Clinical application of anti-Mullerian hormone measurement: an update

Abstract

Anti-Mullerian hormone (AMH) is, in the adult female, almost exclusively produced by ovarian granulosa cells. AMH expression peaks in early antral follicles, declining to very low or undetectable levels in follicles larger than 9 mm. Serum AMH measurement has been explored as a unique marker of ovarian function. A strong correlation between serum AMH level and antral follicle count (AFC) is generally observed. Compared to AFC, serum AMH measurement is less cycle- or operator-dependent Serum AMH potentially serves as a useful marker for the differential diagnosis of anovulatory disorders. It is significantly raised in women with polycystic ovary syndrome, and reduced to undetectable level in ovarian failure. Serum AMH may drop to undetectable level 3-5 years before menopause. However, the clinical value and application remains to be determined. It may have some prognostic value in women receiving gonadotoxic chemotherapy or ovarian surgery. Most available studies indicated that AMH and AFC are among the best markers in predicting ovarian response in assisted reproduction treatment; both AMH and AFC have similar predictive value for poor response and hyper-response, but both are poor predictors of pregnancy. Nonetheless, pre-treatment AMH measurement may assist in patient counselling, and may guide the determination of gonadotrophin dosage. However, treatment should not be denied based on low AMH levels. Serum AMH measurement is also useful in the differential diagnosis of disorders of sexual differentiation. There are a few existing assay methods which give values not equivalent to each other. An international standard is not yet available.