The Role of Anti-Müllerian Hormone (AMH) in Polycystic Ovarian Syndrome (PCOS) Diagnosis: Providing a Simplified, Accessible, and Objective Test to Improve Patient Outcomes

This is a verbatim transcript of an interview conducted with Dr Huang Zhongwei in January 2026. The transcript has been lightly edited for clarity.

Introduction

Hi, I’m Dr. Huang Zhongwei, working as a consultant at the National University Hospital in Singapore. I also focus on ovarian research, understanding its aging and the biology. And therefore I also helm as a deputy director at the Asia Center for Reproductive Longevity and Equality at NUS School of Medicine in Singapore.

PCOS is one of the most common endocrine disorders globally, yet it remains significantly underdiagnosed, with many women going years without a proper diagnosis. From your perspective, what contributes to this high disease burden and underdiagnosis rate?

PCOS is termed as polycystic ovarian syndrome. And this condition in short is called PCOS, where unfortunately, as you mentioned, many women actually come in presenting differently to different clinicians. And that could actually be causing some of the lack of awareness to some of these non-specialist clinicians.

So one big issue is where that comes in with the diagnostic criteria. When we talk about diagnostic criteria, we mean, commonly the Rotterdam criteria which we use And that means achieving two out of the three criteria in the diagnosis. So firstly it’s irregular menstrual cycles. Second, it’s using transvaginal ultrasound assessment of the ovaries to determine polycystic ovarian morphology (PCOM). And finally, the more confusing and slightly more complex one is either the evidence of biochemical hyperandrogenism, that means high testosterone levels or any clinical presentation of hirsutism or what we mentioned are excessive body hair or facial hair in the women.

Women can come in many forms when they present to clinicians. They can come in complaining of inability to conceive. They are concerned because they have irregular cycles, to maybe concern that there might be more body hair than expected, or after investigations of some of the gynecological complaints that she may have. Then the doctors notice that she has what we call PCOS diagnosed on the ultrasound or what we term more accurately, PCOM, which is polycystic ovarian morphology. Clinicians will start thinking, is this PCOS or should I call it PCO something else? And that’s the problem which may lead to underdiagnosis or even sometimes I’m more concerned is over labeling of women with PCOS, which may cause concern to the women and it causes undue anxiety regarding their future fertility and future health.

Could you walk us through the current evidence supporting the role of AMH in the diagnosis of PCOS?

This is a very important aspect and I think an advancement in the diagnosis of PCOS. Anti-Müllerian Hormone, as we call AMH clinically in short. It is a very important glycoprotein that we measure in the blood of women who come usually to seek for fertility. And why we say it is important because we know that AMH is supposedly high in women with PCOS. And that’s very interesting because it is due to the ovaries having the antral follicles, with lots of them producing very high amounts of AMH.

And I think one of the important things is that there are already some clinical and population studies that have shown that AMH at a particular cutoff that’s measured in the blood, really suggests that it correlates to the PCOM. that we mentioned earlier on that’s seen on transvaginal ultrasound scan. And I think this is interesting because there are already studies out there, which is called the APHRODITE study. And this is one of the first studies that actually shows that they put at 3.2ng/mL as the cut off for AMH to diagnose PCOM.

Not all women can have a transvaginal ultrasound scan. And this includes women who have not had vaginal intercourse before or maybe they’re just too young or women who are on the obese side where ultrasound could be difficult to assess the polycystic morphology. This group of women, this could be very important to measure their AMH levels and to determine a cut off to make the clinician suspect that she might have PCOM. And coupled with other clinical symptoms such as irregular menstrual cycles or even in the young woman who is checking on her ovarian reserves.

I think this is important to note that this is a very good first cut marker to assess her ovarian reserve as well, to see if she has high or low ovarian reserve because if someone with irregular cycles, with low ovarian reserve, we should not be thinking about PCOS.

And also interestingly, I also conducted an Asian population study with colleagues from all around Southeast Asia and in the Asia region from Vietnam, Japan, Korea, India, Indonesia, Malaysia and Singapore, of course, where we actually looked at women who come to the fertility clinic, and we routinely measure their AMH levels. We actually find that there’s a slightly different cut off in the Asian population in terms of AMH, but this remains a higher level than expected for most women. So I believe AMH has a strong place to play, in terms of diagnosing and aiding the diagnosis of PCOS.

Can you summarize how the latest guidelines position the use of AMH for PCOS diagnosis?

So this guideline is actually out in 2023, which is the international PCOS guidelines and the European Society of Human Reproduction and Embryology (ESHRE) have also endorsed this guidelines as well. So this is done by a team of experts. And I think what is most interesting is that they have agreed upon using AMH as an alternative to assess polycystic morphology through transvaginal ultrasound scan to help determine the diagnosis of PCOS. And I think this is something that is a more objective and measurable variable as compared to just mentioning the clinical evidence of hyperandrogenism or even enforcing that women need to undergo a transvaginal ultrasound to assess the ovaries when she cannot obtain a diagnosis itself.

