Comparing the Diagnostic Accuracy of Anti-Müllerian Hormone and Follicle Stimulating Hormone in Detecting Premature Ovarian Failure in Iraqi Women by ROC Analysis

摘要

Background:In women premature ovarian failure (POF) is a devastating disease impacting women under the age of 40.This involves a significant decrease in a women’s quantity and quality of oocytes, or ovarian reserve (OR). POF canresult in long-term physical and psychological health consequences. The earlier treatment can occur to manage thisdisease, the less likely the individual is going to suffer from the potential consequences. Accurate diagnosis is a criticalproponent to ensuring immediate care. A traditional diagnostic marker includes follicular stimulating hormone (FSH).This individual test cannot be used to make a diagnosis in isolation due to the large variability in FSH levels amongdifferent women, and throughout a women’s menstrual cycle. Anti-Müllerian hormone (AMH) is an alternativediagnostic marker for determining a women’s OR. Serum levels of AMH have been shown to be associated with thesize of the resting primordial follicle pool. When the levels of AMH are low, this is generally considered to be anindicator of a decline in fertility. In this study, we examined the specificity, sensitivity and accuracy of the FSH assay,against the more recently emerged AMH assay for diagnosing and predicting POR via Receiver OperatorCharacteristic curve (ROC) analysis.Methods:A total of 60 participants were enrolled in the study. The POF group included 30 infertile women with POF, theinfertile control group included 13 women without POF, and the fertile control group included 17 healthy women.Participants were recruited from the Kamal Al-Samarray Hospital in Bagdad city from December 2017 to March 2018.The age of participants ranged from 19-39 years of age. On day 2 of the menstrual cycle, peripheral blood samples werecollected from each participant andthe serum levels of AMH and FSH were examined using ELISA.Results:Statistical analysis examining the FSH and AMH assays indicate that measuring AMH levels leads to anincreased sensitivity, specificity and accuracy in determining the presence or absence of POF among the control fertile andPOF groups. However, when comparing the specificity, sensitivity, and accuracy of AMH to FSH among the POF groupand infertile controls, there were no differences among sensitivity, furthermore there was a slight decrease in the accuracyand specificity of AMH compared to FSH.Conclusions: Our findings indicate that the serum levels of AMH have higher sensitivity, specificity and accuracy indetecting POR than FSH when comparing the POF patients to healthy fertile controls. As the AMH levels have minimalwithin-menstrual cycle variation they can therefore be assessed whenever necessary, opposed to FSH, in which the levelsvary throughout the menstrual cycle. The role of AMH may therefore hold a more useful role in the early diagnosis of POF.