Clinical Applications of Serum Anti-Müllerian Hormone Measurements in Both Males and Females: An Update

Abstract

Infertility is one of the most common non-communicable diseases, affecting both men and women equally. Ovarian reserve, the number of primordial follicles in the ovaries is believed to be the most important determinants for female fertility. Anti-Müllerian hormone (AMH) secreted from granulosa cells of growing follicles is recognized as the most important biomarker for ovarian reserve. Ovarian reserve models have been developed using AMH and other hormonal indicators, thus childbearing plans and reproductive choices could be arranged by women. In assisted reproductive technology cycles, measurement of AMH helps to predict ovarian response and guide recombinant follicle-stimulating hormone dosing in women. Serum AMH level is increasingly being recognized as a potential surrogate marker for polycystic ovarian morphology, one of the criteria for diagnosis of polycystic ovarian syndrome. AMH is also secreted by Sertoli cells of testes in men, and AMH measurements in the prediction of surgical sperm recovery rate in men have also been investigated. AMH levels are significantly higher in boys than in girls before puberty. Therefore, serum levels of AMH in combination with testosterone is used for the differential diagnosis of disorders of sex development, anorchia, non-obstructive azoospermia, and persistent Müllerian duct syndrome. Recently, serum AMH measurements have also been used in fertility preservation programs in oncofertility, screening for granulosa cell tumors, and prediction of menopause applications. In this review, we will focus on clinical application of AMH in fertility assessments for healthy men and women, as well as for cancer patients.

Keywords: Granulosa cells; PCOS; Sertoli cells; anti-Müllerian hormone assays; assisted reproductive technology; menopause; ovarian reserve.

Graphical abstract

Figure 1

Summary of the Role of AMH in AMH Null Mice In AMH-null female mice 25 days after birth (equivalent to female puberty in humans), the number of primordial follicles was normal, but the numbers of activated follicle were elevated. In 4 months old, AMH-null female mice (equivalent to reproductive middle age in humans), the number of primordial follicles was significantly reduced, while the number of activated follicles was significantly higher than normal, together with larger ovarian volume. At 13 months old in AMH-null female mice (equivalent to the perimenopausal period in humans), the primordial and activated follicle numbers decreased significantly in AMH-null compared with control mice. The scheme is based on the data from Durlinger et al. (https://doi.org/10.1210/endo.140.12.7204).

Figure 2

Dynamic Changes in AMH Levels and Changes in the Numbers of Atretic Follicles with Age The figure is based on the studies by Faddy et al. reporting that the number of primordial follicles was 6–7 million during fetal life (around midgestation), approximately 1–2 million at birth, 300,000–500,000 at the start of puberty, and 1,000 at 51 years of age.^, AMH levels are based on the model proposed by Kelsey et al. to predict menopause. Yellow represents number of primordial follicles (×10⁶), while blue represents log₁₀(AMH + 1) (ng/mL).

Figure 3

AMH Stimulates the HPG Axis in Females with Polycystic Ovarian Syndrome Here, plus (+) means stimulation, while minus (–) means inhibition.

Figure 4

Production of AMH in Both Sexes The production and serum level of AMH throughout the life span in both male and female humans.