Abstract
Serum anti-Mullerian hormone (AMH) is a widely used marker of functional ovarian reserve in the assessment and treatment of infertility. It is used to determine dosing of gonadotropins used for superovulation prior to in vitro fertilization, as well as to determine the degree of damage to ovarian reserve by cytotoxic treatments such as chemotherapy. AMH is also now used to predict proximity to menopause and potentially provides a sensitive and specific test for polycystic ovarian syndrome. Twenty one different AMH immunoassay platforms/methods are now commercially available. Of those compared, the random-access platforms are the most reliable. However, to date there has not been an agreed common international AMH reference preparation to standardize calibration between the various immunoassays. Recently, a purified human AMH preparation (code 16/190) has been investigated by the World Health Organization as a potential international reference preparation. However, this was only partially successful as commutability between it and serum samples was observed only in some but not all immunoassay methods. Development of a second generation reference preparation with wider commutability is proposed.
Highlights
Anti-Mullerian hormone (AMH), known as Mullerian-inhibiting substance (MIS), was first recognized in the 1940s as the factor which determines regression of the Mullerian duct in the male fetus it was only formally characterized and cloned in the 1980s [1, 2]
New sensitive immunoassays are available for situations where AMH serum concentrations are low, as seen in young women following chemotherapy and in women approaching menopause
At recent count there are AMH kits provided by more than 14 manufacturers, most with their own AMH reference preparations which to date have not been calibrated against a common reference preparation
Summary
Anti-Mullerian hormone (AMH), known as Mullerian-inhibiting substance (MIS), was first recognized in the 1940s as the factor which determines regression of the Mullerian duct in the male fetus it was only formally characterized and cloned in the 1980s [1, 2]. With the development of serum AMH immunoassays it has become apparent that AMH is a clinically useful marker of functional ovarian reserve [4, 5] and of clinical value in the treatment of infertility, where measuring the follicle reserve is important. AMH Measurement Methods and monitoring the impact of cytotoxic chemotherapy and radiotherapy on ovarian function. The absence of an agreed international AMH reference preparation has resulted in confusion in defining clinical reference ranges between different kits. The aim of this report is to describe the development of AMH immunoassays and AMH reference preparations, and discuss the recently described WHO AMH Reference Reagent for immunoassay standardization
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