AMH- ANTI MULLERIAN HORMONE

AMH is produced in the ovaries by granulosa cells of antral follicles. It releases into the follicular fluid and blood vessels. This hormone plays significant role in the development of reproductive organs in both sexes during the embryonic period of life. In an adult woman its role probably consists in the regulation of genesis of follicles, predominantly by mechanism of inhibiting primordial follicle recruitment and decreasing the sensitivity of small antral follicles to FSH.

A gradual increase in AMH levels observed in females from the first day of life, with maximum levels at around the age of 25 years. In an adult woman AMH levels gradually decrease until they reach the values below detectable limits in postmenopausal women. AMH considered as a stable hormone as its levels over a menstrual cycle and demonstrates low variability in subsequent cycles. Oral contraceptives (OCP) do not influence AMH levels. However, some studies revealed that OCPs were responsible for the reduction in AMH levels, and the discontinuation of contraception might result in increasing the levels. Therefore, it is suggested that AMH measurement may be unreliable if performed when hormonal (OCP) birth control methods are used.

Uses of AMH- Anti Mullerian Hormone-

The main clinical application of AMH determination in women is the assessment of ovarian reserve in the diagnostics of infertility, premature ovarian failure, hypogonadotropic hypogonadism, polycystic ovary syndrome (PCOS) and predictive marker of the time of menopause.

The assessment of ovarian reserve

AMH is considered a good and reliable parameter in the assessment of ovarian reserve. Reduced levels may indicate reduced ovarian reserve, even if the woman has regular menstrual cycles and normal FSH and E₂ levels. A good correlation has been found between AMH levels and age and also between the number of antral follicles. AMH values of 1 ng/ml and lower may translate into reduced ovarian reserve.

As a marker of the time of menopause

The age of 51 is the average time of menopause, defined as the last menstrual period in a woman’s life. Physiological menopause may occur between 40 and 60 years of age, but the decrease in the natural fertility of women starts 10-13 years prior to menopause.

The determination of predictors of the period of fertility in women is gaining importance because of society ageing and later motherhood. Another problem which tackled better prophylaxis as regards diseases which occur significantly more commonly after menopause. These include osteoporosis, cardiovascular disorders and also hormone-related neoplasms, e.g. breast cancer and endometrial cancer. Parameters which indirectly indicate the time of menopause are the ovarian volume and the number of antral follicles, which directly correlates with AMH levels.

As a marker in premature ovarian failure

Premature ovarian failure (POF) may be considered as premature menopause. It is defined as the loss of ovarian function (the termination of its reproductive and hormonal function due to the depletion of ovarian follicles) before 40 years of age. POF occurs in 1/100 women before 40 years of age and in 1/1000 women before 30. It is associated with certain chromosomal aberrations, fragile X syndrome, galactosemia, and FSH receptor disorders. AMH level determination is of importance here, as it is markedly lower in women with POF than in healthy ones.

As a marker of iatrogenic ovarian failure

The loss of oocytes and the reduction in reproductive potential, and in some cases menopause, including premature, may be associated with exposure to chemotherapy, radiotherapy of the pelvic region or an operative procedure involving the ovaries. Iatrogenic gonad failure may also be observed in girls who have undergone chemotherapy due to various neoplasms occurring in childhood. It is recommended to assess ovarian reserve in women who have undergone this type of treatment. It appears to be a good marker of ovarian reserve assessment also in this group of women

AMH In ovarian tumors

AMH secreted in women only by granulosa cells of ovarian follicles, so it is a very useful marker of tumors originating from these cells. Elevated levels are reported in 76-93% of women with granulosa cell tumors (folliculoma). The levels of AMH may be markedly elevated: average levels are 190 ng/ml (ranging from 2 to 1124 ng/ml). The elevated levels may precede a clinically overt tumor even by 16 months. It appears to be a more specific marker for these tumors than inhibin and estradiol, and the values of AMH correlate with tumor size.

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