Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function

Abstract

Context Anti-Müllerian hormone 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 it 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 acquisition A PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve. Evidence synthesis Serum 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 which potentially can ovulate. Serum AMH levels are used in individualized FSH dosing protocols and may predict the risk of poor response or OHSS, 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 lead to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic. Conclusion Serum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, still little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.

High Variability of Molecular Isoforms of AMH in Follicular Fluid and Granulosa Cells From Human Small Antral Follicles

“…AL-133 (32/33) detected proAMH, AMH N,C, and AMH C ( Table 1 ). The known proteolytic processing of AMH [i.e., cleavage at amino acid positions 451 and 229 ( 20 , 24 , 26 )] introduces conformational changes, which may change the affinity of different antibodies.…”

“…Additional proteolytic cleavage of the AMH N,C complex leads to dissociation of AMH N and AMH C, with the AMH C remaining biologically active and inducing intracellular SMAD signalling upon receptor binding ( Figure 1 ) ( 23 ). ProAMH has two known cleavage sites: at amino acid (aa) 451 (between the AMH N and AMH C domains) and at aa 229 in the AMH N region, giving rise to additional cleavage products ( 21 , 24 – 26 ).…”

“…Illustration modified from Josso (23) and created with BioRender.com. AMH C domains) and at aa 229 in the AMH N region, giving rise to additional cleavage products (21,(24)(25)(26).…”

Use of Anti-Mullerian Hormone (AMH) for Testing of Ovarian Reserve: A Survey of Fifteen (15) Fertility Centres in Ghana

“…A recent study conducted by Hiadzi et al, 2019 [2] showed that, many sub-fertile couples start seeking fertility treatment from herbal products and associated traditional services, then through religious leaders and by the time they visit ART centres, the woman will eventually be advanced in age. Epidemiological data have consistently shown that fertility declines as early as the middle of the third decade [3] and female age remains the most important determinant of success [4] in an IVF programme. Though there is no strict definition of advanced reproductive age in women, subfertility becomes more pronounced after the age of 35 years [5] (Practice committee of ASRM, 2015).…”

The Relationships Between Serum DHEA-S and AMH Levels in Infertile Women: A Retrospective Cross-Sectional Study

“…When follicles grow to over 8 mm during the FSH-dependent stage, AMH expression rapidly declines until it is absent [ 2 ]. Serum AMH levels are strongly and positively associated with the number of growing follicles and can serve as a serum marker for functional ovarian reserve [ 3 ]. However, serum AMH levels negatively correlate with age in adult women.…”