Endocrine Abstracts

AMH is produced by the granulosa cells of growing follicles in the ovary, with peak expression at the small antral stage, followed by a sharp decline, and it is not produced by the corpus luteum. It therefore provides an indirect index of the ovarian reserve, and will also be affected by factors that influence folliculogenesis, such as hormonal contraception. This provides the basis for understanding and developing its potential use as a diagnostic tool in assessing the ovary. The most established role for AMH is prior to ovarian stimulation for assisted reproduction, where is has become very widely used in conjunction with ultrasound assessment of the antral follicle count. This allows identification of women who are likely to over-respond and are at high risk of ovarian hyperstimulation, and conversely those with an unexpectedly low AMH for their age, who will respond poorly: stimulation protocols can be tailored, and expectations managed. Allied to this is a potential diagnostic value in PCOS, and while it is clear that women with this condition often have markedly elevated AMH levels, it has not yet become part of diagnosis. The menopause results from exhaustion of the follicle pool, thus AMH may be of value in its diagnosis and indeed prediction. Initial ELISAs were inadequately sensitive, with AMH becoming undetectable some 5 years before the menopause, but more sensitive assays have been developed, and a role in menopause diagnosis is also now established. Prediction is more challenging, especially with a longer time to menopause and younger age. Thus its value in predicting premature ovarian insufficiency is unclear, although as a diagnostic it has value. Special circumstances include following chemotherapy, where diagnosis of permanent loss of ovarian function would be of value.