Comparison of AMH and LH/FSH Ratio for Predicting Anovulation in PCOS
DOI:
https://doi.org/10.61919/4k3c3w51Keywords:
PCOS, anti-Müllerian hormone, AMH, LH/FSH ratio, anovulation, ovarian follicles, BMI, infertility, predictive biomarker.Abstract
Background: Polycystic ovary syndrome is a common endocrine disorder and a major cause of anovulatory infertility. Although LH/FSH ratio is traditionally used as a supportive hormonal marker in PCOS, its predictive value is inconsistent and may be influenced by BMI and cycle-related variability. Anti-Müllerian hormone reflects small antral follicle burden and may offer a more stable biomarker for ovulatory dysfunction. Objective: To compare the predictive performance of AMH and LH/FSH ratio for anovulation in women with PCOS and to develop a simple clinical scoring tool incorporating hormonal and clinical predictors. Methods: This cross-sectional predictive study included 250 women aged 18–35 years diagnosed with PCOS according to Rotterdam criteria at a tertiary hospital in Quetta, Pakistan. Clinical assessment, BMI categorization, serum AMH, LH, FSH, LH/FSH ratio, and pelvic ultrasonography were evaluated. Correlation analysis, ROC curve analysis, BMI-stratified subgroup analysis, and multivariable logistic regression were performed. Results: AMH showed stronger predictive accuracy for anovulation than LH/FSH ratio, with AUC values of 0.88 (95% CI: 0.83–0.93) and 0.74 (95% CI: 0.67–0.81), respectively. AMH ≥8 ng/mL demonstrated 85% sensitivity and 80% specificity, while LH/FSH ratio ≥2.0 showed 70% sensitivity and 65% specificity. AMH correlated strongly with follicle count (r = 0.72, p < 0.001), whereas LH/FSH ratio showed a moderate correlation (r = 0.41, p = 0.020). AMH retained high predictive performance across BMI categories, while LH/FSH ratio declined in obese women. AMH ≥8 ng/mL was the strongest independent predictor of anovulation (OR = 4.5, 95% CI: 2.7–7.6, p < 0.001), and the proposed scoring tool achieved 82% preliminary accuracy. Conclusion: AMH is a superior and more BMI-stable predictor of anovulation than LH/FSH ratio in women with PCOS. Integrating AMH into a simple scoring model may improve outpatient risk stratification and fertility counseling.
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Copyright (c) 2025 Rawaal Amin, Aneen Akbar, Sadaf Zulfiqar, Mehak Memon, Shafquat Ara, Haleema Shehnaz Bhatti, Naseem Fatima (Author)
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