Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance, is a glycoprotein hormone that belongs to the transforming growth factor beta (TGF-β) superfamily of growth and differentiation factors secreted by immature Sertoli cells (after castration, AMH is no longer detected in serum) and by granulosa cells of growing ovarian follicles.
In males, AMH induces the regression of fetal Müllerian ducts and represses androgen synthesis through receptors located on the Leydig cell membrane. In females, AMH inhibits primary follicle recruitment and sensitivity to Follicle-stimulating hormone (FSH). AMH is synthesized as a homodimeric precursor consisting of two identical polypeptide chains, with a large N-terminal pro-region of 110-kDa and a small C-terminal mature domain of 25-kDa. AMH is subjected to post-translational proteolytic processing; the resulting N-terminal and C-terminal dimers remain associated in a non-covalent complex that is biologically active.
The measurement of circulating anti-Müllerian hormone (AMH) has been applied to a wide array of clinical applications, mainly based on its ability to reflect the number of antral and pre-antral follicles present in the ovaries. AMH has been suggested to predict the ovarian response to hyperstimulation of the ovaries for IVF and the timing of menopause, and to indicate iatrogenic damage to the ovarian follicle reserve.
It has also been proposed as a surrogate for antral follicle count (AFC) in the diagnosis of polycystic ovary syndrome (PCOS). Anti-Mullerian hormone (AMH) is vital in the pathophysiological process of polycystic ovary syndrome (PCOS). AMH levels also correlate positively with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels and negatively with body mass indices (BMI).
(AMH) is an ideal biomarker for the assessment of ovarian reserve. However, the ovarian reserve of premature ovarian insufficiency (POI) patients declines over time even under hormone therapy-treatment. AMH levels are correlated with age, with average AMH levels for 30 years old oscillating around 3.75ng/mL. Generall, higher than 1ng/mL of AMH values usually imply that a woman has a normal ovarian reserve.
However, egg quality and fertility, as studied by the probability of pregnancy, appears to be independent of AMH levels. Egg quality and fertility is associated with age but is independent of AMH levels, as only 1 egg (of sufficient quality) per month is required for successful fertilization and pregnancy. Therefore, a low amount of eggs released per month is not indicative of fertility, but it is a strong predictor of the remaining time that a woman might be fertile (and therefore menopause). Currently, no reliable test exists for measuring the quality of eggs in women, besides the success rate after IVF treatment or pregnancy itself.
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