Maximizing the clinical utility of antimüllerian hormone testing in women's health

Abstract

Purpose of reviewTo provide an update on the latest clinical applications of serum antimüllerian hormone (AMH) testing with practical approaches to mitigate the impact of significant variability in AMH results.Recent findingsRecent studies continue to demonstrate that AMH is the best single serum test for ovarian response management with, at most, a weak-to-moderate age-independent association with live-birth rate and time to conception. Data confirm serum AMH levels improve menopause prediction, monitoring of ovarian damage, and identification of women at risk for several ovary-related disorders such as polycystic ovary syndrome and premature or primary ovarian insufficiency. However, it is now recognized that serum AMH results can have dramatic variability due to common, biologic fluctuations within some individuals, use of hormonal contraceptives or other medications, certain surgical procedures, specimen treatment, assay changes, and laboratory calibration differences. Practical guidelines are provided to minimize the impact of variability in AMH results and maximize the accuracy of clinical decision-making.SummaryAMH is an ovarian biomarker of central importance which improves the clinical management of women's health. However, with the simultaneous rapid expansion of AMH clinical applications and recognition of variability in AMH results, consensus regarding the clinical cutpoints is increasingly difficult. Therefore, a careful approach to AMH measurement and interpretation in clinical care is essential.

Age-Related Distribution of Basal Anti-Mullerian Hormone Levels in a Population of Infertile Women

“…Although there are other tests available to predict ovarian reserves, including the antral follicle count and basal FSH levels, serum AMH measurements have many characteristics, such as less dependence upon operators and less intra-and intercycle variation, that make them favorable for use in the clinical setting. An added advantage of AMH measurements is that the blood can be stored, and the serum concentration of AMH can be analyzed at a later stage in stored blood [15][16][17]. The major drawback with AMH measurements used as an optimal indicator of potential fertility is the obvious lack of reference values for different demographic and ethnic groups.…”

Evidence of an age-related correlation of ovarian reserve and FMR1 repeat number among women with “normal” CGG repeat status

“…Evaluation of the sum of allele 1+allele 2 (Sum) yielded similar curves as well (data not shown). Based on current recommendations to cautiously interpret AMH in women below 25 years of age [20][21][22], Fig. 4 was restricted to women over 25.…”

Ovarian reserve in antiphospholipid syndrome: the jury is still out

“…2,3 It is interesting to note that there was no significant difference in the median values of AMH between the APS patients and controls. The only difference was a trend towards an increased proportion of APS patients with lower AMH.…”