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AMH (ANTI-MULLERIAN HORMONE) Most Sensitive Marker of Ovarian Reserve


What is AMH?

AMH or Anti Mullerian Hormone is a substances produced by granulosa cells.  A granulosa cell or follicular cell is a somatic cell in ovary of female.

Anti- Mullerian Hormone  or AMH is a protein that in humans is encoded by the AMH gene. It is a hormone that inhibits the development of the Müllerian ducts (paramesonephric ducts) in the male embryo.

AMH level as Fertility Test?

We assume AMH blood levels reflect the size of remaining eggs or ovarian reserve. And you know 1 in every 4 couples has been found to be affected by infertility as per WHO!

Features of AMH as a Fertility Test?

  • Earliest and most sensitive marker of Ovarian Reserve
  • Non-cycle dependent- AMH can be measured on any day of the cycle
  • Better Marker for Ovarian reserve- AMH is much more stable and better marker than FSH
  • Earliest marker of Ovarian aging- AMH is earliest marker as AMH levels decline with age

Result Interpretation of AMH Level for Adult Female under 35 Years:

INTERPRETATION         BLOOD LEVEL
HIGH OVER 4.0 NG/ML
NORMAL 1.5-4.0 NG/ML
LOW NORMAL 1.0-1.5 NG/ML
LOW 0.5-1.0 NG/ML
VERY LOW < 0.5 NG/ML

Normal Value of AMH in Diffrent Age Group:


Age Group Normal Value
< 33 YEARS   2.1 NG/ML
33-37 YEARS  1.7 NG/ML
38-40 YEARS 1.1 NG/ML
41+ YEARS  0.5 NG/ML



AMH Level Correlation with IVF Success?

1. High AMH levels correlate with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of leftover embryos.
2. Low AMH levels (alone) do not predict low IVF success rates in women under 35
3. Couples should not be excluded from attempting IVF due to low AMH values alone because live birth success rates were reasonable in these cases.

FAQ
Q1. What is shortcomings of this test?
Answer: This test check the quantity of the substance produce by granulosa cells in ovarian follicles but it did not say anything about quality of eaggs

References:
1.The Journal of Clinincal Endocrinology and Metabolism 90(10) : 5536-5543
2. Human Reproduction, Vol.00, No.0 pp. 1-11, 2012
3. Rzeszowska, Marzena; Leszcz, Agnieszka; Putowski, Lechosław; Hałabiś, Magdalena; Tkaczuk-Włach, Joanna; Kotarski, Jan; Polak, Grzegorz (2016). "Anti-Müllerian hormone: structure, properties and appliance". Ginekologia Polska. 87 (9): 669–674. ISSN 2543-6767. doi:10.5603/gp.2016.0064.
4. Cate RL, Mattaliano RJ, Hession C, Tizard R, Farber NM, Cheung A, Ninfa EG, Frey AZ, Gash DJ, Chow EP (June 1986). "Isolation of the bovine and human genes for Müllerian inhibiting substance and expression of the human gene in animal cells". Cell. 45 (5): 685–98. PMID 3754790. doi:10.1016/0092-8674(86)90783-X.
5. Imbeaud S, Faure E, Lamarre I, Mattéi MG, di Clemente N, Tizard R, Carré-Eusèbe D, Belville C, Tragethon L, Tonkin C, Nelson J, McAuliffe M, Bidart JM, Lababidi A, Josso N, Cate RL, Picard JY (December 1995). "Insensitivity to anti-müllerian hormone due to a mutation in the human anti-müllerian hormone receptor". Nature Genetics. 11 (4): 382–8. PMID 7493017. doi:10.1038/ng1295-382.
6. Taguchi, Osamu; Cunha, Gerald R.; Lawrence, W.Dwayne; Robboy, Stanley J. "Timing and irreversibility of Müllerian duct inhibition in the embryonic reproductive tract of the human male". Developmental Biology. 106 (2): 394–398. doi:10.1016/0012-1606(84)90238-0.
7. Behringer RR (1994). "The in vivo roles of müllerian-inhibiting substance". Current Topics in Developmental Biology. Current Topics in Developmental Biology. 29: 171–87. PMID 7828438. doi:10.1016/S0070-2153(08)60550-5.
8. Rey R, Lukas-Croisier C, Lasala C, Bedecarrás P (December 2003). "AMH/MIS: what we know already about the gene, the protein and its regulation". Molecular and Cellular Endocrinology. 211 (1-2): 21–31. PMID 14656472. doi:10.1016/j.mce.2003.09.007.
9. Taguchi O, Cunha GR, Lawrence WD, Robboy SJ (December 1984). "Timing and irreversibility of Müllerian duct inhibition in the embryonic reproductive tract of the human male". Developmental Biology. 106 (2): 394–8. PMID 6548718. doi:10.1016/0012-1606(84)90238-0.
10. "Serum Anti-Müllerian hormone (AMH) levels are differentially modulated by both serum gonadotropins and not only by serum Follicle Stimulating Hormone (FSH) levels - ScienceDirect" (PDF). ac.els-cdn.com. Retrieved 2017-05-25.
11. Shen WH, Moore CC, Ikeda Y, Parker KL, Ingraham HA (June 1994). "Nuclear receptor steroidogenic factor 1 regulates the müllerian inhibiting substance gene: a link to the sex determination cascade". Cell. 77 (5): 651–661. PMID 8205615. doi:10.1016/0092-8674(94)90050-7.
12. Nachtigal MW, Hirokawa Y, Enyeart-VanHouten DL, Flanagan JN, Hammer GD, Ingraham HA (May 1998). "Wilms' tumor 1 and Dax-1 modulate the orphan nuclear receptor SF-1 in sex-specific gene expression". Cell. 93 (3): 445–454. PMID 9590178. doi:10.1016/s0092-8674(00)81172-1.

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