Tehrani Fahimeh Ramezani, Firouzi Faezeh, Behboudi-Gandevani Samira
1Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2Pathology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Aging Dis. 2022 Apr 1;13(2):458-467. doi: 10.14336/AD.2021.0825. eCollection 2022 Apr.
Low ovarian reserve is a serious condition, leading to sterility in up to 10% of women in their mid-thirties. According to current knowledge, serum anti-Müllerian hormone (AMH) levels for age are the best available marker for the screening the quantity of a woman's functional ovarian reserve, better than age alone or other reproductive markers. This review summarizes recent findings, clinical utility and limitations in the application of serum AMH testing as an accurate marker for the screening of functional ovarian reserves and predicting age at menopause. AMH assessment hold promise in helping women make informed decisions about their future fertility and desired family size. However, screening of the functional ovarian reserve could be offered to all women at 26 years of age or older who seek to assess future fertility or in case of personal request, ovarian reserve screening may be considered beyond 30 years; however, it has never been advocated beyond 35 years, since it is not advisable to delay childbearing beyond this age. In this respect, an age-specific serum AMH levels lower than the 10th percentile may be used as a threshold for the identification of a low functional ovarian reserve in an individual woman. Its level should be interpreted with caution in the adolescent and young women aged below 25 years (since AMH levels peak at this age); recent users of hormonal contraceptives (since AMH levels transiently decrease until two months after discontinuation); and women with PCOS (which dramatically increases AMH levels). However, the ability of AMH levels to predict the time to menopause is promising but requires further investigation and routine AMH testing for the purposes of predicting the time to menopause is not recommended.
卵巢储备功能低下是一种严重的情况，在35岁左右的女性中，高达10%的人会因此导致不孕。根据目前的认识，按年龄划分的血清抗苗勒管激素（AMH）水平是筛查女性功能性卵巢储备数量的最佳可用标志物，比单独的年龄或其他生殖标志物更好。本综述总结了血清AMH检测作为功能性卵巢储备筛查和预测绝经年龄的准确标志物在应用中的最新发现、临床效用及局限性。AMH评估有望帮助女性就其未来生育能力和期望的家庭规模做出明智的决定。然而，对于所有寻求评估未来生育能力的26岁及以上女性，或在个人要求的情况下，可提供功能性卵巢储备筛查；30岁以上可考虑进行卵巢储备筛查；但从未有人主张在35岁以上进行筛查，因为不建议在这个年龄之后推迟生育。在这方面，特定年龄的血清AMH水平低于第10百分位数可作为识别个体女性功能性卵巢储备低下的阈值。对于25岁以下的青少年和年轻女性（因为AMH水平在这个年龄段达到峰值）、近期使用激素避孕药的女性（因为AMH水平在停药后两个月内会短暂下降）以及患有多囊卵巢综合征的女性（这会显著提高AMH水平），其水平的解读应谨慎。然而，AMH水平预测绝经时间的能力很有前景，但需要进一步研究，不建议为了预测绝经时间而进行常规AMH检测。
