Grynnerup Anna G-A, Lindhard Anette, Sørensen Steen
aFertility Unit, Copenhagen University Hospital Roskilde, Roskilde bDepartment of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Curr Opin Obstet Gynecol. 2014 Jun;26(3):162-7. doi: 10.1097/GCO.0000000000000068.
To discuss the recent developments in the utility of anti-Müllerian hormone (AMH) in the context of female infertility.
AMH measurements have entered the clinical practice in counseling of women before in-vitro fertilization (IVF) treatment. AMH measurements can predict both poor and hyperresponse, and can enable clinicians to individualize the treatment strategies. In natural conception, AMH is a good predictor of age at menopause, but it is unclear whether AMH correlates with the fecund ability in the normal population. AMH has also proven its utility in the assessment of ovarian damage due to gonadotoxic treatment or ovarian surgery. Lastly, AMH might assist in the initial diagnosis of oligomenorrhea or amenorrhea, as high levels of AMH are suggestive of polycystic ovarian syndrome and seem to correlate with the severity of the syndrome.
AMH is a glycoprotein secreted by the granulosa cells of small growing follicles and indirectly reflects the primordial follicle pool. The ovaries contain a limited number of primordial follicles and their depletion marks the menopause. Thus, the remaining primordial follicle pool is referred to as the ovarian reserve. The clearest data for the clinical utility of AMH is in the context of IVF. The support for other indications is weaker, but rapidly increasing.
综述目的：探讨抗苗勒管激素（AMH）在女性不孕症方面应用的最新进展。
最新发现：AMH检测已应用于体外受精（IVF）治疗前女性咨询的临床实践中。AMH检测既能预测低反应和高反应，还能使临床医生制定个体化治疗策略。在自然受孕中，AMH是绝经年龄的良好预测指标，但AMH与正常人群生育能力之间是否相关尚不清楚。AMH在评估性腺毒性治疗或卵巢手术所致卵巢损伤方面也已证实其作用。最后，AMH可能有助于初潮少或闭经的初步诊断，因为高水平的AMH提示多囊卵巢综合征，且似乎与该综合征的严重程度相关。
总结：AMH是由生长中的小卵泡颗粒细胞分泌的一种糖蛋白，间接反映原始卵泡池。卵巢中原始卵泡数量有限，其耗竭标志着绝经。因此，剩余的原始卵泡池被称为卵巢储备。AMH临床应用最明确的数据是在IVF方面。对其他适应证的支持力度较弱，但正在迅速增加。
