Anti-Müllerian Hormone: Current Understanding and Clinical Use

Anti-Mullerian hormone (AMH) is secreted by ovarian granulosa cells and has become a surrogate marker for ovarian reserve. We review anticipated AMH levels throughout the reproductive lifespan and how AMH levels can be used in assisted reproductive technology. While AMH is a surrogate marker for ovarian reserve, values do not predict fertility. Patients with low versus normal AMH have similar fertility. AMH levels are helpful in guiding treatment for infertility, including medication dosing for IVF and anticipated cycle outcomes. AMH levels are positively correlated with ovarian response in IVF cycles. For cancer patients with planned gonadotoxic chemotherapy, AMH levels are useful in counseling patients prior to treatment, recommending fertility preservation options, and monitoring ovarian function following treatment. New studies have shown a possible protective effect of AMH injection on the ovaries for women undergoing gonadotoxic chemotherapy treatment. AMH levels are a useful adjunct to follicle-stimulating hormone (FSH) levels when diagnosing menopause and premature ovarian insufficiency (POI) and can be used to estimate the menopausal transition in women above the age of 40 but have limited clinical utility in predicting menopause for women at risk for POI. AMH is a useful tool to assess ovarian reserve and response to ovarian stimulation, but levels are not correlated with rates of conception and should not be used to counsel on spontaneous fertility. While AMH can be used as a quantitative measure of ovarian reserve, AMH level is not a qualitative marker for oocytes. AMH injection may be a therapeutic option for fertility preservation in the future.