Anti-Mullerian hormone, discovered by Professor Alfred Jost in the 1940s.
AMH is expressed differently in different stages of male and female growth and development, and there are also differences in biological effects. Female AMH is mainly secreted by preantral follicles (primary and secondary follicles) and granulosa cells of small antral follicles. However, granulosa cells of >8mm antral follicles, mature preovulatory follicles, and atretic follicles do not secrete AMH. Male AMH is secreted by Setoli cells and regulates the function of testicular stromal cells.
In the embryonic development stage, AMH can regulate the differentiation and development of the reproductive duct, which is essential for gender differentiation; in adult women, AMH inhibits the recruitment of primordial follicles and the development of antral follicles, preventing premature follicle depletion.
1. Assess ovarian reserve function: AMH level can remain relatively stable throughout the menstrual cycle and is not affected by the menstrual cycle. It is currently considered to be a more ideal serological index for ovarian reserve assessment. The fertility of patients undergoing ovarian/uterine surgery and tumor radiotherapy and chemotherapy will be significantly affected. The evaluation of ovarian function for tumor patients before choosing a treatment plan will help guide the selection of individualized strategies for preserving fertility.
2. Prediction of ovarian response: In assisted reproductive technology, the ovarian response of patients receiving controlled hyperstimulation can be predicted, and individualized hyperstimulation programs can be selected for IVF patients by predicting ovarian response.
The consensus of Chinese experts pointed out that the AMH level in the index predicting normal ovarian response is: [1.0~1.4 ng/mL4.5ng/mL. The AMH level in predicting low ovarian response is <0.5~1.1 ng/mL. Ovarian hyperstimulation syndrome is one of the main complications of assisted reproductive technology, and AMH level can also better predict ovarian hyperstimulation syndrome.
3. Diagnosis of polycystic ovary syndrome (PCOS): PCOS is the most common reproductive endocrine disorder in the population. Clinical studies have found that the serum AMH level of PCOS patients is 2 to 3 times higher than the normal level, and there is no uniform standard for the cut-off value of AMH level for the diagnosis of PCOS. In 2018, the Maternity Hospital of Fudan University included 653 PCOS patients (standard enrollment in Rotterdam) and 118 healthy controls. The recommended diagnostic value for AMH was 7.69 ng/mL. The diagnostic cut-off value of 20-29 years old is 8.16 ng/mL; the diagnostic cut-off value of 30-39 years old is 5.89 ng/mL.
4. AMH predicts menopause: In childhood (before the age of 10), the AMH level of men is much higher than that of women. Compared with men, the AMH level of women is relatively stable. Women reach the peak of AMH levels at the age of 24 and 5, and decrease with age. After 40 years of age, the decline of AMH levels accelerates, and the level after menopause is extremely low, which is difficult to detect.
AMH is an intuitive and accurate evaluation index of ovarian reserve.
In recent years, anti-Mullerian hormone (AMH) has been used clinically to evaluate ovarian function. It mainly comes from the secretion of preantral follicles and early antral follicles, which can be used as an indicator to assess the level of ovarian stock and reflect the ovarian reserve function of expectant mothers.
Ovarian reserve is one of the key factors that determine whether IVF can get a satisfactory outcome. Before the implementation of assisted fertility, both physicians and patients hope that there will be a "divine calculation" that can predict success. Doctors assess the patient's ovarian function and predict ovarian responsiveness before performing controlled ovulation induction, which is a prerequisite for a comprehensive and objective evaluation of the feasibility of IVF and individualized medication.
Before ovulation-stimulating drugs, evaluate the ovarian reserve to predict ovarian responsiveness and improve the success rate of treatment. AMH can be used to diagnose diseases related to ovarian reserve, such as PCOS, POF, granulosa cell tumor, etc. Not all female friends need to be tested for AMH level, so when should AMH be tested? It is up to the doctor in charge to determine whether you need to test the AMH level based on the patient's age, fertility needs, infertility, and the method of fertility.
1. AMH represents the number of eggs, but does not represent the quality
If the AMH is only low, but the patient's young eggs are of good quality, even if the number of eggs is small, they still have a chance to get pregnant. Older eggs will have poor quality. Even if the AMH value is good, the pregnancy rate will still be affected! Therefore, when patients hear that their AMH is low, don't feel depressed, but stay optimistic.
2. AMH is not as high as possible
In a 2012 study on "Low levels of AMH hormone does not predict the reduction of fertility in young healthy women", scientists observed and studied 186 young Danish couples. It was found that there was not much difference in the pregnancy odds between low-level AMH and medium-level AMH. In contrast, the pregnancy rate of high levels of AMH is reduced.
In addition, high AMH levels are common in patients with polycystic ovary syndrome. Patients with polycystic ovary syndrome often have many small follicles (As mentioned earlier, AMH is a hormone secreted by small follicles), so AMH will increase. Moreover, high AMH levels are more likely to cause ovarian hyperstimulation syndrome (OHSS) in IVF treatment.
