Defining Reference Ranges for Serum Anti-Müllerian Hormone on a Large Cohort of Normozoospermic Adult Men Highlights New Potential Physiological Functions of AMH on FSH Secretion and Sperm Motility.

BACKGROUND: Few studies to date have attempted to measure serum anti-Müllerian hormone (AMH) levels in adult men, and solid references ranges have not yet been defined in a large cohort. OBJECTIVE: In this study, we aimed, first, to establish the reference ranges for serum AMH and AMH-to-total testosterone ratio (AMH/tT) in adult males. Second, we investigated the relationship between serum AMH and both reproductive hormones and semen parameters. METHODS: This single-center retrospective study included 578 normozoospermic adult men. Serum AMH concentrations were determined with an automated sandwich chemiluminescent immunoassay. RESULTS: The median serum AMH was 43.5 pmol/L. The 2.5th and 97.5th percentile values for serum AMH and AMH/tT were 16.4 and 90.3 pmol/L and 0.45 and 3.43, respectively. AMH was positively correlated with inhibin B and sperm concentration and negatively correlated with age, follicle-stimulating hormone (FSH), and progressive sperm motility. Interestingly, using immunofluorescence, we documented for the first time that AMH type II receptor (AMH-R2) is expressed in ejaculated human spermatozoa and gonadotrophic cells in the postmortem pituitary gland. CONCLUSIONS: We establish a new age-specific reference range for serum AMH and AMH/tT. Moreover, AMH-R2 expression in human spermatozoa and gonadotrophic cells, together with the relationship between serum AMH levels and sperm motility or mean FSH levels, highlight new potential functions of AMH in regulating sperm motility or FSH secretion in adult men.

Low vitamin D3 and high anti-Müllerian hormone serum levels in the polycystic ovary syndrome (PCOS): Is there a link?

OBJECTIVES: Low vitamin D serum level has been reported in women with polycystic ovary syndrome (PCOS) compared to controls. A few in vitro studies showed that the bioactive form of vitamin D is able to modulate the expression of the anti-Müllerian hormone (AMH) gene. However, in vivo studies failed to demonstrate clearly whether low vitamin D3 serum level is involved in the AMH excess of PCOS. This prospective study evaluates serum vitamin D3 and AMH levels in women with PCOS and in controls, before and after vitamin D supplementation. MATERIALS AND METHODS: Among vitamin D deficient patients, 23 patients with PCOS were compared to 27 women with normal ovarian reserve (NOR). The vitamin D deficient patients received a vitamin D supplementation according to the depth of their insufficiency. For the 23 patients with PCOS and the 27 controls, serum AMH assay and serum calciotropic hormone assays [25-hydroxyvitamin D (25[OH]D), 1,25 dihydroxyvitamin D (1,25[OH]2D) and parathyroid hormone (PTH)] were performed before and after supplementation. RESULTS: Serum 25(OH)D levels before treatment were statistically lower in PCOS women than in NOR patients (P<0.05), even after adjustment for BMI, age and AMH level, but not after adjustment for waist circumference measurement. No difference in the serum AMH levels before and after treatment was observed neither in PCOS patients nor in NOR patients. In both groups, 25(OH)D serum levels were not related to serum AMH levels, serum 1,25(OH)2D and serum PTH levels, before and after treatment. CONCLUSION: We found no evidence that serum calciotropic hormones are linked to circulating AMH levels, particularly in PCOS.

Falsely elevated serum antimüllerian hormone level in a context of heterophilic interference.

OBJECTIVE: To describe a case of falsely elevated serum antimüllerian hormone (AMH) level in an infertile 37-year-old woman with rheumatoid arthritis. DESIGN: Case report. SETTING: Lille University IVF center. PATIENT(S): A 37-year-old woman with rheumatoid arthritis demonstrating a high serum AMH level (74.5 ng/mL) and a low antral follicle count. INTERVENTION(S): Assay with a Heterophilic Blocking Tube (HBT) to avoid heterophilic interference. MAIN OUTCOME MEASURE(S): Serum AMH level, ultrasound antral follicle count, hormonal assays on the 4th day of a spontaneous cycle. RESULT(S): The results of the infertility workup were as follows: serum AMH: 74.5 ng/mL (15-fold the upper limit of normal) (immunoassay: Immunotech); LH: 3.2 IU/L; FSH: 4.5 IU/L; E2: 27 pg/mL; PRL: 10 ng/mL. The antral follicle count (follicles from 2 to 9 mm) at ultrasound was 7 for both ovaries. Because there were discrepancies between the serum AMH level and the results of the infertility workup using the bioassays, we suspected a case of falsely elevated AMH level due to heterophilic interference. An HBT tube revealed a serum AMH level of 0.63 ng/mL. CONCLUSION(S): This case illustrates, for the first time, the possibility of a falsely high serum AMH level due to heterophilic interference.