Antimullerian hormone (AMH), is a dimeric glycoprotein, a member of the transforming growth factor beta superfamily which acts on tissue growth and differentiation AMH is produced by Sertoli cells of the testis in males and by ovarian granulosa cells in females. In women AMH levels represent the ovarian follicular pool and could be a useful marker of ovarian reserve.
A serum level of AMH strongly correlates with antral follicle count and reflects the size of
primordial follicle pool.
Role of AMH in gender differentiation
AMH remains distinctly higher in males than in females and levels increases during the 1st month to reach its peak in the 2nd year of life . Circulating levels remain high during childhood but fall at the onset of puberty, downregulated by the rising intratesticular concentration of testosterone.
Serum concentrations clearly above female values indicate that testicular tissue is present. Serum AMH is usually 50-fold lower in girls than in boys at birth and remains relatively stable from childhood through young adulthood .
Anti-Müllerian hormone (AMH), also known as Müllerian-inhibiting substance (MIS), was discovered and named based on its role in prenatal gender differentiation. The process of sexual differentiation in humans involves the development of either male or female reproductive organs.
The Y chromosome, found in males, contains a gene called SRY (sex-determining region Y). The presence of this gene triggers the differentiation of the gonad (an undifferentiated structure) into testes. Once the testes begin to develop, specialized cells called Sertoli cells within the testes secrete anti-Müllerian hormone (AMH).
AMH plays a crucial role in male sexual development by causing the regression or degeneration of the Müllerian ducts, which are embryonic structures that would otherwise develop into female internal reproductive organs such as the fallopian tubes, uterus, and upper vagina. In other words, AMH prevents the formation of female secondary sex organs in males.
The absence of AMH in females allows the Müllerian ducts to develop into the fallopian tubes, uterus, and vagina, which are essential for female reproductive function. Thus, AMH is a key factor in the sexual differentiation of male and female reproductive systems during prenatal development.
AMH as marker of Ovarian reserve
AMH lab test is a diagnostic tool used to assess the ovarian reserve in women. Ovarian reserve refers to the quantity and quality of a woman’s remaining eggs or follicles in the ovaries. The test measures the level of AMH hormone in the blood, which is produced by the small follicles in the ovaries
AMH has another important advantage over other biomarkers of ovarian reserve in that measuring it is more convenient for patients. AMH secretion is independent of gonadotropin regulation, with relatively stable serum levels throughout the menstrual cycle. As a result, samples can be collected without regard to cycle day. Again, this contrasts with other candidate markers like FSH, inhibin B, and estradiol that have variable patterns of secretion across the menstrual cycle. AMH has also proved to have the highest reproducibility between consecutive menstrual cycles.
In females Levels of AMH increase until early adulthood and then slowly decrease with increasing age until becoming undetectable before menopause.
Clinical indications of AMH testing
- To assess ovarian status, including follicle development, ovarian reserve, and ovarian responsiveness, as part of evaluation for infertility and assisted reproduction protocols
- To assess menopausal status, including premature ovarian failure
- To assess ovarian function in patients with Polycystic ovarian syndrome (PCOS)
- To evaluate infants with ambiguous genitalia and other intersex conditions
- To evaluate testicular function in infants and children
- To diagnose and monitor patients with AMH secreting Ovarian granulosa cell tumors
Method : CLIA/ECLIA
| Sample Requirement | Description |
|---|---|
| Sample Type | Venous blood sample in plain /serum separator bulb (red top) (no additives) |
| Sample Volume | Typically 1-2 milliliters (ml) |
| Fasting Requirement | Generally not required |
| Timing | Can be tested at any time during the menstrual cycle. Also suitable for women with irregular cycles or those on hormonal contraceptives or menopausal women |
| Special Considerations | Inform healthcare provider of any medications or medical conditions that may influence AMH levels |
| Biotin interference | It is recommended to avoid biotin supplementation for at least 72 hours (3 days) prior to the test. |
Significance of low anti-Müllerian hormone (AMH) levels:
Low AMH levels are often associated with a reduced ovarian response to fertility medications used in IVF stimulation protocols. A lower number of retrieved eggs may be expected, which can impact the chances of successful IVF outcomes, such as fewer embryos available for transfer or freezing.
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