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Developments in Clinical & Medical Pathology

Significant of Antimullerian Hormone (AMH) as Fertility Marker

Mohd Nizar Battikhi*

Battikhi Central Laboratories, Canada

*Corresponding author: Mohd Nizar Battikhi, Battikhi Central Laboratories, Canada

Submission: May 14, 2018;Published: August 21, 2018

Volume1 Issue5
August 2018

Abstract

Role of Anti-Mullerian hormone (AMH) test indicate adequate strategy for the initial stages of infertility treatment.

keywords: Antimullerian hormone (AMH)

Introduction

AMH is defined as: “Anti-mullerian hormone, it is a protein released by the ovaries that start the growth of an egg in the ovaries and is related to the development of follicles in the ovary. AMH levels correspond to the number of antral follicles, that can be used to indicate the number of eggs available in the ovaries [1,2]. It is virtually undetectable but increases gradually until puberty and remains relatively stable through the reproductive period [3,4]. A very low level of AMH may indicate poor ovarian reserves. A very high level of AMH may correspond to PCOS. One of the best uses currently of the AMH test is the ability to titrate fertility medications based on ovarian reserve and the ability to differentiate between polycystic Ovary Syndrome (PCOS) and those potential donors with a PCOS like ovarian response. By utilizing AMH, those woman with higher numbers may stimulate faster on less fertility medication and it can help decrease hyper stimulation in the high AMH and basal antral follicle count donors [1].

Level of AMH hormone corresponds to the number of eggs a woman has left in her ovarian reserve. That decline with age, however, not every woman is borne with the same number of eggs or loses them at the same rate [5]. There are some factors influence ovarian reserve such as genetics, exposure to chemotherapy, radiation and some medical conditions [5]. AMH detection is very good test because it indicates some information about biological clock, where no reliable test give such information before. [5]. AMH can be tested on any day of the menstrual cycle and It’s levels correlate with the number of oocytes retrieved and treatment can be individualized for optimal cycle [6-8], although level variation between different blood samples for the same patient was reported during the same menstrual cycle especially in young patients [9,10] never the less AMH can still show 80% sensitivity and 93% specificity in predicting poor ovarian response at random blood test [11] and It’s levels correlate with the number of oocytes retrieved and treatment can be individualized for optimal cycle [6-8].

The facts that AMH reported to show assays controversies [12], pregnancies even at undetectable levels [13] and intracycle variations level [14,15] raise question about the possible role of AMH to assist reproduction. It is widely accepted that the reduction of AMH levels in serum is the first indication for decline in the follicular reserve of the ovaries and can be measured in the blood at any time in the menstrual cycle due to its stability [14,15]. Normal ranges of AMH in under 30 population tend to be higher than a 1.0ng/ml. Most fertility professionals use a cut-off of 1.5 up to 8.0 to gauge fertility potential in oocyte donors and many will use an AMH up to 14-15ng/ml even though this could indicate PCOS. With higher AMH numbers the need for special attention in medication titration is warranted [1]. Until now, a woman’s ovarian reserve was checked using methods that have been around for decades [5]. Follicular-stimulating hormone (FSH) for instant must be measured using a blood test on day three of a woman’s menstrual cycle, but it can fluctuate from month to month, unlike AMH also antral follicle count is done using vaginal ultrasound, but it is highly dependent on equipment quality and the precision of the technician [6].

AMH on the other hand, is not yet familiar to all family doctors and gynecologists, who would need to refer a woman to a fertility specialist for the test [5]. AMH level found to be lower in women over 40 year of age and higher in younger female with Polycystic ovaries (PCO) and polycystic Ovary Syndrome (P OCS) [6,15] therefore, AMH is considered to be more specific marker of ovarian response to gonadotrophins [9] and more significance fertility markers over other hormones such as FSH,E2 and antral follicle count (AFC) for treatment female infertility [16,17]. However, both AMH and FSH are still used as ovarian reserve tests [14] despite that FSH test showed several obstacles [18,19] and it needs to be measured during early follicular phase [20-23].

Therefore AMH test believed to has advantages over FSH test [24-26], although AMH level shows variation in different blood samples for the same patient during the same menstrual cycle AMH can still show 80% sensitivity and 93% specificity to predict poor ovarian response at random and treatment can be monitor for optimal cycle [27,28]. The facts that AMH reported to show assays controversies [29-31] raise question mark about the possible role of AMH in assisted reproduction. Although other studies showed that levels of FSH and E2 were used as biochemical markers for assessment of low ovarian reserve for many years however, identification of AFC at later stage considered more reliable marker in assessment of the ovarian reserve where, Follicle count can be determined easily using high resolution sonographic systems [32- 34].

Although difficulties were reported in obtaining AFC however, it has been recommended over basal FSH [32]. Thus, by some investigators AFC is considered as the first choice test [32,34]. FSH and AMH are two different hormones to predict ovarian reserve at two different stages of follicular development. FSH levels reflect antral and postantral follicular development while AMH values are representative of post primordial prenatal follicular pool [15]. Despite the use of both these hormones in parallel to determine ovarian reserve, there is not much literature about the frequency of discordance and concordance between them and its clinical significance [15]. Therefore, some studies have been conducted to determine the frequency of concordance and discordance between AMH and other markers such as FSH levels in female infertility patients [35].

Conclusion

AMH test seems to be future reliable indicator over other hormone markers fork evaluating fertility potential and monitoring infertility treatment.

References

  1. Mary F (2011) AMH-What does it mean, what does it do???
  2. Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G (2009) The correlations of anti-mullerian hormone, follicle stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril 8(4): 393-398.
  3. Barrend WM, Uilenbroek JT, Karmer P, Hoogerbrugge JW, Van Leeuwen EC, et al. (1995) Antimullerian hormone and antimullerian hormone type II receptor messenger ribonucleic acid expression in rat ovaries during postnatal development, the estrous cycle, ropin-induced follicle growth. Endocrinology 136(11): 4951-4962.
  4. Hussain M, Cahill D, Akande V, Gordon U (2013) Discrepancies between antimullerian hormone and follicle stimulating hormone in assisted reproduction. Obstetrics and gynecology international 2013(383278): 6.
  5. A new fertility test is changing women’s lives.
  6. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, et al. (2009) Anti Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 16(2): 113-130.
  7. Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G (2009) The correlations of anti-mullerian hormone, follicle stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril 8(4): 393-398.
  8. Yates AP, Rustamov O, Roberts SA (2011) Anti-Müllerian hormonetailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod 26(9): 2353-2362.
  9. Jayaprakasan K, Deb S, Batcha M, Hopkisson J, Johnson I, et al. (2010) The cohort of antral follicles measuring 2-6mm reflects the quantitative status of ovarian reserve as assessed by serum levels of anti-Mullerian hormone and response to controlled ovarian stimulation. Fertil Steril 94(5): 1775-1781.
  10. Gleicher N, Weghofer A, Barad DH (2010) Discordances between follicle stimulating. Discordances between follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) in female infertility. Reprod Biol Endocrinol 8: 64.
  11. Jayaprakasan K, Deb S, Batcha M, Hopkisson J, Johnson I, et al. (2010) The cohort of antral follicles measuring 2-6mm reflects the quantitative status of ovarian reserve as assessed by serum levels of anti-Mullerian hormone and response to controlled ovarian stimulation. Fertil Steril 94(5): 1775-1781.
  12. Baarends WM, Uilenbroek JT, Kramer P, Hoogerbrugge JW, Van Leeuwen EC, et al. (1995) Anti-müllerian hormone and antimüllerian hormone type II receptor messenger ribonucleic acid expression in rat ovaries during postnatal development, the estrous cycle, and gonadotropininduced follicle growth. Endocrinology 136(11): 4951-4962.
  13. Bancsi LF, Broekmans FJ, Eijkemans MJ, De Jong FH, Habbema JD, et al. (2002) Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve. Fertil Steril 77(2): 328-336.
  14. Van Montfrans JM, Hoek A, Van Hooff MH, De Koning CH, Tonch N, et al. (2000) Predictive value of basal follicle-stimulating hormone concentrations in a general subfertility population. Fertil Steril 74(1): 97-103.
  15. Anderson RA, Nelson SM, Wallace WHB (2012) Measuring anti-Müllerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas 71(1): 28-33.
  16. Gleicher N, Weghofer A, Barad DH (2010) Discordances between follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) in female infertility. Reprod Biol Endocrinol 8: 64.
  17. Leader B, Hegde A, Baca Q, Stone K, Lannon B, et al. (2012) High frequency of discordance between anti-Müllerian hormone and folliclestimulating hormone levels in serum from estradiol-confirmed days 2 to 4 of the menstrual cycle from 5,354 women in US fertility centers. Fertility and Sterility 98: 1037-1042.
  18. Leader B, Hegde A, Baca Q, Stone K, Lannon B, et al. (2012) High frequency of discordance between anti-Müllerian hormone and folliclestimulating hormone levels in serum from estradiol-confirmed days 2 to 4 of the menstrual cycle from 5,354 women in US fertility centers. Fertil Steril 98(4): 1037-1042.
  19. Molinaro T, Samra A (2011) Patients with discordant AMH and FSH have a better prognosis in in-vitro fertilization than those with two abnormal markers of ovarian reserve. Fertility and Sterility 96(3): S199.
  20. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB (2006) A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 12(6): 685-687.
  21. Wolff EF, Taylor HS (2004) Value of the day 3 follicle-stimulating hormone measurement. Fertility and Sterility 81(6): 1486-1488.
  22. Toner JP, Philput CB, Jones GS, Muasher SJ (1991) Basal folliclestimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 55(4): 784-791.
  23. LaMarca A, Sighinolfi G, Radi D (2009) Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 16(2): 113-130.
  24. Yates AP, Rustamov O, Roberts SA (2011) Anti-Müllerian hormonetailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod 26(9): 2353-2362.
  25. Wunder DM, Bersinger NA, Yared M, Kretschmer R, Birkhäuser MH (2008) Statistically significant changes of anti-Müllerian hormone and inhibin levels during the physiologic menstrual cycle in reproductive age women. Fertil Steril 89(4): 927-933.
  26. Overbeek A, Broekmans FJ, Hehenkamp WJ, Wijdeveld ME, Van Disseldorp J, et al. (2012) Intra-cycle fluctuations of anti-Müllerian hormone in normal women with a regular cycle: a re-analysis. Reproductive BioMedicine Online 24(6): 664-669.
  27. Weghofer A, Dietrich W, Barad DH, Gleicher N (2011) Live birth chances in women with extremely low-serum anti-Müllerian hormone levels. Hum Reprod 26(7): 1905-1909.
  28. La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, et al. (2007) Anti- Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod 22(3): 766-771.
  29. Bancsi LF, Broekmans FJ, Eijkemans MJ, De Jong FH, Habbema JD, et al. (2002) Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve. Fertil Steril 77(2): 328-336.
  30. Nelson SM, Anderson RA, Broekmans FJ, Raine FN, Fleming R, et al. (2012) Anti-Müllerian ne: clairvoyance or crystal clear? Hum Reprod 27(3): 631-636.
  31. Overbeek A, Broekmans FJ, Hehenkamp WJ (2012) Intra cycle fluctuations of anti-Müllerian hormone in normal women with a regular cycle: a re-analysis. Reprod Biomed Online 24(6): 664-669.
  32. Broekmans FJ, Soules MR, Fauser BC (2009) Ovarian aging: mechanisms and clinical consequences. Endocr Rev 30(5): 465-493.
  33. Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J (2003) Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update 9(1): 61-76.
  34. Surrey ES (2007) Management of poor responders: the role of GnRH agonists and antagonists. J Assist Reprod Genet 24(12): 613-619.
  35. Battikhi MN, Zqlam W, Banat E, Battikhi Q (2016) Correlation of antimullerian hormone (AMH) and follicle stimulating hormone FSH. EC Microbiology 4(1): 617-622.

© 2018 Mohd Nizar Battikhi. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.



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