What Is Anti-Mullerian Hormone?
Anti-Müllerian hormone is a protein hormone produced (before birth) by the testes and ovaries and is vital in developing the male reproductive tract. The human fetus contains two sets of ducts about eight weeks after conception; one can develop into the male reproductive system and the other into the female reproductive tract. The embryonic testes will generate anti-Müllerian hormones if the fetus is genetically male (XY chromosomes). The anti-Müllerian hormone causes the Müllerian (female) ducts to vanish, but testosterone released by the testes causes the male (Wolffian) ducts to remain.
The Wolffian ducts grow into the various sections of the male reproductive system, such as
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Epididymis.
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Seminal vesicles.
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Vas deferens.
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Prostate gland.
The Wolffian ducts disappear in a female fetus (XX chromosomes) due to a lack of testosterone. In contrast, the Müllerian ducts grow into the uterus, fallopian tubes, cervix, and vagina (upper part).
What Are the Functions of Anti-Mullerian Hormone?
The anti-Müllerian hormone (AMH) is responsible for the following functions-
- Sex Organs Development in Fetus- While a baby is developing inside the womb, AMH is crucial for the development of the sex organs. Since AMH inhibits the development of female reproductive organs, male neonates have higher quantities of the hormone. The growth of female newborns requires a very small amount of AMH.
- Regulation of Steroid Production- Anti-Müllerian hormone is also involved in the regulation of sex steroid production in the ovaries and testes during puberty and adulthood.
- Development of the Ovarian Follicles- Anti-Müllerian hormone appears to be vital in the early phases of follicle development, which house and support the eggs prior to fertilization in the ovaries.
What Is Ovarian Reserve and Its Significance?
Ovarian Reserve: Female ovarian follicle cells produce AMH. In the ovary, follicles are tiny sacs filled with fluid that store and release eggs. A woman's ovaries may produce more anti-Müllerian hormones if they have more ovarian follicles. AMH can be detected in the bloodstream to determine how many follicles they still have in their ovaries or ovarian reserve. Ovarian reserve or egg production is correlated with AMH levels in the following ways-
- High Level- Greater AMH levels are related to larger ovarian reserves and more eggs.
- Low Level- Reduced AMH levels are related to fewer eggs and a smaller ovarian reserve.
What Happens if Levels of Anti-Mullerian Hormone Fluctuate?
Low Levels of Anti-Müllerian Hormone-
- In Males- The Müllerian ducts do not disappear when the male fetus does not produce enough anti-Müllerian hormone, resulting in persistent Müllerian duct syndrome. Patients with this disease have a male appearance, but due to faulty Wolffian duct development, they frequently have undescended testes (cryptorchidism) and a low or missing sperm count. This has been linked to vas deferens and epididymis malformations. This is a very uncommon condition.
- In Females- Since anti-Müllerian hormone is produced by ovarian follicles in adults, assessing anti-Müllerian hormone levels in the blood can be used to estimate ovarian reserve in women. Anti-Müllerian hormone levels are frequently used to forecast the response of a woman to ovarian stimulation during in-vitro fertilization (IVF) and to recommend the doses of the hormone to be utilized for the procedure.
High Levels of Anti-Müllerian Hormone- Anti-Müllerian hormone levels in women peak around puberty. They remain generally stable until after menopause when there are no more follicles and anti-Müllerian hormone levels drop. Anti-Müllerian hormone levels may be lower than normal in women who experience early ovarian failure. Polycystic ovarian syndrome (PCOS) may be linked to high levels of anti-Müllerian hormone. Anti-Müllerian hormone testing, on the other hand, can be deceiving and does not provide a conclusive diagnosis of premature ovarian failure or polycystic ovary syndrome.
What Is the Anti-Mullerian Hormone Test?
An AMH test is used to measure the levels of anti-Müllerian hormone (AMH) in the blood of a woman. The AMH test is a blood test. A tiny needle is used to draw a blood sample from a vein in the arm by a healthcare expert. The process is very quick and is completed in a few minutes.
AMH is produced by both males (those assigned males at birth) and women (those assigned females at birth). However, the test is most commonly used in women primarily to offer a glimpse of a woman's reproductive health.
What Are the Uses of the Anti-Mullerian Hormone Test?
AMH test can be used for the following-
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An AMH test determines how many eggs a woman has left and whether or not their ovaries are rapidly aging. It could imply that the window of chance to conceive is closing.
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An AMH test can also tell about how well women respond to injectable fertility medicines that help the ovaries grow numerous eggs in preparation for in-vitro fertilization (IVF).
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AMH test to see if a granulosa cell tumor is present in an ovarian mass. AMH levels can also be evaluated to determine whether or not treatment is effective or if the tumor has reappeared.
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The AMH test is performed to determine whether an infant's genitals are unmistakably male or female.
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It helps to identify the cause of amenorrhea or the absence of menstruation. It is more common among girls who have not started menstruation by the age of 15 and women who have missed multiple cycles.
What Are the Limitations of the Anti-Mullerian Hormone Test?
AMH test has the following limitations -
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Although AMH is linked to the egg count, it does not predict fertility (with or without therapies).
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It does not help to predict menopause.
What Are the Normal Levels of Anti-Mullerian Hormone?
The amount of AMH in the body varies with age. AMH levels in women begin to rise during adolescence and peak around the age of 25. AMH levels naturally fall after that. The unit used to measure AMH levels is nanograms per milliliter (ng/mL). The general range is as follows -
- Average Range: It ranges between 1.0 ng/mL to 3.0 ng/mL.
- Low Range: below 1.0 ng/mL.
- Severely Low Range: below 0.4 ng/mL.
Conclusion:
Anti-Müllerian hormone (AMH) is a transforming growth factor (TGF), glycoprotein (TGF-P). In the male embryo, AMH plays a critical function in the regression of Müllerian ducts. Müllerian ducts grow into female inner reproductive organs without it. In cryptorchid males, AMH serves as a biochemical marker for the presence of testes. The granulosa cells of the small follicles in the female ovary are responsible for producing AMH. The assessment of ovarian follicular reserve can be done using serum AMH levels measured throughout the reproductive life of a woman. For several clinical conditions, AMH is the best ovarian reserve measure currently available.
