Anti-Müllerian hormone
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.[1]
In males, AMH induces the regression of fetal Müllerian ducts and represses androgen synthesis through receptors located on the Leydig cell membrane.[2] 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.[3]
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.[4] 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.[5][6]
It has also been proposed as a surrogate for antral follicle count (AFC) in the diagnosis of polycystic ovary syndrome (PCOS).[7] Anti-Mullerian hormone (AMH) is vital in the pathophysiological process of polycystic ovary syndrome (PCOS).[8] AMH levels also correlate positively with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels and negatively with body mass indices (BMI).[9]
(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.[10] AMH levels are correlated with age, with average AMH levels for 30 years old oscillating around 3.75ng/mL.[11] 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.[11] 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.
References
- ↑ Holt, R., Yahyavi, S. K., Kooij, I., Andreassen, C. H., Andersson, A. M., Juul, A., ... & Blomberg Jensen, M. (2023). Low serum anti-Müllerian hormone is associated with semen quality in infertile men and not influenced by vitamin D supplementation. BMC medicine, 21(1), 79.
- ↑ Edelsztein, N. Y., Valeri, C., Lovaisa, M. M., Schteingart, H. F., & Rey, R. A. (2022). AMH regulation by steroids in the mammalian testis: Underlying mechanisms and clinical implications. Frontiers in Endocrinology, 13. PMID: 35712256 PMCID: PMC9195137 DOI: 10.3389/fendo.2022.906381
- ↑ Rajpert-De Meyts, E., Jørgensen, N., Græm, N., Müller, J., Cate, R. L., & Skakkebæk, N. E. (1999). Expression of anti-Mullerian hormone during normal and pathological gonadal development: association with differentiation of Sertoli and granulosa cells. The Journal of Clinical Endocrinology & Metabolism, 84(10), 3836-3844. PMID: 10523039 DOI: 10.1210/jcem.84.10.6047
- ↑ Durlinger, A., Visser, J., & Themmen, A. (2002). Regulation of ovarian function: the role of anti-Mullerian hormone. Reproduction. PMID: 12416998 DOI: 10.1530/rep.0.1240601
- ↑ Nelson, S. M., Davis, S. R., Kalantaridou, S., Lumsden, M. A., Panay, N., & Anderson, R. A. (2023). Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Human Reproduction Update.
- ↑ Vijay AS, Gopireddy MMR, Fyzullah S, Gollapalli P, Maheswari M, Rani U, Rajesh S. Association Between AMH Levels and Fertility/Reproductive Outcomes Among Women Undergoing IVF: A Retrospective Study. J Reprod Infertil. 2022 Jan-Mar;23(1):54-60. doi: 10.18502/jri.v23i1.8453.
- ↑ Di Clemente, N., Racine, C., Pierre, A., & Taieb, J. (2021). Anti-Müllerian hormone in female reproduction. Endocrine reviews, 42(6), 753-782. PMID: 33851994 DOI: 10.1210/endrev/bnab012
- ↑ Sivanandy, M. S., & Ha, S. K. (2023). The Role of Serum Anti-Mullerian Hormone Measurement in the Diagnosis of Polycystic Ovary Syndrome. Diagnostics, 13(5), 907.
- ↑ Zhao, H., Zhou, D., Liu, C., & Zhang, L. (2023). The Relationship Between Insulin Resistance and Obesity and Serum Anti-Mullerian Hormone Level in Chinese Women with Polycystic Ovary Syndrome: A Retrospective, Single-Center Cohort Study. International Journal of Women's Health, 151-166. PMID: 36778752 PMCID: PMC9911904 DOI: 10.2147/IJWH.S393594
- ↑ Kuang, X., Wei, L., Huang, Y., Ji, M., Tang, Y., Wei, B., ... & Xu, H. (2023). Development of a digital anti-Müllerian hormone immunoassay: ultrasensitive, accurate and practical strategy for reduced ovarian reserve monitoring and assessment. Talanta, 253, 123970. PMID: 36206626 DOI: 10.1016/j.talanta.2022.123970
- ↑ 11.0 11.1 Gunasheela D, Murali R, Appaneravanda LC, Gerstl B, Kumar A, Sengeetha N, Nayak H, Chandrikadevi PM. Age-Specific Distribution of Serum Anti-Mullerian Hormone and Antral Follicle Count in Indian Infertile Women. J Hum Reprod Sci. 2021 Oct-Dec;14(4):372-379. doi: 10.4103/jhrs.jhrs_65_21.
