Name of the Test: Anti-Mullerian Hormone (AMH)
Alias names : AMH, Anti-Mullerian inhibiting substance , AMS .
AMH determination is useful in:
–Determine ovarian reserve in cycling women
–Predict likelihood of success and avoid hyperstimulation syndrome in women undergoing in vitro fertilization (IVF)
–Diagnose polycystic ovary syndrome
Clinical applications:
Anti-Mullerian hormone (AMH) is a 140 kD glycoprotein that is produced by the Sertoli cells of the embryonic testis. It causes involution of the Mullerian duct and inhibits female gonadogenesis by producing apoptosis of target gonadal cells. AMH belongs to the transforming growth factor-β family. AMH is also secreted by preantral and small antral follicles in the ovary. Circulating levels of AMH positively correlate with the number of remaining ovarian follicles. Therefore, AMH levels reflect the ovarian reserve (i.e. the number of primordial follicles present). Since AMH levels positively correlate with the antral follicle count commonly used as a measure of ovarian reserve , the higher the AMH concentration is the higher the number of remaining follicles present. This is being used in IVF patients to assess the risk of ovarian hyperstimulation syndrome (OHSS) caused by exaggerated response to gonadotropin treatment. High AMH levels are associated with an increased risk of developing OHSS. AMH is also used in the management of cancer patients after chemotherapy to determine reproductive capacity of the individuals. Circulating levels of AMH in the adult female plateau at 25 years of age, begin to decline at 30 years of age, and continue to decline throughout reproductive life. The levels remain relatively constant during the menstrual cycle. AMH decline in females reflects the progression to menopause better than FSH, inhibin B, or chronological age. AMH levels are elevated in polycystic ovary syndrome (PCOS) and are especially useful when either hyperandrogenism or oligoanovulation is absent.
Method:
AMH is quantitated using an immunochemiluminometric assay. It is a three step sandwich-type immunoassay using two monoclonal antibodies to AMH ; one that is specific for the Pro region of the molecule and other is for mature region of AMH. Recombinant AMH is used as a calibrator. When the samples have high concentration of AMH, it is diluted and reported as absolute results. This assay has no interference for dilution. The assay is sensitive to 30 pg / ml.
Test Information:
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Specimen requirements: 1.0 ml (minimum 0.2 ml) of serum.
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Shipping requirements: Ship the samples frozen or in ice pack. Shipping samples at room temperature is not recommended.
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Turnaround time: 1 day (Set up every Monday and Thursday)
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Reference Range:
| FEMALES | ||
|---|---|---|
| < 14 yrs | 0.49 – 3.15 ng /ml | |
| 14 – 19 yrs | 1.28 -16.37 ng /ml | |
| 20 – 29 yrs | 0.76 – 11.34 ng /ml | |
| 30 – 39 yrs | < 9.24 ng /ml | |
| 40 – 49 yrs | < 4.46 ng /ml | |
| ≥ 50 yrs (Post menopause) | < 0.45 ng / ml | |
| MALES | ||
| < 1 yrs | 37.20 – 345.67 ng /ml | |
| 1- 6 yrs | 59.54 – 320.65 ng /ml | |
| 7 – 11 yrs | 40.99 – 203.67 ng /ml | |
| 12 – 17 yrs | < 128 .29 ng /ml | |
| > 17 yrs | 1.15 – 15.23 ng /ml | |
References:
- Anderson RA, and Wallace WHB( 2013) Antimullerian hormone, the assessment of theovarian reserve and the productive outcome of the young patient with cancer. Fertility and Sterility 99: 1-7.
- de Vet A,Laven JSE, de Jong FH ,Themmen APN , Fauser BCJM ( 2002 ) Antimullerian hormoneserum levels : a putative marker for ovarian aging. Fertility and Sterility 77: 357 – 362.
- Freeman EW, Sammel MD,Lin H, Garcia CR (2012) Anti-Mullerian hormone as a predictor of time to menopause in late reproductive age women . J clin Endocrin metab 97: 1673 – 80.
- Nelson, SM (2013 ) Biomarkers of ovarian response : current and future applications. Fertility and Sterility 99: 963 – 969.