Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications
Top Cited Papers
Open Access
- 12 May 2014
- journal article
- review article
- Published by Oxford University Press (OUP) in Human Reproduction Update
- Vol. 20 (5), 688-701
- https://doi.org/10.1093/humupd/dmu020
Abstract
In women, anti-Müllerian hormone (AMH) is exclusively produced by granulosa cells of ovarian follicles during the early stages of follicle development. After an initial increase until early adulthood, AMH concentrations slowly decrease with increasing age until becoming undetectable ∼5 years before menopause when the stock of primordial follicles is exhausted. However, major individual variability exists in the pace of follicle pool depletion and the initial size of the follicle pool, reflected by a wide range of age at menopause. Individual AMH serum concentration does accurately reflect the size of the pool of antral follicles, representing the quantity of the remaining primordial follicles. Accordingly, AMH levels may vary significantly in women of the same chronological age, allowing AMH to predict the remaining length of a woman's reproductive lifespan. Following 10 years of intense clinical research in this area (with over 300 papers published in core clinical journals every year), the level of evidence justifying use of AMH in ovarian reserve testing is rapidly increasing. We have conducted a summarizing review regarding all evidence published. Many studies have convincingly demonstrated that AMH is the best currently available measure of ovarian reserve under a variety of clinical situations, such as infertility treatment (especially IVF), the forecasting of reproductive lifespan, ovarian dysfunction (especially polycystic ovary syndrome) and gonadotoxic cancer treatment or ovarian surgery. Moreover, AMH may help to individualize dosing for ovarian stimulation thereby improving the efficiency and safety of IVF. However, there are concerns about the performance of the AMH assay under different conditions regarding storage of samples and handling techniques. Therefore an international guideline for laboratories and a reference preparation are needed to make test results between laboratories truly comparable. AMH is the best current available measure of ovarian reserve for different clinical conditions. However, prospective well powered studies comparing different infertility treatment strategies based on initial AMH levels using appropriate end-points, such as live birth and cost-effectiveness, are urgently awaited. Such studies could represent a true step forward in rendering counseling and infertility care more patient tailored.Keywords
This publication has 136 references indexed in Scilit:
- Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysisFertility and Sterility, 2013
- Pretreatment antimüllerian hormone levels determine rate of posttherapy ovarian reserve recovery: acute changes in ovarian reserve during and after chemotherapyFertility and Sterility, 2012
- Quantifying effect of combined oral contraceptive pill on functional ovarian reserve as measured by serum anti‐Müllerian hormone and small antral follicle count using three‐dimensional ultrasoundUltrasound in Obstetrics & Gynecology, 2012
- Genetic variants and environmental factors associated with hormonal markers of ovarian reserve in Caucasian and African American womenHuman Reproduction, 2011
- Serum antimüllerian hormone in healthy premenopausal womenFertility and Sterility, 2011
- Development of a second generation anti-Müllerian hormone (AMH) ELISAJournal of Immunological Methods, 2010
- Antimullerian hormone and obesity: insights in oral contraceptive usersContraception, 2010
- Variations in serum müllerian inhibiting substance between white, black, and Hispanic womenFertility and Sterility, 2009
- Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserveJournal of Assisted Reproduction and Genetics, 2008
- Body size affects measures of ovarian reserve in late reproductive age womenMenopause, 2008