Anti Mullerian Hormone

Clinical background:

AMH is a glycoprotein dimer composed of two 72 kDa monomers linked by disulphide bridges. It belongs to the transforming growth factor-β family. AMH performs various physiological functions. In males, AMH is secreted by the Sertoli cells. During embryonic development AMH is responsible for Mullerian duct regression. AMH continues to be produced by the testicles until puberty and then decreases slowly to residual post-puberty values. In females, AMH plays an important role in ovarian folliculogenesis. AMH helps to regulate the transition of follicles from primordial to maturation stages and plays a role in follicular selection. Serum AMH levels are barely detectable at birth in females, reach their highest levels after puberty, decrease progressively thereafter with age, and become undetectable at menopause.

Clinical applications of AMH measurements have been proposed for a variety of indications. Measurement is primarily used for assessment of ovarian reserve reflecting the number of antral and pre-antral follicles – antral follicle count (AFC), and for the prediction of response to controlled ovarian stimulation. In particlular, AMH can help to identifiy women likely to show a poor response to ovarian stimulation and those at higher risk of ovarian hyperstimulation syndrome. Another potential application for AMH is as a surrogate biomarker for polycystic ovarian morphology in the diagnosis of polycystic ovary syndrome (PCOS), although it is not currently clear what diagnostic thresholds should be used. Further clinical applications of AMH are diagnosis of disorders of sex development in children, and monitoring of granulosa cell tumours to detect residual or recurrent disease.

Specimen container paediatric:

Serum (SST or plain tube)

Specimen container adult:

Serum (SST or plain tube)

Minimum volume paediatric:

1ml

Minimum volume adult:

1ml

Sample stability:

Unseparated sample: 2 days at 15-25^oC, and 3 days at 2-8^oC

Separated sample: 3 days at 15-25^oC, 5 days at 2-8^oC, 6 months at -20^oC

Transport requirements:

Ambient

Interpretation:

In females, serum AMH concentrations are relatively low at birth and increase during adolescence. AMH peaks at 22 to 26 years of age and then steadily declines until the menopause. At any particular age, there is very wide variation in AMH concentrations between individual women, so that a population-based reference range is not very useful in informing assessment prior to IVF. NICE Clinical Guideline 156 recommends the use of AMH in the assessment of patients undergoing IVF quoting specific cut-offs that are predictive of low or high response to ovarian stimulation.

Serum AMH may be used in neonates or children to determine the presence of testicular tissue in disorders of sexual differentiation or development. Prior to puberty, male AMH concentrations are typically much higher than female (around 30 times on average) due to Sertoli cell activity. After the onset of puberty, male AMH concentrations decline so that they overlap with normal female concentrations. AMH in pre-pubertal males is typically greater than 100 pmol/L (and usually significantly higher) and typically much lower than this in pre-pubertal females.

Reference ranges:

Other info:

Lithium heparin plasma also acceptable