A sequential laboratory algorithm based on the luteinizing hormone to follicle-stimulating hormone ratio and anti-Müllerian hormone for identifying polycystic ovarian morphology in women with ovulatory dysfunction

Abstract Objectives The aim of this study was to evaluate the performance of serum anti-Müllerian hormone (AMH) concentrations and the luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio and to propose a sequential algorithm for identifying polycystic ovarian morphology (PCOM) in women with menstrual irregularity. Methods This retrospective study included 149 women aged 18–40 years evaluated between 2018 and 2023. Participants were classified into control, ovulatory dysfunction (OD), and polycystic ovarian morphology with ovulatory dysfunction (PCOM + OD) groups based on menstrual status and transvaginal ultrasound findings. Serum AMH, LH and FSH were measured by automated immunoassays, and diagnostic performance was evaluated using ROC curve analysis. A new dataset of 42 patients was used to validate the diagnostic performance of AMH and the LH/FSH ratio. Results Women with PCOM + OD had significantly higher serum AMH concentrations and LH/FSH ratios than the OD and control groups, while AMH was also higher in the OD group than in controls. AMH and a regression model combining AMH and LH/FSH had moderate to strong diagnostic performance for identifying PCOM in women presenting with OD, with an AUC of 0.783 and 0.811, respectively. Conclusions Comparing women with PCOM and OD to women with OD alone could provide a more meaningful assessment of biomarker performance than comparisons with healthy controls, as it reflects the real diagnostic challenge encountered in routine practice. A sequential strategy using the LH/FSH ratio as an initial test followed by AMH measurement could improve the selection of patients requiring transvaginal ultrasound.