Abstract
ContextAnti-müllerian hormone (AMH) is produced by granulosa cells of small, growing follicles in the ovary. Serum AMH levels strongly correlate with the number of growing follicles, and therefore AMH has received increasing attention as a marker for ovarian reserve. This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment.Evidence AcquisitionA PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve.Evidence SynthesisSerum AMH levels are measured to assess the “functional ovarian reserve,” a term that is preferred over “ovarian reserve,” since AMH levels reflect the pool of growing follicles that potentially can ovulate. Serum AMH levels are used in individualized follicle-stimulating hormone dosing protocols and may predict the risk of poor response or ovarian hyperstimulation syndrome but has limited value in predicting ongoing pregnancy. Serum AMH levels are studied to predict natural or disease-related age of menopause. Studies show that the age-dependent decline rates of AMH vary among women. The generalized implementation of serum AMH measurement has also led to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic.ConclusionSerum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.
Highlights
Anti-müllerian hormone (AMH) is a member of the transforming growth factor beta family that has derived its name from its role during male sex differentiation by inducing the regression of the müllerian ducts
This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment
An Iranian study analyzing longitudinal data of 959 women during a follow-up of 14 years, of whom 55% reached menopause, did show that serial measurements of AMH improved the prediction of age of menopause, since addition of AMH decline rate to the model increased the C statistic to 78% compared with 70% for AMH alone [60]
Summary
Anti-müllerian hormone (AMH) is a member of the transforming growth factor beta family that has derived its name from its role during male sex differentiation by inducing the regression of the müllerian ducts. Serum AMH levels are studied to predict natural or disease-related age of menopause. Initial studies, performed nearly 2 decades ago, showed that serum AMH levels strongly correlate with the number of growing follicles and that both decline with increasing age [3].
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