Hormone Biomarkers: Anti-Mullerian Hormone in Women

Optimal Takeaways

Anti-Mullerian hormone (AMH) is considered a marker of ovarian reserve and is assessed during workup for infertility and PCOS in women. Low levels are seen with infertility, low ovarian reserve, and fewer eggs retrieved during fertility treatment. An elevated AMH is observed in PCOS and associated with higher testosterone in those with the condition.

Standard Range: 0.01 - 14.63 ng/mL (0.07 - 104.50 pmol/L)

The ODX Range: 1.10 - 4.0 ng/mL (7.86 - 28.57 pmol/L)  

Low levels of AMH are seen with infertility, low ovarian reserve, and fewer pregnancies (Homberg 2021). Levels decrease and become undetectable in menopause (Moolhuijsen 2020).

High levels of AMH are seen with polycystic ovary syndrome (PCOS) and polycystic ovarian morphology (PCOM) (Song 2017).

Overview

Anti-Mullerian hormone is secreted from ovarian follicles and is regarded as a marker of ovarian reserve (Gruijters 2003). It can be decreased with reduced ovarian reserve and increased with polycystic ovary syndrome (PCOS).

Serum levels of AMH can be used during infertility assessment to predict egg count and potentially viable pregnancies following ovarian stimulation. A cut-off of 0.77 ng/mL (5.5 pmol/L) or less indicated a poor response with 3 or fewer eggs retrieved. However, an AMH level of 2.19 ng/mL (15.6 pmol/L) correlated with a favorable response with greater than 15 eggs retrieved and significantly greater number of pregnancies achieved (Homberg 2021). Another study suggested that a lower AMH, with a cut-off below 1.65 ng/mL (11.8 nmol/L), was correlated with poor ovarian response to stimulation with 4 or fewer eggs retrieved in women undergoing fertility treatment (Aghssa 2015).

Levels of AMH decline as a woman approaches menopause at which time levels become undetectable. If levels become undetectable in women in their 40s, then research suggests they are likely to become menopausal within five years, especially in those overweight and obese (Moolhuijsen 2020).

Anti-mullerian hormone levels will be higher in individuals with polycystic ovary syndrome. In one study of 207 women with PCOS and 220 controls, an AMH cut-off of 10 ng/mL (71 pmol/L) or above correlated with the presence of PCOS. Elevated AMH was also significantly associated with elevated testosterone in those with PCOS, with total testosterone above 67 ng/dL (2.32 nmol/L) or free testosterone of 0.84 ng/dL (0.03 nmol/L) or above. Controls in this study maintained a mean AMH of 4.2–7.9 ng/mL (30-56.4 pmol/L). Although the current study used an AMH cut-off of 10 ng/mL, previous studies found a correlation of PCOS with AMH levels of 5.0 ng/mL (35.7 nmol/L) or above (Song 2017).

Other studies have confirmed a lower cut-off for PCOS including a retrospective case-control study which determined an AMH cut-off of 4.57 ng/mL (32.6 nmol/L) was best for determining the presence of PCOS (Casadei 2018). Another study suggested an AMH cut-off of 3.51 ng/mL (25.0 pmol/L) and above for detecting PCOS (Aydoğmuş 2018). Further biochemical and clinical assessment should be performed in the diagnosis of PCOS.

References

Aghssa, Malek Mansour et al. “Optimal cut-off value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation.” Reproductive health vol. 12 85. 10 Sep. 2015, doi:10.1186/s12978-015-0053-4

Aydoğmuş, Hüseyin et al. “Can we use serum Anti-Mullerian hormone to differentiate the diagnosis between polycystic ovary syndrome patients and healthy women with polycystic ovarian morphology and regular menstrual cycles.” Saudi medical journal vol. 39,10 (2018): 1011-1016. doi:10.15537/smj.2018.10.23413

Casadei, Luisa et al. “The diagnosis of PCOS in young infertile women according to different diagnostic criteria: the role of serum anti-Müllerian hormone.” Archives of gynecology and obstetrics vol. 298,1 (2018): 207-215. doi:10.1007/s00404-018-4803-8

Gruijters, Maria J G et al. “Anti-Müllerian hormone and its role in ovarian function.” Molecular and cellular endocrinology vol. 211,1-2 (2003): 85-90. doi:10.1016/j.mce.2003.09.024

Homburg, R et al. “Automated anti-Mullerian hormone measurement: data review to provide insights and interpretation.” Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology vol. 37,6 (2021): 511-514. doi:10.1080/09513590.2020.1785419

Moolhuijsen, Loes M E, and Jenny A Visser. “Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function.” The Journal of clinical endocrinology and metabolism vol. 105,11 (2020): 3361–3373. doi:10.1210/clinem/dgaa513

Song, Do Kyeong et al. “Differentiation between polycystic ovary syndrome and polycystic ovarian morphology by means of an anti-Müllerian hormone cutoff value.” The Korean journal of internal medicine vol. 32,4 (2017): 690-698. doi:10.3904/kjim.2016.038