Antimullerian hormone (AMH), also known as Mullerian inhibitory substance (MIS), is produced by testicular Sertoli cells in men and ovarian granular cells in women, with a dimorphic pattern that makes it a useful indicator in the evaluation of gonadal disorders, both in men and women. The antimullerian hormone is a glycoprotein member of the TGF superfamily, the growth factor that regulates tissue growth and differentiation.
The antimullerian hormone in men
The prenatal secretion of AMH triggers regression of Muller's ducts to facilitate the normal development of the male reproductive system. The antimullerian hormone in men is usually higher before puberty than in adolescence or adults. The antimullerian hormone is used in the evaluation of sexual disorders and gonadal function in men.
The antimullerian hormone in women
The antimullerian hormone is generally not detectable in pre-adolescent women but increases during reproductive age and decreases during menopause. Recent studies show that AMH levels are correlated with the status of the follicles and the ovarian deposit. The antimullerian hormone may play a role in folliculogenesis and the onset of menopause. The antimullerian hormone is also associated with granular cells tumors and may be a useful marker for monitoring these ovarian tumors.
The clinical utility of antimullerian hormone measurement is:
Assessment of fertility potential in women. AMH serum levels are correlated with the number of follicles with greater specificity than inhibin B, estradiol, follicle-stimulating hormone, and luteinizing hormone when measured on day 3 of the cycle. Thus, AMH may reflect the condition of the follicles better than other hormonal markers.
Measuring ovarian aging. Decreased ovarian reserve, associated with a poor response to IVF, is signaled by decreased basal levels of serum antimullerian hormone. AMH appears to be a useful indicator for predicting ovarian aging and the potential for successful IVF.
Predicting the onset of menopause. The duration of the menopausal transition can vary greatly from woman to woman, and reproductive ability can be seriously compromised before clinical diagnosis. Measurement of AMH may predict the onset of the menopausal transition.
Evaluation of polycystic ovary syndrome. Serum AMH levels are elevated in patients with polycystic ovary syndrome and may be useful as an indicator for disease monitoring.
Monitoring of patients with ovarian tumors. Serum AMH concentrations are increased in some patients with ovarian granular cell tumors, which account for approximately 10% of ovarian tumors.
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