Reviewer’s report  
 
Title: Age-dependent changes in anti -Müllerian hormone levels i n Lebanese females: correlation 
with basal FSH and LH levels and LH/FSH ratio: a cross -sectional study  
 
Version: 0 Date: 26 Dec 2019  
 
Reviewer: Rodolfo Alberto Rey  
 
Reviewer's repo rt: 
 
The manuscript by Racoubian and colleagues reports the findings of serum AMH, LH and FSH 
levels in a large cohort of apparently healthy Lebanese women of different ages. The authors 
performed a cross -sectional study in 1190 apparently healthy Lebanese female volunteers, aged 
17-54 years, with regular menses. They conclude that circulating AMH levels are  inversely 
related to age and are predictors of LH/FSH ratio and FSH but not LH levels in eumenorrheic 
females.  
 
 
I have the following comments:  
 
Major points:  
 
1. The fact that serum AMH is inversely related to age has been an established fact for 
many yea rs now. Can the authors underscore what this manuscript adds to what it is already 
known about this fact? Do the authors mean to show that this inverse relationship also occurs in 
Lebanese women? Is there any reason to suspect otherwise?  
 
a. I suggest that  the authors make it clear that AMH decline with age is not a novel 
conclusion from this work (p 2 Highlights, p 3 line 48, p 10 line 45), and that it is an established 
marker of declining ovarian reserve (p 8, first line of the Discussion).  
 
b. In the las t paragraph of the Introduction, it would be clarifying if the authors stated why 
they performed this work.  
 
2. The background section of the Introduction needs to be fully rewritten. There are 
several incorrect affirmations and inadequate references:  
 
a. Ref 1 should be replaced by Cate et al, Cell 1986.  
 
b. The main proven role of AMH is its action on Müllerian ducts in foetal life rather than 
its recently suggested action on the GnRH system. The whole paragraph should be rewritten to 
underscore this (p 4, line 11).  
 
c. Immediately after, from the sentence "I t was suggested that AMH secretion is regulated 
through gonadotropin releasing hormone (GnRH) neurons …." until the end of the paragraph has 
too many controversial (sometimes apparently incorrect) statements that do not seem necessary 
for the understanding  of the study. The paragraph could be reduced to the essential background 
on AMH.  
 
d. Ref 8,9 in p 4 line 50 should be replaced by Vigier PNAS 1989 and Wilson, di 
Clemente et al Mol Endocrinol 1993)  
 
e. Ref 8 in p 5 line 26 should be replaced by Hagen Hum Reprod 2012, and the statement 
that AMH increases during childhood should be revised according to this paper.  
 
3. The STROBE guidelines should be followed in order for the quality of the report to be 
improved. For instance: the number of participants shou ld be reported in results, rather than in 
Methods.  
 
4. Table 1: please mention the proportion of individuals in each group that were 
menopausal.  
 
 
Minor points:  
 
1. Table 1: please change &lt;20 yr for 17 -20 yr; similarly say precisely what ages were 
includ ed in the " &gt;50 yr" group  
 
2. English should be revised by a native speaker with technical expertise.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please speci fy which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing inter ests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating to the c ontent 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I havereceived royalties der ived from an agreement betwe en INSERM (France) and Beckman -
Coulter -Immunotech for the development of the AMH ELISA .I have received honoraria from 
CONICET (Argentina) for technology services using the AMH ELISA.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the websi te along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my name d report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal