Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment

Abstract

IntroductionFertility is referred to the capability for having offspring and can be evaluated by fertility rate. Women’s fertility is strictly dependent on individual’s age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35).AimThe aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Müllerian hormone (AMH) levels.Results There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Müllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor-β (TGF-β) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMH’s predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids.Conclusions AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.

Genome-wide association study of anti-Müllerian hormone levels in pre-menopausal women of late reproductive age and relationship with genetic determinants of reproductive lifespan

“…In males, AMH is required for regression of the Müllerian ducts during testis development in the fetus, and is involved in testicular development and function (2) . In females, AMH is produced by granulosa cells of primary, pre-antral and small antral follicles, inhibiting both the further recruitment of primordial follicles from the follicle pool and also FSH-dependent selection of follicles for growth during the menstrual cycle (3,6,14,24). AMH expression starts in utero at 36 week's gestation, peaking at around 25 years before declining to undetectable levels at menopause (3,5,6).…”

“…In females, AMH is produced by granulosa cells of primary, pre-antral and small antral follicles, inhibiting both the further recruitment of primordial follicles from the follicle pool and also FSH-dependent selection of follicles for growth during the menstrual cycle (3,6,14,24). AMH expression starts in utero at 36 week's gestation, peaking at around 25 years before declining to undetectable levels at menopause (3,5,6). In our analysis, a polymorphism in the promoter of FSHB (-211G>T) that affects FSH levels (25)(26)(27) had no effect on AMH levels in pre-menopausal women, supporting the absence of direct negative feedback of FSH on AMH.…”

“…AMH levels increase in women from birth until their 20s, before declining gradually with age until levels are undetectable after menopause when ovarian reserve is exhausted (1,(3)(4)(5). Since AMH levels are stable throughout the menstrual cycle, they can be used as a measure of fertility in women of late reproductive age and to predict response to fertility treatment (6).…”

Consider: The Ramification of Female Age on Reproductive Health

“…The most significant effect of Advance Maternal Age (AMA) in women 35 year and older is the rate of aneuploidy and genetic defects that plague oocytes [4,5]. One known cause of decreased quality of oocytes comes from increased meiotic nondisjunction, resulting in aneuploidy.…”

The effect of laparoscopic salpingectomy for ectopic pregnancy on ovarian reserve

“…Anti‐Müllerian hormone (AMH) is a glycoprotein produced by the granulosa cells of the secondary, pre‐antral and antral follicles of the ovary, and serum concentrations correlate closely with the number of primordial follicles, making it the most accurate hormonal marker of ovarian reserve …”