Generality
The antimullerian hormone ( AMH ) is a glycoprotein, measurable in the blood, which is produced both by men and women, respectively by the testicle and by the ovarian follicles.
Generally, its blood concentration is measured in women of childbearing age, but, in some cases, the examination may also be required for the evaluation of male infants .
The anti-Mullerian hormone test is performed when the presence of conception problems ( hypofertility ) is suspected or to support the diagnosis of some typically female diseases, such as polycystic ovary syndrome .
What's this
The antimullerian hormone is a homodimeric glycoprotein produced exclusively by the somatic cells that surround the gametes (granulosa cells, in women, and of Sertoli, in humans). Its main action appears in embryonic development, during sexual differentiation .
- In MADS, the antimullerian hormone is produced by Sertoli cells (cells of the seminiferous tubules that provide metabolic and structural support in spermatogenesis). AMH results in high doses from the fetal period up to two years of age ; its role consists in preventing the formation of the female genital organs, through the regression of Müller's ducts, from which the name of the hormone in question derives. With growth, the levels of this hormone tend to decrease physiologically until they are practically absent. In men, the antimullerian hormone makes it possible to evaluate testicular function and defects of sexual differentiation in infancy (intersexual states and non-palpable gonads).
- In FEMALE, instead, the production of the anti-Mullerian hormone follows a cyclical trend : it is low at birth, increases with puberty and decreases, until it is completely exhausted with the onset of menopause. In women, the antimullerian hormone is produced by the granulosa cells of the primary ovarian follicles; the value is proportional to the number of follicles that the woman can start to mature: basically, the concentration of AMH can be interpreted as an index of fertility .
In women, a high or low value of this parameter can be an important indicator in determining the presence of pathological conditions, such as polycystic ovary syndrome and primary ovarian failure .
Synonyms
- The anti-Mullerian hormone is also called " anti-Mullerian hormone ": its name refers to the fact that it prevents, in men, the formation of Müller's ducts, responsible for the formation of the uterus and fallopian tubes in female embryonic development.
- In some cases, the hormone is called mullerian inhibition substance (MIS) .
- In the analysis reports, often the antimullerian hormone is indicated simply with the acronym AMH .
Functions and biological role
The antimullerian hormone belongs to the superfamily of TGF-β (beta-transforming growth factors), which also includes inhibins and activins .
The Müller and Wolff ducts coexist in the embryo, where:
- Müller's ducts are precursors of uterus, fallopian tubes and upper part of the vagina;
- The Wolffian duct allows the development of epididymis, vas deferens and seminal vesicles.
During fetal development, the antimullerian hormone is secreted only in males, in which it is responsible for the regression of the Müller ducts (so the AMH dosage is high from birth to two years of age).
In females, however, the absence of the antimullerian hormone allows the development of the female sexual organs: the parameter is low at birth, but increases progressively during fertile age, to then be no longer detectable after menopause.
In female ovaries, the antimullerian hormone is a regulator of follicologenesis (ie the maturation of the follicles, ie the set of cells that serve as accompaniment and protection, while the oocyte grows in the ovaries). In particular, its physiological function consists in inhibiting the recruitment of primordial follicles, at least until the opportune moment, or until the hypophysis starts the secretion of FSH (follicle-stimulating hormone), which stimulates the maturation of a cell "dominant" egg at each menstrual cycle.
In women, the antimullerian hormone is an indicator of ovarian reserve and its concentration is directly correlated with the antral follicular count : in practice, it not only reflects the amount of follicles, but also the oocyte quality.
What makes the dosage of the antimullerian hormone interesting is the fact that this parameter is independent of the menstrual cycle, unlike other predictors of ovarian reserve, such as FSH or estradiol (whose values depend on the time of the month in which the woman is found ), and does not vary significantly between consecutive cycles.
Because it is measured
Antimullerian hormone in women
The dosage of the antimullerian hormone can be carried out for different purposes:
- Ovarian reserve test : in women, the antimullerian hormone can be considered an indicator of fertility and the relative serum dosage allows the evaluation of ovarian function . In particular, the decrease of the parameter to minimal levels is related to a reduced number of follicles. Unlike other tests that measure the ovarian reserve, such as FHS and estradiol, which must be dosed in the first few days of the cycle, the antimullerian hormone remains constant during all phases of the menstrual cycle and during pregnancy. Therefore, AMH can be measured at any time. In the case of assisted reproduction techniques, levels of antimullerian hormone are also predictive of ovarian response and the possibility of success of a pregnancy .
- Diagnosis of polycystic ovary syndrome ( PCOS ): the antimullerian hormone is a useful indicator of PCOS, as its abnormal increase correlates to an excess of follicles at a very precocious maturation stage.
- Monitoring of ovarian cancer : some ovarian tumors (benign or malignant) correlate with an excessive production of antimullerian hormone. The determination of this value allows, therefore, to monitor the effectiveness of the treatment and determine the appearance of recurrences.
Antimullerian hormone in men
- In children, the antimullerian hormone makes it possible to evaluate the function of the testes and, before puberty, is an indicator of the activity of Sertoli cells.
- In the adult, the determination of this parameter has clinical relevance for the evaluation of mature testicle spermatogenesis.
- In the case of secretory azoospermia, the dosage of the antimullerian hormone can help to know if there are sperm in the testicle that can be taken by biopsy, to be used in assisted reproduction methods, such as ICSI (intracytoplasmic sperm injection).
