Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Hum Reprod Update. 2014 Sep-Oct;20(5):688-701. doi: 10.1093/humupd/dmu020. Epub 2014 May 12.
In women, anti-Müllerian hormone (AMH) is exclusively produced by granulosa cells of ovarian follicles during the early stages of follicle development. After an initial increase until early adulthood, AMH concentrations slowly decrease with increasing age until becoming undetectable ∼5 years before menopause when the stock of primordial follicles is exhausted. However, major individual variability exists in the pace of follicle pool depletion and the initial size of the follicle pool, reflected by a wide range of age at menopause. Individual AMH serum concentration does accurately reflect the size of the pool of antral follicles, representing the quantity of the remaining primordial follicles. Accordingly, AMH levels may vary significantly in women of the same chronological age, allowing AMH to predict the remaining length of a woman's reproductive lifespan.
Following 10 years of intense clinical research in this area (with over 300 papers published in core clinical journals every year), the level of evidence justifying use of AMH in ovarian reserve testing is rapidly increasing. We have conducted a summarizing review regarding all evidence published.
Many studies have convincingly demonstrated that AMH is the best currently available measure of ovarian reserve under a variety of clinical situations, such as infertility treatment (especially IVF), the forecasting of reproductive lifespan, ovarian dysfunction (especially polycystic ovary syndrome) and gonadotoxic cancer treatment or ovarian surgery. Moreover, AMH may help to individualize dosing for ovarian stimulation thereby improving the efficiency and safety of IVF. However, there are concerns about the performance of the AMH assay under different conditions regarding storage of samples and handling techniques. Therefore an international guideline for laboratories and a reference preparation are needed to make test results between laboratories truly comparable.
AMH is the best current available measure of ovarian reserve for different clinical conditions. However, prospective well powered studies comparing different infertility treatment strategies based on initial AMH levels using appropriate end-points, such as live birth and cost-effectiveness, are urgently awaited. Such studies could represent a true step forward in rendering counseling and infertility care more patient tailored.
在女性中，抗苗勒管激素（AMH）仅由卵巢卵泡发育早期的颗粒细胞产生。在成年早期初始增加后，AMH 浓度随着年龄的增长而缓慢下降，直到绝经前 5 年左右，当原始卵泡储备耗尽时，AMH 无法检测到。然而，卵泡池耗竭的速度和原始卵泡池的初始大小存在很大的个体差异，这反映在绝经年龄的广泛差异上。个体 AMH 血清浓度确实反映了窦卵泡池的大小，代表了剩余原始卵泡的数量。因此，在相同年龄的女性中，AMH 水平可能会有很大差异，这使得 AMH 能够预测女性生殖寿命的剩余长度。
在该领域进行了 10 年的深入临床研究（每年在核心临床期刊上发表超过 300 篇论文）之后，证明 AMH 在卵巢储备测试中使用的证据水平正在迅速提高。我们对所有已发表的证据进行了总结性综述。
许多研究令人信服地表明，在各种临床情况下，如不孕治疗（尤其是 IVF）、预测生殖寿命、卵巢功能障碍（尤其是多囊卵巢综合征）和性腺毒性癌症治疗或卵巢手术，AMH 是目前可用的最佳卵巢储备测量方法。此外，AMH 可能有助于个体化卵巢刺激剂量，从而提高 IVF 的效率和安全性。但是，人们对 AMH 检测在不同条件下的表现存在担忧，例如样本储存和处理技术。因此，需要为实验室制定国际指南和参考制剂，以使实验室之间的测试结果真正具有可比性。
AMH 是目前不同临床情况下评估卵巢储备的最佳方法。然而，迫切需要进行前瞻性、强有力的研究，比较基于初始 AMH 水平使用适当终点（如活产和成本效益）的不同不孕治疗策略。这些研究可能代表着在使咨询和不孕治疗更符合患者需求方面迈出了真正的一步。
