AMH as the primary marker for fertility

Abstract

In women, the anti-Müllerian hormone (AMH) is secreted by the granulosa cells of growing follicles. Its measurement is strongly correlated with antral follicle count and represents a reliable marker of ovarian reserve. It also has the advantage of being highly reproducible since it has little variation within and between cycles. However, although it seems to be a good quantitative reflection of the ovarian reserve, it does not assess oocyte or embryo quality. This drawback precludes any good prediction of female fertility in the general population as well as in specific subgroups of patients. However, the AMH assay can become an indirect marker of the remaining female fertile years in some cases such as in those women who are at risk for premature ovarian failure or in those suffering from polycystic ovary syndrome. Its interest is no more to be proven in assisted reproductive technology where it is a valuable aid to the choice of the proposed techniques, ovarian stimulation protocols and gonadotropin dosage. AMH is finally very informative in monitoring cancer patients having received gonadotoxic drugs or having undergone mutilating ovarian surgeries. In conclusion, although it cannot be considered as a reliable predictor of pregnancy in women, AMH is now a useful tool in the management and treatment of female infertility.

scRNA‐seq of ovarian follicle granulosa cells from different fertility goats reveals distinct expression patterns

“…AMH, a member of TGF‐β family, is expressed in the GCs of growing follicles and plays vital roles in follicle recruitment. Moreover, AMH is the marker for ovarian reservation because the knockout of this gene leads to the premature depletion of follicles (Dewailly & Laven, 2019; Durlinger et al., 1999). It also has been confirmed that AMH is highly expressed in mouse ovary (Johnson et al., 2008).…”

High Anti-Müllerian Hormone Level is Associated with A Lower Chromosomal Aberration Rate in Miscarried Conceptus From Women with Early Spontaneous Abortion

“…Expression of AMH and other proteins involved in the TGF-β signaling pathways were signi cantly reduced among patients older than 37 compared with younger ages [15] . Several studies have found that there is a signi cant positive correlation between AMH levels and the quality [5] and quantity [16] of oocytes, although the value of AMH in predicting oocyte quality is controversial [17,18] .…”

Anti-Müllerian hormone: clinical implications in Gynecological Endocrinology. An update review

“…It has also been hypothesized that in women with PCOS AMH may be useful in deciding the initial dose of stimulation to start with, in fact some authors argue that if AMH is high then stimulation should be started with higher doses (61). On the contrary, it seems there is no correlation between AMH serum levels and gonadotropin sensitivity in patients with PCOS, and the only real role of AMH in these patients is to predict the risk of hyperstimulation syndrome, to which they are more exposed (24). Moreover, a recent Cochrane review show that current evidence does not provide a justification for adjusting the standard dose of FSH in the case of poor or normal responders, indeed this would only lead to using a higher total dose of FSH and increasing the costs of stimulation.…”

“…In addition, this model involves multiple serial doses over time and requires reliable laboratories to perform the test (101). Moreover, the main issue consists in the absence of a widely accepted cut-off value in AMH serum level to diagnose a decline in ovarian reserve (24). In literature many authors suggest different thresholds, such as 1 ng/ml, but since there is evidence of pregnancies occurring even in women with undetectable levels of AMH, is clear that those thresholds do not predict the chances of spontaneous pregnancy (102,103).…”