AMH and Its Clinical Implications

Anti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation in the male fetus. In women, AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation. As the size of the residual follicular pool depends on the quantity of small antral follicles and declines over time, the serum AMH level in women follows a characteristic trajectory: a gradual decline throughout the reproductive years and a precipitous drop at menopause, becoming undetectable soon after. Thus, AMH is clinically useful as a screening tool for diminished ovarian reserve (Cui et al. in Fertil Steril 105(02):481–485, 2016). Perturbations in serum AMH are linked with a variety of pathological conditions, for instance, polycystic ovaries syndrome (PCOS), the pathophysiology likely being the excess follicles in this syndrome which produce increased amounts of AMH (Dumont et al. in Reprod Biol Endocrinol 13:137, 2015). AMH is also elevated in some ovarian tumors such as adult granulosa cell tumors, and it can be used as a tumor marker to gauge response to therapy and monitor for recurrence. Within the domain of assisted reproductive technology, serum AMH assays are widely used to derive prognostic information such as the chance of successful ovarian stimulation, subsequent embryo quality and even pregnancy rates. Finally, in the rapidly evolving field of oncofertility, serum AMH holds great promise as a predictor of ovarian reserve after completion of cancer therapy. Our aim is to put forth an in-depth review of the clinical applications of AMH in contemporary practice.