Anogenital distance and anti-Mullerian hormone combined improves the diagnosis of polycystic ovary syndrome

The objective of this study was to assess the accuracy of the combination of anogenital distance (AGD) and anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). The study included women diagnosed with PCOS and a control group who attended the Clinical University Hospital 'Virgen de la Arrixaca' in Murcia (Spain). Serum concentrations of AMH were measured and two AGD measurements were obtained: (i) from the anterior clitoral surface to the upper verge of the anus (AGD(AC)); and (ii) from the posterior fourchette to the upper verge of the anus (AGD(AF)). Data were assessed by receiver operator characteristic (ROC) curves. Women with PCOS (n = 126) had significantly larger AGD(AC)(80.5 +/- 11.3 versus 76.0 +/- 10.4 mm;p < 0.001) and higher AMH (7.2 +/- 4.7 versus 3.1 +/- 2.2;p < 0.001) compared to control women (n = 159). Women with serum AMH above 3.8 ng/mL (clinical cut-off used in PCOS) were 9.1 times more likely to have PCOS (95% CI: 5.1-16.2). The area under the ROC curve of combined model of AMH and AGD(AC)was 0.87 (95% CI: 0.83-0.91). The combined model for predicting PCOS based on AMH and AGD(AC)has better diagnostic accuracy than that of AMH or AGD(AC)alone. This model could be useful for clinicians and improve diagnosis and clinical management of these women.