21/12/2024
*Anti-Müllerian Hormone (AMH):*
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What is AMH?
Anti-Müllerian Hormone (AMH) is a glycoprotein hormone primarily involved in the development of reproductive organs and regulation of follicle development in the ovaries. It belongs to the transforming growth factor-beta (TGF-β) family.
In women: AMH is produced by granulosa cells of ovarian follicles.
In men: AMH is secreted by Sertoli cells in the te**es during early fetal development.
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Functions of AMH
1. In Female Physiology
Follicle Development:
AMH regulates the recruitment and development of ovarian follicles by inhibiting premature follicle activation.
Marker of Ovarian Reserve:
AMH levels correlate with the number of antral and pre-antral follicles in the ovaries, making it an excellent marker of ovarian reserve.
Fertility Assessment:
AMH levels provide insight into a woman’s fertility potential and responsiveness to fertility treatments like IVF.
Predicting Menopause:
AMH declines with age, and very low levels suggest an approach to menopause.
2. In Male Physiology
Fetal Sexual Differentiation:
AMH plays a critical role during embryogenesis by causing the regression of Müllerian ducts in males, ensuring the development of male reproductive structures.
Indicator of Testicular Function:
In boys, AMH is used to evaluate the presence and function of testicular tissue.
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Clinical Applications of AMH Testing
1. Women
Ovarian Reserve Assessment:
Measures fertility potential by evaluating ovarian reserve.
Assisting IVF:
Predicts ovarian response to stimulation and guides treatment protocols.
PCOS Diagnosis:
Elevated AMH levels are often associated with polycystic o***y syndrome (PCOS).
Monitoring Treatment for Ovarian Cancer:
Used as a tumor marker in specific ovarian tumors (e.g., granulosa cell tumors).
2. Men
Detecting Disorders of Sexual Development:
Helps diagnose ambiguous genitalia or inters*x conditions.
Evaluating Cryptorchidism:
AMH can confirm the presence of functional testicular tissue.
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AMH Levels: Interpretation
AMH levels vary with age, s*x, and reproductive status. Here's a general guide:
In Women
In Men
Neonates and Infants: High AMH due to active Sertoli cells.
Adults: AMH levels drop significantly after puberty.
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High AMH Levels
Elevated AMH can indicate:
Polycystic O***y Syndrome (PCOS): Increased number of small follicles.
Granulosa Cell Tumors: Rare ovarian tumors can elevate AMH.
Ovarian Hyperstimulation Syndrome (OHSS): Risk in fertility treatments.
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Low AMH Levels
Low AMH suggests:
Diminished Ovarian Reserve (DOR): Reduced number of eggs.
Approaching Menopause: Natural age-related decline.
Ovarian Damage: Caused by surgery, chemotherapy, radiation, or autoimmune diseases.
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Factors Affecting AMH Levels
1. Age: Levels decline with age, especially after 35.
2. Genetics: Family history of early menopause may lower levels.
3. Obesity: May lead to slightly lower AMH.
4. Smoking: Associated with reduced ovarian reserve and AMH.
5. Hormonal Treatments: Some drugs may suppress AMH temporarily
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Testing for AMH
Sample: Blood test (serum sample).
Timing: Can be done at any point in the menstrual cycle.
Preparation: No fasting or specific preparation required
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Advantages of AMH Testing
Reliable measure of ovarian reserve.
Independent of menstrual cycle fluctuations.
Helps customize fertility treatments.
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Limitations of AMH Testing
Cannot predict natural conception chances with certainty.
Levels do not indicate egg quality, only quantity.
Requires interpretation alongside other tests like FSH, estradiol, and antral follicle count .