Secondary Logo

Journal Logo


Antimüllerian hormone: A marker for prediction of ovarian function and polycystic ovary syndrome

Seow, Kok-Min1; Wang, Peng-Hui*,2

Author Information
Journal of the Chinese Medical Association: March 2012 - Volume 75 - Issue 3 - p 93-94
doi: 10.1016/j.jcma.2011.12.014

    The antimüllerian hormone (AMH) – located in the short arm of chromosome 19 with 2750 nucleotide bases – is a homodimeric glycoprotein that weighs 140 kDa and is a member of the transforming growth factor-ß superfamily, which is involved in male sex differentiation and is responsible for the regression of Müllerian ducts.1 AMH is exclusively produced by granulosa cells and is the only marker that is thought to be stable throughout the menstrual cycle. AMH has been suggested as a marker for the quantity of oocytes remaining within the ovaries as it is a better marker of ovarian reserve than age, basal FSH, estradiol and inhibin.2

    AMH also enables: (1) prediction of both over and poor response in the controlled ovarian stimulation environment; (2) the most appropriate stimulation regimen to be determined; and (3) pretreatment counseling − helping couples make an appropriate and informed choices.3 Recent reports further suggest that AMH may be useful in the following situations, including: (1) prediction of long-term fertility; (2) prediction of the age of menopause; (3) prediction of ovarian ageing in women prior to or following chemotherapy; (4) prediction of long-term fertility following ovarian surgery; and (5) screening for polycystic ovaries (PCO).3 In this issue, Chao and colleagues aimed to respond to two questions simultaneously, that is, assessing the age-related changes of AMH levels in Taiwanese women with and without PCO.4

    At first, Chao and colleagues found that AMH levels revealed an age-related decline in the regular menstrual cycle of healthy women.4 Furthermore, the AMH level rapidly dropped between 30 and 40 years of age, followed by a slow decrease after 40 years of age. This substantiates previous findings that the AMH concentration declines significantly with increasing age in premenopausal women.5

    Polycystic Ovaries Syndrome (PCOS), a common endocrinopathy characterized by oligo- or anovulation, clinical or biochemical hyperandrogenemia, and polycystic ovaries on ultrasonography, affects 5–10% of women of reproductive age.6 Recent studies have shown that 50% of women with PCOS fulfill the criteria of metabolic syndrome and that PCOS is frequently associated with insulin resistance accompanied by compensatory hyperinsulinemia, resulting in an increased risk for the development of type 2 diabetes mellitus and cardiovascular disease.7 PCOS was reported to have a higher level of AMH compared with healthy controls.8 Pigny et al indicated that serum AMH levels were three-fold higher in PCOS patients than in controls, and the elevated levels of AMH were significantly related to the follicle number in women with PCOS.9 Chao's report was in agreement with the above finding – AMH levels were significantly higher in women with PCOS than in healthy fertile controls. The sensitivity and specificity of AMH in detecting PCOS was calculated using an AMH cut-off value of 3.5 ng/mL.4

    AMH levels were found to be positively correlated with testosterone, androstendione and the free androgen index.9 The data in Chao's study were similar; however, the Chao and colleagues failed to investigate the relationship between AMH and insulin sensitivity in Taiwanese women with PCOS. If additional data addressing the above question were available, this report from Chao and colleagues would be more appealing. Based on other reports, we believed this correlation may be present, since the La Marca group found that AMH levels were positively correlated with the homeostasis model's assessment (HOMA) index,10 and the use of metformin – an insulin-sensitizer – can significantly reduce both androgen and AMH levels in obese women with PCOS.11

    Overall, the serum AMH level is a good marker in the evaluation of gynecological endocrinology, menopause and assisted reproduction in healthy and PCOS women.

    Kok-Min Seow

    Peng-Hui Wang

    1Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC, Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC

    2Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC


    1. Cate RL, Mattaliano RJ, Hession C, Tizard R, Farber NM, Cheung A, et al. Isolation of the bovine and human genes for Mullerian inhibiting substance and expression of the human gene in animal cells. Cell. 1986;45:685-698.
    2. Tran ND, Cedars MI, Rosen MP. The role of anti-Mullerian hormone (AMH) in assessing ovarian reserve. J Clin Endocrinol Metab. 2011;96:3609-3614.
    3. Loh J, Maheshwari A. Anti-Mullerian hormone – is it a crystal ball for predicting ovarian ageing? Hum Reprod. 2011;26:2925-2932.
    4. Chao KC, Ho CH, Shyong WY, Huang CY, Tsai SC, Cheng HY, et al. Anti-mullerian hormone serum level as a predictive marker of ovarian function in Taiwanese women. J Chin Med Assoc. 2012;75:70-74.
    5. Shaw CM, Stanczyk FZ, Egleston BL, Kahle LL, Spittle CS, Godwin AK, et al. Serum antimüllerian hormone in healthy premenopausal women. Fertil Steril. 2011;95:2718-2721.
    6. Seow KM, Hwang JL, Wang PH, Ho LT, Juan CC. Peripheral blood mononuclear cell visfatin mRNA expression is not correlated to omental adipose visfatin mRNA in women with polycystic ovary syndrome. Hum Reprod. 2011;26:2869-2873.
    7. Seow KM, Lin YH, Hwang JL, Wang PH, Ho LT, Lin YH, et al. Expression levels of haem oxygenase-1 in the omental adipose tissue and peripheral blood mononuclear cells of women with polycystic ovary syndrome. Hum Reprod. 2011;26:431-437.
    8. Cook CL, Siow Y, Brenner AG, Fallat ME. Relationship between serum mullerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril. 2002;77:141-146.
    9. Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:941-945.
    10. La Marca A, Orvieto R, Giulini S, Jasonni VM, Volpe A, De Leo V. Mullerian-inhibiting substance in women with polycystic ovary syndrome: relationship with hormonal and metabolic characteristics. Fertil Steril. 2004;82:970-972.
    11. Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS. Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod. 2005;20:1820-1826.
    © 2012 by Lippincott Williams & Wilkins, Inc.