From the Guidelines
Anti-Mullerian hormone (AMH) is a protein that serves as a marker of ovarian reserve, indicating the number of remaining eggs in the ovaries, with levels highest in young women and declining with age until becoming undetectable around menopause. In women, AMH is produced by the granulosa cells in the ovarian follicles and is used to assess fertility potential, predict response to fertility treatments, diagnose polycystic ovary syndrome (PCOS), and estimate the time to menopause 1. AMH levels are measured through a simple blood test that can be performed at any time during the menstrual cycle, as levels remain relatively stable throughout.
Key Points About AMH
- AMH is a protein produced by the granulosa cells in the ovarian follicles of women and by the Sertoli cells in the testes of men.
- In women, AMH indicates the number of remaining eggs in the ovaries and is used to assess fertility potential.
- AMH levels decline with age and become undetectable around menopause.
- AMH testing involves a simple blood test that can be performed at any time during the menstrual cycle.
- Normal AMH values vary by age, with higher levels generally indicating better ovarian reserve, though extremely high levels may suggest PCOS 1.
Clinical Use of AMH
- AMH is used to assess fertility potential and predict response to fertility treatments.
- AMH is used to diagnose polycystic ovary syndrome (PCOS) and estimate the time to menopause.
- AMH levels can be affected by various factors, including age, ovarian reserve, and certain medical conditions.
Limitations of AMH Testing
- AMH testing is not a definitive predictor of fertility, and results should be interpreted in conjunction with other clinical factors.
- AMH levels can be affected by the quality of the test and the laboratory used, highlighting the need for standardized testing procedures 1.
From the Research
Definition and Function of Anti-Mullerian Hormone
- Anti-Mullerian hormone (AMH) is a protein produced by the granulosa cells of early developing follicles in the ovary 2.
- It plays a crucial role in the differentiation of the reproductive tract, regulation of the ovaries and testes, and inhibits the transition from the primordial to the primary follicular stage 2, 3.
- AMH levels can be measured in serum and are proportional to the number of small antral follicles, making it a useful marker of ovarian reserve 2, 4.
Clinical Use of Anti-Mullerian Hormone
- AMH is used in clinical practice to assess ovarian reserve and predict the response to ovarian stimulation in assisted reproductive treatment (ART) patients 5, 4.
- It can also be used to predict the risk of ovarian failure after anticancer treatment in young cancer patients, and as a tumor marker for monitoring patients with granulosa tumors 3.
- AMH may be useful in assessing the need for fertility preservation strategies and detecting post-chemotherapy or surgical damage to the ovarian reserve 6.
Measurement and Interpretation of Anti-Mullerian Hormone
- AMH levels decrease with age and are undetectable in the post-menopausal period 2.
- In patients with premature ovarian failure, AMH is undetectable or greatly reduced, while in women with polycystic ovary syndrome (PCOS), AMH levels are increased 2, 6.
- The measurement of AMH can be used to predict poor response to ovarian stimulation, with a cutoff value of 2.74 ng/mL having a sensitivity of 69% and specificity of 70.5% 4.