Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, San Francisco, California, USA.
J Clin Endocrinol Metab. 2022 May 17;107(6):1510-1519. doi: 10.1210/clinem/dgac039.
Evaluation of the infertile female requires an understanding of ovulation and biomarkers of ovarian reserve. Antimüllerian hormone (AMH) correlates with growing follicles in a menstrual cycle. Increasingly, AMH has been used as a "fertility test." This narrative review describes how to integrate the use of AMH into diagnosis and treatment.
A PubMed search was conducted to find recent literature on measurements and use of serum AMH as a marker of ovarian reserve and in treatment of infertility.
Serum AMH estimates ovarian reserve, helps determine dosing in ovarian stimulation, and predicts stimulation response. As such, AMH is a good marker of oocyte quantity but does not reflect oocyte health or chances for pregnancy. Screening of AMH before fertility treatment should be used to estimate expected response and not to withhold treatment. Low AMH levels may suggest a shortened reproductive window. AMH levels must be interpreted in the context of the endogenous endocrine environment where low follicle-stimulating hormone, due to hypogonadotropic hypogonadism or hormonal contraceptive use, may lower AMH without being a true reflection of ovarian reserve. In addition, there is an inverse correlation between body mass index and AMH that does not reflect ovarian response.
AMH is a useful marker of ovarian reserve in reproductive-aged women. Increased screening of noninfertile women requires a thorough knowledge of situations that may affect AMH levels. In no situation does AMH reflect oocyte health or chances for conception. Age is still the strongest driver in determining success rates with fertility treatments.
评估不孕女性需要了解排卵和卵巢储备的生物标志物。抗苗勒管激素（AMH）与月经周期中的生长卵泡相关。AMH 越来越多地被用作“生育测试”。本叙述性综述描述了如何将 AMH 的使用整合到诊断和治疗中。
通过 PubMed 搜索，查找有关血清 AMH 作为卵巢储备标志物以及在治疗不孕中的测量和使用的最新文献。
血清 AMH 估计卵巢储备，有助于确定卵巢刺激的剂量，并预测刺激反应。因此，AMH 是卵母细胞数量的良好标志物，但不能反映卵母细胞健康或妊娠机会。在进行生育治疗之前进行 AMH 筛查应用于估计预期反应，而不是拒绝治疗。低 AMH 水平可能表明生殖窗缩短。必须在内在内分泌环境中解释 AMH 水平，在这种环境中，由于促性腺激素低下性性腺功能减退或激素避孕的使用，低卵泡刺激素可能会降低 AMH，但这并不是卵巢储备的真实反映。此外，BMI 与 AMH 呈负相关，这并不反映卵巢反应。
AMH 是生殖期妇女卵巢储备的有用标志物。对非不孕女性进行更多的筛查需要充分了解可能影响 AMH 水平的情况。在任何情况下，AMH 都不能反映卵母细胞健康或受孕机会。年龄仍然是决定生育治疗成功率的最强驱动因素。
