Anti-Müllerian Hormone (AMH)

Anti-Müllerian hormone (AMH; Mullerian inhibiting substance (MIS)) is a proteohormone or glycoprotein that plays an important role in sexual differentiation during embryonic development. It is produced in male fetuses in the Sertoli cells of the testis and leads to the regression of the so-called Müller’s duct. This causes physiological development of the male gonads and suppresses the formation of the uterus, tubes and vagina.AMH is produced in the ovary in sexually mature females. It is absent in female fetuses. The anti-Müllerian hormone is not subject to fluctuations and can therefore be determined at any time with high significance.

The procedure

Material required

  • Blood serum

Preparation of the patient

  • Not necessary

Disruptive factors

  • Not known

Normal value

Gender Normal value in μg/l (ng/mL)
Females (fertile) 1-10
Women (menopausal) < 0,4
Men 1,5-4,3

Assessment

  • AMH level <0.1 ng/mL – suspected infertility.
  • AMH level ≥ 0.1 – < 1.0 ng/mL – suspected impending infertility.

Indications

  • Woman
    • Fertility diagnostics (determination of ovarian functional reserve; premature ovarian failure (POF)).
    • Sterility therapy (due tohormonal stimulation therapy).
    • Granulosa cell tumor progression control
    • Assessment of ovarian response in obesity and PCO syndrome.
  • Man
    • Examination of gonadal function/gonadal function (DD. Intersexuality and cryptorchidism/anorchidism* ; testis is not palpable and has an intra-abdominal location (retensio testis abdominalis) or the testis is absent (anorchia)).
    • Estimation of sertoli cell function
    • Pubertas praecox/tarda (premature or late puberty).

* AMH is suitable for detecting the presence of testes in crytorchic boys.

Interpretation

Interpretation of elevated values

Interpretation of decreased values

  • Ms.
    • Limited ovarian functional reserve and poor response to ovarian stimulation (patients with low AMH levels require higher FSH doses during ovarian stimulation than women with high/normal levels).
    • Therapy with metformin – oral drug used in diabetes mellitus (oral antidiabetic drug).
  • Man
    • Anorchia/complete absence or complete inoperability of both testes (AMH severely decreased or absent).
    • Pubertas praecox vera/genuine premature puberty (severe AMH drop).

Important notes

  • In approximately one-tenth of all infertility patients, a genetic defect causes the stimulation treatment (ovarian response/ovarian response) to be worse than would be expected given AMH determination. It has been demonstrated that women with a congenital dysfunction of an enzyme of folic acid metabolism (methylene tetra-hydro-folate reductase: MTHFR) respond by almost 25% worse to hormone treatment.
  • Simultaneous analysis of the MTHFR gene can significantly increase the correct score of the AMH test.
  • Prophylactic salpingectomy (surgical removal of one fallopian tube) does not decrease ovarian reserve capacity.
  • AMH levels are often decreased in BRCA1 mutation but not in BRCA2 mutation.
  • Within a cycle, a fluctuation in AMH levels of about 20% is normal.
  • Women with low levels of anti-Müllerian hormone (AMH < 0.7 ng/ml) had a similar cumulative probability of becoming pregnant within six attempts as women with normal serum AMH levels (65% versus 62%) in one study.
  • Concentration of air pollutants has a negative effect on AMH levels: the lowest AMH levels were found in women exposed to the following concentrations at home:
      • Particulate matter concentration (PM10) above 29.5 µg/m3
      • Fine dust concentration (PM2.5) of more than 22 µg/m3
      • Nitrogen dioxide concentration (NO2) of more than 26 µg/m3

    Note: All three measured concentrations were below the upper limits recommended by local authorities (40, 25 and 40 µg/m3).