The use of anti-Müllerian hormone for controlled ovarian stimulation in assisted reproductive technology, fertility assessment and -counseling.

Ovarian reserve can be determined by serum anti-Müllerian hormone (AMH) level and/or antral follicle count before controlled ovarian stimulation. The aim of controlled ovarian stimulation is to achieve an appropriate number of mature follicles and avoid complications such as ovarian hyperstimulation syndrome. Measurement of the ovarian reserve is useful for clinicians as it predicts the ovarian response to controlled ovarian stimulation. Further, it assists in giving the patient realistic expectations regarding the treatment. By determining the ovarian reserve, the most appropriate stimulation protocol and gonadotropin dose can be chosen specifically for each woman enabling so-called "individualized treatment" in line with the personalized treatment concept. Many benefits come with using AMH as a biomarker for ovarian reserve; the hormone is considered fairly cycle independent apart from a small decrease in the late follicular phase and there is no inter-observer variance. However, the use of AMH also has limitations; since the implementation of AMH in fertility treatment several AMH assays have been developed. This has made direct comparisons of AMH serum levels complicated. Currently, no international standardized assays exist. AMH is a valid predictor of the ovarian response to controlled ovarian stimulation and to some extent the chance of pregnancy in relation to assisted reproductive technology, but AMH is less optimal in prediction of spontaneous pregnancy and live birth after assisted reproductive technology. Accordingly, AMH can be used to optimize gonadotropin stimulation in fertility treatment, but is not recommended as a screening tool in the general population.

Recent progress in the utility of anti-Müllerian hormone in female infertility.

PURPOSE OF REVIEW: To discuss the recent developments in the utility of anti-Müllerian hormone (AMH) in the context of female infertility. RECENT FINDINGS: AMH measurements have entered the clinical practice in counseling of women before in-vitro fertilization (IVF) treatment. AMH measurements can predict both poor and hyperresponse, and can enable clinicians to individualize the treatment strategies. In natural conception, AMH is a good predictor of age at menopause, but it is unclear whether AMH correlates with the fecund ability in the normal population. AMH has also proven its utility in the assessment of ovarian damage due to gonadotoxic treatment or ovarian surgery. Lastly, AMH might assist in the initial diagnosis of oligomenorrhea or amenorrhea, as high levels of AMH are suggestive of polycystic ovarian syndrome and seem to correlate with the severity of the syndrome. SUMMARY: AMH is a glycoprotein secreted by the granulosa cells of small growing follicles and indirectly reflects the primordial follicle pool. The ovaries contain a limited number of primordial follicles and their depletion marks the menopause. Thus, the remaining primordial follicle pool is referred to as the ovarian reserve. The clearest data for the clinical utility of AMH is in the context of IVF. The support for other indications is weaker, but rapidly increasing.

Anti-Müllerian hormone levels in salpingectomized compared with nonsalpingectomized women with tubal factor infertility and women with unexplained infertility.

OBJECTIVE: To investigate the consequence of salpingectomy on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before in vitro fertilization (IVF) treatment in salpingectomized women compared with nonsalpingectomized women with tubal factor infertility, women with unexplained infertility and fertile control women, and to evaluate whether AMH levels could predict IVF outcome. DESIGN: Cross-sectional study extended from a previous prospective study. SETTING: Four university fertility clinics. PATIENTS: Seventy-one women with infertility and 21 fertile controls. INTERVENTIONS: Blood sampling and IVF and embryo transfer in the following cycle. MAIN OUTCOME MEASURE: Serum AMH levels and oocytes retrieved. RESULTS: Anti-Müllerian hormone levels were significantly lower in the salpingectomy infertility group (median 16.1, range 5.2-54 pmol/L) compared with the nonsalpingectomy tubal factor infertility group (median 23.4, range 3.5-50 pmol/L; p = 0.04). In all groups, AMH levels correlated positively with the number of oocytes retrieved. AMH predicted poor response (five or fewer oocytes) with a sensitivity and specificity of 90% and 70%, at a 19 pmol/L cut-off value. CONCLUSION: Serum AMH levels were lower in salpingectomized women compared with women with tubal factor infertility and preserved Fallopian tubes, indicating that ovarian reserve might be affected by tubal surgery. Furthermore, serum AMH levels could predict a poor oocyte response (five or fewer oocytes) in the study group of infertile women.