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Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency

Abstract

Primary ovarian insufficiency (POI), also known as premature ovarian failure, is a disorder of infertility characterized by amenorrhoea, low estrogen levels and increased gonadotropin levels in women aged <40 years. POI is the result of premature exhaustion of the follicle pool or can be attributed to follicular dysfunction, for example, owing to mutations in the follicle-stimulating hormone receptor or steroidogenic cell autoimmunity. Moreover, advances in cancer therapeutics over the past decades have led to increasing survival rates for both paediatric and adult malignancies. Given the gonadotoxic effect of many cancer treatments, more women develop POI. A marker that predicts whether women are at risk of POI would, therefore, aid in early diagnosis and fertility counselling. Anti-Müllerian hormone (AMH), a growth factor produced solely by small, growing follicles in the ovary, might constitute such a marker, as serum levels of this hormone correlate strongly with the number of growing follicles. In addition, AMH could potentially help assess the progression of ovarian senescence, as serum AMH levels are independent of hypothalamic–pituitary–gonadal axis function and decrease to undetectable levels at menopause. In cancer survivors, serum AMH levels correlate with the extent of gonadal damage. In this Review, we provide an overview of the current studies that have measured AMH in women with POI of various aetiologies and discuss its possible application as a marker to determine ovarian reserve.

Key Points

  • Primary ovarian insufficiency (POI) is a disorder of infertility caused by cessation of ovarian function before the age of 40 years

  • The number of women that develop POI is growing owing to the increased success of cancer treatments

  • Anti-Müllerian hormone (AMH) is an ovary-specific growth factor, the expression of which is independent of hypothalamic–pituitary–gonadal axis function

  • Serum AMH levels correlate with the size of the primordial follicle pool and can be used in the early assessment of a diminished ovarian reserve, which most patients with POI are affected by

  • Serum AMH levels correlate with the degree of ovarian damage—induced by the gonadotoxic effect of cancer treatment—in cancer survivors and might aid in fertility counselling of these patients

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Figure 1: Folliculogenesis—the process of follicle maturation from the primordial follicle to the ovulatory follicle.
Figure 2: Serum AMH levels and follicle numbers in aging mice.
Figure 3: Schematic model for induced POI.
Figure 4: Serum AMH levels in adult childhood cancer survivors.

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J. A. Visser researched the data and wrote the article. All authors provided a substantial contribution to discussions of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Jenny A. Visser.

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J. A. Visser declares an association with the following company: MSD (speakers bureau/honoraria). J. S. E. Laven declares an association with the following companies: Genovum (grant/research support; stockholder/director), Merck-Serono (grant/research support), MSD (grant/research support). A. P. N. Themmen declares an association with the following company: ANSH Labs (consultant). I. Schipper declares no competing interests.

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Visser, J., Schipper, I., Laven, J. et al. Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency. Nat Rev Endocrinol 8, 331–341 (2012). https://doi.org/10.1038/nrendo.2011.224

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