Is the measurement of anti-Müllerian hormone essential?

Abstract

Over the past decade, a large number of studies examining the multiple roles of anti-Müllerian hormone (AMH) have been published. The purpose of this article is to focus on the clinical usefulness of AMH in the fields of current gynecological clinical practice. AMH has entered clinical practice in terms of poor ovarian response definition. It prevents folliculogenesis by reducing follicle sensitivity to follicle-stimulating hormone (FSH), and leads to anovulation when secreted in excess amounts in polycystic ovary syndrome (PCOS). Better results might be obtained in the assisted reproductive technique cycle in the presence of high AMH levels even though FSH is increased in women diagnosed with diminished ovarian reserve. In a more recently published study it has been reported that AMH can also predict the outcome of pregnancy in assisted reproduction. AMH levels accurately reflect the ovarian follicular reserve and might, therefore, be considered as a sensitive marker of ovarian aging and ovarian reserve. Evaluation of the level of AMH has clinical value in predicting the success of in-vitro fertilization (IVF). Hyper-response/ovarian hyperstimulation syndrome (OHSS) might be anticipated as about 3.5 ng/ml or above. The cycle stability and operator independency make AMH a most appealing single marker of ovarian reserve. Use of AMH to paint tailored stimulation protocol could result in a reduced risk of OHSS, optimized treatment burden and maintained pregnancy rates. Cost-effectiveness of the use of AMH as a single test before initiating an IVF program should be determined.