 37.9±17.8 pmol/L, P=0.021). Only responders had reductions in fasting insulin (6.1±5.9 mU/L, P=0.001) and HOMA (1.3±5.9, P=0.002) with acute weight loss (week 0–8). Baseline AMH was most strongly predicted by baseline ghrelin, free testosterone and insulin (r2=0.528 p=0.002).

Conclusion: Overweight women with PCOS who respond to weight loss with menstrual improvements have significantly reduced pre-weight loss AMH and demonstrate improvements in surrogate measures of insulin resistance with weight loss. Pre-treatment AMH is a potential clinical predictor of menstrual improvements with weight loss in PCOS.