Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency

Abstract

Primary ovarian insufficiency (POI), also known as premature ovarian failure, is a disorder of infertility characterized by amenorrhoea, low estrogen levels and increased gonadotropin levels in women aged <40 years. POI is the result of premature exhaustion of the follicle pool or can be attributed to follicular dysfunction, for example, owing to mutations in the follicle-stimulating hormone receptor or steroidogenic cell autoimmunity. Moreover, advances in cancer therapeutics over the past decades have led to increasing survival rates for both paediatric and adult malignancies. Given the gonadotoxic effect of many cancer treatments, more women develop POI. A marker that predicts whether women are at risk of POI would, therefore, aid in early diagnosis and fertility counselling. Anti-Müllerian hormone (AMH), a growth factor produced solely by small, growing follicles in the ovary, might constitute such a marker, as serum levels of this hormone correlate strongly with the number of growing follicles. In addition, AMH could potentially help assess the progression of ovarian senescence, as serum AMH levels are independent of hypothalamic-pituitary-gonadal axis function and decrease to undetectable levels at menopause. In cancer survivors, serum AMH levels correlate with the extent of gonadal damage. In this Review, we provide an overview of the current studies that have measured AMH in women with POI of various aetiologies and discuss its possible application as a marker to determine ovarian reserve.

Anti-Müllerian hormone is a gonadal cytokine with two circulating forms and cryptic actions

“…The number and state of the germ cells in the gonads is the major determinant of the level of AMH in the circulation. This is most clearly established for females (Visser et al 2012), but it may also be the case for males, as germ cells regulate Sertoli cells (O'Shaughnessy et al 2008, Cool et al 2012, Dabaja et al 2015. Consequently, AMH is uniquely and ideally placed to convey information about the current and future reproductive capacity of an individual.…”

Anti‐Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?

“…Therefore, similar to the prediction of menopause onset, serum AMH has been considered as a possible marker for identifying women with diminished ovarian reserve who are likely to develop POI. Several studies have shown that serum AMH levels are much lower in women with symptomatic ovarian insufficiency [50][51][52][53]. In an era in which it is possible to maintain fertility via cryopreservation of ovaries and/or oocytes, these trials seem to be meaningful for the presupposition of accurate prediction.…”

Genetics of primary ovarian insufficiency: a review

“…It is characterized by primary or secondary amenorrhea for at least 4 months in women under the age of 40, menopausal serum FSH levels (above 40 IU/L) obtained on two occasions at least 1 month apart and low estradiol levels (below 50 pg/mL) [1]. Another indicator is the antiMüllerian hormone (AMH), whose serum levels can help assess the state of follicular senescence, which is a possible predictor of risk for POI [2]. However, there are presently no single screening tests that can predict a woman's reproductive lifespan [3].…”