Evaluation and Interpretation of AMH in Female Infertility

Abstract

Anti-Müllerian hormone (AMH) is a glycoprotein that secreted by the granulosa cells of the pre-antral and antral ovarian follicles that have a diameter <8 mm. By inhibiting both initial recruitments of primordial follicles into primary follicles and also the sensitivity of antral follicles to follicle stimulating hormone (FSH) in cyclic recruitment AMH acts as a “follicular gatekeeper”. AMH is recognized as an early marker of the decline in the follicular pool. Although AMH levels are accepted to be stable all through the menstrual cycle, inter- and intracycle variability are detected in the studies with the highly sensitive automated assays. Besides aging, body mass index, obesity, oral contraceptive use, previous ovarian surgery, chemotherapy, BRCA mutations, and ethnicity play a role on the AMH levels. Polycystic ovary syndrome (PCOS) is related with increased AMH level and thus proposed to be used as a diagnostic criterion. However, there is no universally accepted threshold value for AMH that can be used in the diagnosis of PCOS. AMH levels have also been used for designing an ideal treatment protocol in assisted reproduction. AMH measurements can be utilized for the prediction of poor or hyper ovarian response. The value of AMH levels in the prediction of pregnancy outcome remains controversial.