When is the exam prescribed?
The measurement of the amount of anti-Mullerian hormone is prescribed above all to evaluate:
- The state of the developing ovaries ;
- Ovarian function, in the case of polycystic ovary syndrome ;
- The ovarian reserve, that is the number of oocytes present in a certain period of the woman's life;
- The probability of a miscarriage .
The doctor may prescribe the anti-Mullerian hormone test to determine the woman's likelihood of entering precocious or physiological menopause and when she has symptoms of polycystic ovary syndrome (PCOS).
At other times, the examination allows us to verify a condition of ovarian failure and, in the area of assisted fertilization, allows us to predict the fertilization rate, the number and quality of embryos.
The antimullerian hormone can be used as a tumor marker for some types of ovarian tumors (note: a tumor marker is basically a molecule that in the presence of a neoplastic process will be more concentrated in the blood).
The dosage of the antimullerian hormone can also be indicated in newborns when there are problems in sexual development, in the presence of ambiguous external genitalia (not clearly male, or female) or intersexuality conditions . In children, then, this parameter allows us to assess the functionality of the testicles .
Normal values
The normal values of antimullerian hormone vary according to age and sex. The test measures its concentration in the blood.
Women
- Under 2 years of age: values below 4.7 ng / ml;
- 2 - 12 years: values less than 8.8 ng / ml;
- Between 13 and 45 years: values between 0.9 and 9.5 ng / ml;
- Over 45 years: values less than 1.0 ng / ml.
Men
- Under 2 years of age: values between 14 and 466 ng / ml;
- 2-12 years: values between 7.4 and 243 ng / ml;
- Adults: values between 0.7 and 19 ng / ml.
Warning! The reference range of the antimullerian hormone may change depending on the instrumentation used in the analysis laboratory. For this reason, it is preferable to consult the ranges listed directly on the report. It should also be remembered that the results of the analyzes must be assessed as a whole by the general practitioner who knows the patient's medical history.
High Antimullerian Hormone - Causes
In women, the high antimullerian hormone is found mainly in the case of:
- Polycystic ovary syndrome ;
- Some AMH-secreting ovarian tumors .
In the case of polycystic ovary syndrome, levels of the antimullerian hormone can be 2 or 5 times higher than the reference values.
Some ovarian malignancies cause an increase in blood hormone levels. In these cases, the examination is useful to evaluate the response to the treatment of the tumor and can act as an indicator in the presence of recurrences.
In the field of medically assisted procreation, high values of antimullerian hormone are also found in ovarian hyperstimulation syndrome, during the pharmacological induction of ovulation.
Low Antimullerian Hormone - Causes
A no or low concentration of antimullerian hormone is normal in females during infancy or after menopause . A reduction in levels is found, therefore, over 40 years of age or in perimenopausal women. As a result, this hormone can be considered an indicator of fertile age, although its value considered individually is not conclusive.
Antimullerian hormone and fertility
The concentration of the antimullerian hormone is an important predictive value for couples who undertake the assisted reproduction pathway . This parameter is useful, in particular, in determining the most appropriate therapeutic protocol, depending on the woman's ovarian reserve (among other factors): before undergoing pharmacological stimulation of ovulation, the value of antimullerian hormone can predict success or the failure of the same, therefore the fertilization rate.
A low level of antimullerian hormone can be found in case of reduction or insufficiency of the ovarian reserve. If the woman was trying to become pregnant, this would imply considerable difficulties in getting pregnant.
How to measure it
The dosage of anti-Mullerian hormone levels is done by a simple blood test . The sample is taken from the vein of an arm.
Preparation
The blood sample useful for the anti-Mullerian hormone test is usually taken in the morning. To perform the analysis, the patient must observe a fast of at least 8 hours, in which it is allowed to take only a modest amount of water, to prevent any alteration of the results.
The sampling is fast, painless and can be carried out any day of the month, since the monthly hormonal oscillations caused by the menstrual cycle do not affect the results of the analyzes.
Interpretation of results
The results of the antimullerian hormone test must be carefully evaluated by the doctor .
The determination of this parameter alone is not sufficient, then, to formulate a complete and appropriate diagnosis; therefore, it is very likely that further tests are prescribed to investigate, ascertain or exclude the suspected pathology. When the entire clinical picture is defined, the doctor can indicate which treatments to take .
What does the test result mean?
ANTIMULLERIANO BASS HORMON
- In women of fertile age, a decrease in the concentration of the antimullerian hormone may be due to a low number of oocytes still present or to their poor quality ( low ovarian reserve ). This finding correlates to reduced fertility or poor responsiveness to medically assisted procreation (MAP) treatment.
- A low antimullerian hormone value can also indicate that the ovaries do not function normally ( premature ovarian dysfunction ).
- The reduction of the parameter can also result from the imminent physiological or early menopause .
- In monitoring an AMH-secreting ovarian tumor, the decrease in this hormone indicates a good response to treatment .
- In the child, a low level of antimullerian hormone may indicate hypogonadism and disorders of sexual development .
ANTIMULLERIANO HIGH HORMONE
- An increase in the antimullerian hormone concentration is often observed in women with polycystic ovary syndrome .
- In medical-assisted procreation treatments, a high concentration of AMH can also indicate ovarian hyperstimulation, which leads to the need to correct the treatment.
- During treatment for ovarian cancer, an increase in the antimullerian hormone may indicate a probable recurrence .
