Background In women, anti-Mullerian hormone (AMH) levels may represent the ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies (ART). In men AMH is secreted in both the serum and seminal fluid. Its measurement may be useful in clinical evaluation of the infertile male. Methods The PubMed database was systematically searched for studies published until the end of January 2009, search criteria relevant to AMH, ovarian reserve, ovarian response to gonadotrophin stimulation, spermatogenesis and azoospermia were used. Results AMH seems to be a better marker in predicting ovarian response to controlled ovarian stimulation than age of the patient, FSH, estradiol and inhibin B. A similar performance for AMH and antral follicular count has been reported. In clinical practice, AMH measurement may be useful in the prediction of poor response and cycle cancellation and also of hyper-response and ovarian hyperstimulation syndrome. In the male, the wide overlap of AMH values between controls and infertile men precludes this hormone from being a useful marker of spermatogenesis. Conclusions As AMH may permit the identification of both the extremes of ovarian stimulation, a possible role for its measurement may be in the individualization of treatment strategies in order to reduce the clinical risk of ART along with optimized treatment burden. It is fundamental to clarify the cost/benefit of its use in ovarian reserve testing. Regarding the role of AMH in the evaluation of infertile men, AMH as single marker of spermatogenesis does not seem to reach a satisfactory clinical utility.

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Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART)

Inwomen,anti-Mu¨llerianhormone(AMH)isexclusivelyproducedbygranulosacellsofovarianfolliclesduringtheearlystagesof follicle development. After an initial increase until early adulthood, AMH concentrations slowly decrease with increasing age until becomingundetectable 5 years before menopause when the stock of primordial follicles is exhausted. However, major individual variability exists inthe pace of follicle pool depletion and the initial size of the follicle pool, reﬂected byawide range of age at menopause. Individual AMH serumconcentrationdoesaccuratelyreﬂectthesizeofthepoolofantralfollicles,representingthequantityoftheremainingprimordialfollicles.Accord-ingly,AMHlevelsmayvarysigniﬁcantlyinwomenofthesamechronologicalage,allowingAMHtopredicttheremaininglengthofawoman’sre-productive lifespan.

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Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications.

BACKGROUND: The antral follicle count (AFC) and anti-Mullerian hormone (AMH) both represent age-related follicular decline quite accurately, although long-term follow-up studies are still lacking. The best ovarian reserve test would need only a single, cycle-independent measurement to be representative. METHODS: To compare the inter-and intra-cycle stability of AFC and AMH, we used age-adjusted intra-class correlation coefficients (ICCs). To measure inter-cycle stability across a number of up to four menstrual cycles, we used data, prospectively collected for the purpose of an other study, from 77 regularly cycling, infertile women aged 24-40 years. AMH and AFC values were measured on cycle day 3. To study intra-cycle variability, we used data from a prospective cohort study of 44 regularly cycling volunteers, aged 25-46 years and measured AMH and assessed the AFC (2-10 mm) every 1-3 cycle days. RESULTS: Between menstrual cycles, AFC and AMH varied between 0 and 25 follicles (median 10), and 0.3 and 27.1 ng/ml (median 4.64). The difference in age-adjusted ICC between AMH [ICC, 0.89 (95% CI, 0.84-0.94)] and AFC [ICC, 0.71 (95% CI, 0.63-0.77)] was 0.18 (95% CI, 0.12-0.27). For the intra-cycle variation, 0-43 antral follicles (median 7) were counted per volunteer. The difference in age-adjusted ICC between AMH [ICC, 0.87 (95% CI, 0.82-0.91)] and AFC [ICC, 0.69 (95% CI, 0.46-0.82)] was 0.18 (95% CI, 0.034-0.42). CONCLUSION: SSerum AMH demonstrated less individual intra-and inter-cycle variation than AFCs and may therefore be considered a more reliable and robust means of assessing ovarian reserve in subfertile women.

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Comparison of inter- and intra-cycle variability of anti-Müllerian hormone and antral follicle counts

Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization.

Ovarian reserve testing: a user's guide.

https://www.fertstert.org/article/S0015-0282(07)01017-5/pdf

Robert Kretschmer

Papers

Statistically significant changes of antimüllerian hormone and inhibin levels during the physiologic menstrual cycle in reproductive age women