What is the anti-müllerian hormone?
The anti-müllerian hormone (AMH) is a glycoprotein that belongs to the family of the transforming growth factors TGF–β, which are involved in the differentiation and follicular development. In women, AMH is produced by the granulosa cells of the small follicles (<6 mm). Hormone production decreases as the follicles increase in size and is not detected in follicles larger than 8 mm. It is detected at high levels in the reproductive age and starts to decrease at the age of 35. In women, before adolescence and after menopause, it cannot be detected. The anti-müllerian hormone can be used to assess the ovarian reserve.
Clinical utility of AMH
Infertility marker: The anti-müllerian hormone acts as a hormonal marker by assessing the ovarian reserve. According to the levels of AMH, the physician will choose the best stimulation protocol by adjusting the ovarian stimulation according to its level, avoiding over response and reducing the chances of developing ovarian hyperstimulation syndrome.
Ovulation Assessment Index: AMH can detect ovarian dysfunction. It is a useful indicator for the monitoring of polycystic ovary syndrome (PCOS), as well as the premature ovarian failure. Decreased hormone levels can predict ovarian aging and the IVF success rates.
Ovarian Failure Index: It concerns young women. In this case, AMH can detect damage to the ovaries and the reduction of ovarian reserve.
Tumor marker: Ovarian cancer increases the levels of the anti-müllerian hormone, so AMH is used as a tumor marker. Decreased hormone levels indicate a positive response to treatment, while elevated levels indicate a chance of cancer recurrence.
AMH LEVELS AND RATES FOR SUCCESSFUL IVF
Women with high levels of AMH have a better response to ovarian stimulation and more eggs collected during oocyte retrieval, which makes IVF more successful.
The levels of AMH do not give information about the quality of the eggs, especially when the woman is young and less than 35 years old, however the AMH levels are consistent with the number of eggs retrieved.
Research on the use of AMH as a prognostic factor for the outcome of IVF has shown:
· High rates of AMH are associated with lower rates of cancellation of ovarian stimulation cycles, with more eggs being retrieved, higher pregnancy rates and an increased possibility of freezing additional embryos for future use.
· Low AMH levels are not a prognostic factor for the outcome of IVF for women <35 years old
· Infertile couples with low AMH levels should not be excluded from trying to conceive through in vitro fertilization process as pregnancies can occur even with low AMH, always depending on the female age.
For more information about the anti-müllerian hormone (AMH) and what information it provides in your case, contact the Obstetrician-Gynecologist, Dr. Melina Stasinou.
