Anti-Mullerian hormone – AMH

Anti-Mullerian hormone - AMH nowdays represents one of the basic, most commonly used tests, or indicators of ovarian reserve. In biological terms, AMH is a glycoprotein of transforming growth factor (TGF) beta superfamily, and it is produced exclusively in granulosa cells, prenatal and small antral follicles. Anti-Mullerian hormone gene is located on chromosome 19. AMH is previously known for its role in the development of reproductive tract in men, while its role in women is less well known, and it is assumed that it serves as a controller of excessive follicular growth, thus performing the role of "guardian" of ovarian reserve. The advantage of this marker, in comparison to many others, is that its value is constant throughout the cycle, and certainly it is not subject to variations under the influence of gonadotropins and other factors (prenatal and small antral follicles are independent of gonadotropin). There is increasing evidence of its superiority as a predictor of ovarian reserve, which is significantly better correlated with a reduction in ovarian reserve and group of antral follicles compared to other markers. Nowdays, creating of a modern stimulation protocols in IVF is based primarily on the values of AMH. Direct clinical use of AMH today includes: • Monitoring of ovarian aging • Test for ovarian reserve - a marker of premature ovarian failure • Predictor of answers, success and the necessary doses of drugs in ART procedures • predictor of long-term fertility • Screening and diagnosis of PCOS • How long a women can delay reproductive plans • Damage to ovarian tissue after surgical intervention • Predictor of occurrence for the menopause – the only marker that has a longitudinal decline over the years • The special role in the oncology caused fertility (decision on which patient has a chance of preserving fertility) Besides problems with the interpretation of laboratory results, there are problems with the clinical interpretation and consensus on decision for referential values. The point is that the lower the level of AMH is, the lower the ovarian reserve is and vice versa, but sometimes there are thin boundaries between different categories. The difference in test results in range of only 0.1, which is happening even if test is repeated on the same day, could place the patient in a different category. Due to practical use, in everyday work we are guided by the following criteria: Interpretation of results The level of AMH in the blood (ng / ml) High values (often PCOS) >4,0 Regular values >1,5-4,0 Low regular values >1,0-1,5 Low values >0,5-1,0 Extreme low values <0,5