Basic Medical Sciences, St George's, University of London, Cramner Terrace, London SW17 0RE, UK.
Reproduction. 2010 May;139(5):825-33. doi: 10.1530/REP-09-0415. Epub 2010 Mar 5.
Anti-Müllerian hormone (AMH) was initially thought to be produced solely by the foetal male during sexual differentiation to promote regression of the Müllerian ducts. Over the last decade, however, a new and interesting role has emerged for AMH in the ovary. In human ovaries, AMH is produced by granulosa cells from 36 weeks of gestation until menopause, with the highest expression being in small antral follicles. AMH production gradually declines as follicles grow; once follicles reach a size at which they are dominant, it has largely disappeared. Its removal from these larger follicles appears to be an important requirement for dominant follicle selection and progression to ovulation as AMH has an inhibitory role in the ovary, reducing both primordial follicle initiation and follicle sensitivity to FSH by inhibition of aromatase. It is for this reason that AMH is a focus of interest in polycystic ovary syndrome (PCOS). Serum levels are doubled, and granulosa cell production is greatly increased. Interestingly, there appear to be two groups of women with PCOS who can be distinguished by their AMH level: one group consists of those who have high levels which do not reduce with treatment and who respond less well to induction of ovulation, and a second group consists of those in whom the level is less elevated and reduces on treatment and who seem to respond rather better. Understanding the reason for the raised AMH in PCOS may give clues as to the mechanism of anovulation. To conclude, AMH appears to have a major inhibitory role during folliculogenesis, which may contribute to anovulation in PCOS.
抗缪勒管激素（AMH）最初被认为仅由性分化过程中的胎儿男性产生，以促进缪勒管的退化。然而，在过去的十年中，AMH 在卵巢中出现了一个新的有趣作用。在人类卵巢中，AMH 由颗粒细胞从妊娠 36 周产生到绝经，其最高表达存在于小窦卵泡中。随着卵泡的生长，AMH 的产生逐渐减少；一旦卵泡达到优势大小，它就基本消失了。其从这些较大卵泡中的去除似乎是优势卵泡选择和向排卵进展的重要要求，因为 AMH 在卵巢中具有抑制作用，通过抑制芳香酶来减少原始卵泡的起始和卵泡对 FSH 的敏感性。这就是 AMH 成为多囊卵巢综合征（PCOS）关注焦点的原因。血清水平翻了一番，颗粒细胞的产生大大增加。有趣的是，似乎有两组 PCOS 女性可以通过 AMH 水平来区分：一组是 AMH 水平较高且治疗后不会降低的女性，她们对诱导排卵的反应较差，另一组是 AMH 水平较低且治疗后降低的女性，她们的反应似乎更好。了解 PCOS 中 AMH 升高的原因可能有助于揭示无排卵的机制。总之，AMH 在卵泡发生过程中似乎具有主要的抑制作用，这可能导致 PCOS 中的无排卵。
