Skip to main content Skip to main navigation menu Skip to site footer

Relationship between angiopoietin-like-protein-2 levels and anti-mullerian hormone levels in polycystic ovary syndrome of reproductive age

  • Dyan Asih Rachmawati ,
  • Ashon Sa’adi ,
  • Budi Utomo ,
  • Arif Tunjungseto ,


Introduction: Polycystic Ovary Syndrome (PCOS) is the most prevalent metabolic disease affecting reproductive-age women and is often present with insulin resistance. Angiopoietin-like-protein-2 (ANGPTL2) is an angiogenic factor influencing insulin resistance in PCOS, manifesting in the anti-mullerian hormone (AMH). There are no previous studies regarding the relationship between ANGPTL2 levels and AMH in PCOS. The study aims to analyse the relationship between ANGPTL2 and AMH levels in PCOS and to compare ANGPTL2 and AMH levels between PCOS phenotypes.

Methods: This cross-sectional study on 43 women aged 18-40 diagnosed with PCOS according to the Rotterdam criteria. Subjects were recruited consecutively and categorized into four PCOS phenotypes. Serum levels of ANGPTL2 and AMH were measured and analysed by correlation and comparison test using SPSS 26.

Results: A total of 43 PCOS samples were included in the study within 4 months. Based on the severity, phenotype A (anovulation, hyperandrogenic and polycystic ovaries) showed the highest levels of ANGPTL2 and AMH. There was no significant difference in ANGPTL2 levels between the PCOS phenotypes. There was a significant difference in AMH levels between phenotypes, where the highest value was between phenotypes A and B. There was a positive correlation between ANGPTL2 and AMH levels.

Conclusion: There is a positive relationship between ANGPTL2 and AMH serum levels. The ANGPTL2 serum levels were not significantly different. In contrast, the AMH serum levels significantly differed across the four PCOS phenotypes, with the highest level found in phenotype A.


  1. Deligeoroglou E. Vrachnis N. Athanasopoulos N. Iliodromiti Z. Sifakis S. Iliodromiti S. Siristatidis C. Creatsas G. Mediators of chronic inflammation in polycystic ovarian syndrome. Gynecol Endocrinol. 2012;28(12):974-8. doi: 10.3109/09513590.2012.683082.
  2. Hashemi AH. Mozdarani H. Mozdarani S. The relationship between hormones level and body mass index with insertion and deletion (D/I) polymorphism of ACE gene in infertile patients with polycystic ovary syndrome. Bali Med. 2017;6(1):90-6. doi: 10.15562/bmj.v6i1.382.
  3. Guyansyah A. Wratsangka R. Dhanardono D. Ghazali MF. Edy HJ. Widyatama HG. Kusumaningrum D. Tjahyadi D. Parwanto E. Primary infertility of male and female factors. polycystic ovary syndrome and oligoasthenoteratozoospermia dominate the infertile population in agricultural and industrial areas in Karawang Regency. West Java Province. Indonesia. Bali Med J. 2021;10(1):167-73. doi: 10.15562/bmj.v10i1.2281.
  4. Indonesian Association of Reproductive Endocrinology and Fertility (HIFERI). Indonesian Society of Obstetrics and Gynecology (POGI). Consensus on the management of polycystic ovary syndrome. 2016:1-69.
  5. Herawati S. Anti-Mullerian Hormone (AMH) as a Novel Marker for Ovarian Function: A Review. Bali Med J. 2019;8(2):475-81. doi: 10.15562/bmj.v8i2.1372.
  6. Abdulah N. Dwifitriana Kouwagam A. Andina and A. Anti-Mãœllerian Hormone And Inhibin-B Level Profile In Cervical Cancer Patients Treated With Paclitaxel And Cisplatin Combination. Bali Med J. 2014;3(2). doi: 10.15562/bmj.v3i2.78.
  7. Wiweko B. Indra I. Susanto C. Natadisastra M. Hestiantoro A. The correlation between serum AMH and HOMA-IR among PCOS phenotypes. BMC Res Notes. 2018;11(1):114. doi: 10.1186/s13104-018-3207-y.
  8. Gürsu T. Eraslan A. Angun B. Comparison of body mass index. anti-müllerian hormone and insulin resistance parameters among different phenotypes of polycystic ovarian syndrome. Gynecology and Obstetrics Clinical Medicine. 2022;2(4):164-170. doi: 10.1016/j.gocm.2022.10.002
  9. Gupta M. Yadav R. Mahey R. Agrawal A. Upadhyay A. Malhotra N. Bhatla N. Correlation of body mass index (BMI). anti-mullerian hormone (AMH). and insulin resistance among different polycystic ovary syndrome (PCOS) phenotypes - a cross-sectional study. Gynecol Endocrinol. 2019;35(11) 970-973. doi: 10.1080/09513590.2019.1613640.
  10. Ozay AC. Emekcı Ozay O. Gulekli B. Comparison of Anti-müllerian Hormone (AMH) and Hormonal Assays for Phenotypic Classification of Polycystic Ovary Syndrome. Ginekol Pol. 2020;91(11):661-667. doi: 10.5603/GP.a2020.0122.
  11. Carmina E. Lobo RA. Comparing Lean and Obese PCOS in Different PCOS Phenotypes: Evidence That the Body Weight Is More Important Than the Rotterdam Phenotype in Influencing the Metabolic Status. Diagnostics. 2022;12(10):2313. doi: 10.3390/diagnostics12102313.
  12. Rahmani E. Akbarzadeh S. Broomand A. Torabi F. Motamed N. Zohrabi M. Serum Levels of Angiopoietin-Like Protein 2 and Obestatin in Iranian Women with Polycystic Ovary Syndrome and Normal Body Mass Index. J Clin Med. 2018;7(7):159. doi: 10.3390/jcm7070159.
  13. Dai H. Liu F. Lu J. Yang Y. Liu P. miR-124-3p Combined with ANGPTL2 Has High Diagnostic Values for Obese and Nonobese Polycystic Ovary Syndrome. Int J Endocrinol. 2022;2022:2155018. doi: 10.1155/2022/2155018.
  14. Barber TM. Dimitriadis GK. Andreou A. Franks S. Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clin Med (Lond). 2015; 15(6):72-6. doi: 10.7861/clinmedicine.15-6-s72.
  15. Tabata M. Kadomatsu T. Fukuhara S. Miyata K. Ito Y. Endo M. Urano T. Zhu HJ. Tsukano H. Tazume H. Kaikita K. Miyashita K. Iwawaki T. Shimabukuro M. Sakaguchi K. Ito T. Nakagata N. Yamada T. Katagiri H. Kasuga M. Ando Y. Ogawa H. Mochizuki N. Itoh H. Suda T. Oike Y. Angiopoietin-like protein 2 promotes chronic adipose tissue inflammation and obesity-related systemic insulin resistance. Cell Metab. 2009;10(3):178-88. doi: 10.1016/j.cmet.2009.08.003.
  16. Ran Y. Yi Q. Li C. The Relationship of Anti-Mullerian Hormone in Polycystic Ovary Syndrome Patients with Different Subgroups. Diabetes Metab Syndr Obes. 2021; 14: 1419-1424. doi: 10.2147/DMSO.S299558.

How to Cite

Dyan Asih Rachmawati, Ashon Sa’adi, Budi Utomo, & Arif Tunjungseto. (2023). Relationship between angiopoietin-like-protein-2 levels and anti-mullerian hormone levels in polycystic ovary syndrome of reproductive age. Bali Medical Journal, 12(1), 861–865.




Search Panel