I think one important update in the guidelines is that a young woman, especially an adolescent, should at least be 8 years from menarche before she can be diagnosed with PCOS, especially when we know that, due to immaturity of the hypo pituitary ovarian axis, they might present with irregular cycles until later on in adolescence. And so if you suspect a young woman to have PCOS, then using AMH and also understanding that that she needs to be 8 years away from her first period, which is known as the menarche, it could be quite helpful in determining and help us diagnose PCOS more objectively early on in life such that clinicians can do the appropriate interventions, and should ensure that the women actually will have less issues later on in life in terms of fertility, weight loss and any endocrinological problems that associated with the condition itself.

From your clinical experience, in what practical scenarios including the patient profiles does AMH add the most value compared to the current standard of care—such as Transvaginal ultrasound?

I believe AMH is very suitable in a few clinical scenarios. And I think the first one we’re talking about is really for women who have not had vaginal intercourse or have never had sex before in their lives. And so this is definitely a most suitable test and also a quantitative test from the blood versus a transvaginal ultrasound scan. And also in women who are having very high BMI, even with the transvaginal ultrasound scan, it may be difficult to reliably identify PCOM. And in this case, it will be very helpful to correlate with blood measurements of your AMH level. Thirdly, as we’ve mentioned, we usually need the transvaginal ultrasound scan to assess PCOM.

However, there are limitations to the use of transvaginal ultrasound scan because we know there are significant intraobserver and interobserver variations when the sonographer is performing the transvaginal ultrasound scan. And hence AMH will come in as a more objective and quantifiable test that’s more accessible because it can be done in almost any clinic that has a lab associated with it. And I think in this particular case, AMH is a better alternative than any other test to assess for PCOM. And this is further supported by the latest international 2023 PCOS guidelines.

PCOS is increasingly recognised as a condition that spans both reproductive and metabolic health. Why is a multispecialty or multidisciplinary approach across IVF,  OB/GYN, endocrinology, metabolic specialists, and primary care so essential in the holistic management of PCOS?

I think that’s a very excellent point that we need to mention that PCOS for women is still termed a syndrome, and which means we still have a lot to learn about this condition. At the same time, as we mentioned earlier on, there is concern about the diagnosis, either underdiagnosis or misdiagnosis of the condition. And the woman can present to any doctor in a different specialty, be it a family physician, general practitioner, endocrinologist, fertility specialist based on her presenting symptoms. And I think it’s important that her entire health and wellbeing is being looked after, and that includes some association of women with PCOS that have higher risk of metabolic and cardiovascular issues such as diabetes, hyperlipidaemia. And I think some of them, instead of presenting metabolic health issues, may present more irregular cycles and more reproductive goals that need to be achieved rather than metabolic health alone. And so every discipline should be aware of this condition. And also, once you’re aware of this condition, you will want to look out if the woman is suffering from this condition, so that, for example, as simple as measuring her AMH levels, if she has irregular cycles, this may benefit from early identification and then referral to the right specialty or the right medical discipline for further intervention. So I think this allows patient outcomes to be improved and allows the continuity of care in the entire journey, be it reproductive or her future long term cardiovascular metabolic health.

Given the unique demographic and phenotypic features in Asian women, are there specific considerations clinicians should keep in mind when interpreting AMH values for PCOS diagnosis in this population?

I think uniquely in this part of the world where I practise and clinicians who are also working in the Asia-Pacific region will know that the Asian phenotype, even if they have PCOS, is really quite different from what we traditionally understood women with. A lot of times we see lean Asian women coming to us with irregular cycles and we are wondering, or even suspicious, is this woman having PCOS? And I think using a more objective measurement as AMH could be very helpful, especially this population, I almost do not see hyperandrogenism being detected in the blood. So many of them have normal blood testosterone levels and definitely they do not have clinical hirsutism at all. So using AMH as a more objective biomarker in place or an addition and on top of PCOM may be very helpful to help us identify PCOS in the Asian population. And as we’ve mentioned earlier, APHRODITE and the HARMONIA studies have nicely done a cut off of AMH of 3.2ng/mL to be a nice balance of high sensitivity and specificity for PCOM, which is polycystic ovarian morphology. Now this gives clinicians additional confidence when they use this cut off in women who they are suspicious of or are concerned about PCOS to help them achieve their diagnosis with more confidence and accuracy.

To close, what is one message you would like to share with clinicians on incorporating AMH into their diagnostic approach for PCOS to solve the huge underdiagnosed population in APAC?

What we’re doing now is very important is to understand PCOS better as a condition and also learning that AMH is an accessible, objective, and a more accurate assessment of PCOS other than PCOM alone. I think it’s one of the biggest leaps in the diagnosis and management of PCOS in women.

The views and opinions expressed by Dr Huang Zhongwei are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.