Anti-Müllerian Hormone (AMH)
Code:9050|CPT:82166|LOINC:38476-8
| Includes | Anti-Müllerian hormone (AMH) |
|---|
Analysis details
Methodology
- Electrochemiluminescence immunoassay (ECLIA)
- Chemiluminescent immunoassay (CLIA)
Expected Turnaround Time
1–2 days
Special Instructions
- Infants younger than 1 year: do not feed for 30–40 minutes before the blood draw
- Children 1–5 years: avoid food for 2–3 hours prior to collection
- Adults: fast for 12 hours; water is allowed
- With clinician approval, withhold estrogens and androgens for 48 hours before specimen collection
- Do not smoke during the 30 minutes before collection
How to use
The Anti-Müllerian Hormone (AMH) assay, also known as Müllerian-inhibiting hormone (MIH) or Müllerian inhibiting factor (MIS), is used to assess ovarian reserve and to individualize assisted reproductive technology by estimating ovarian response to stimulation and gauging risk for ovarian hyperstimulation syndrome. AMH shows comparatively little fluctuation across the menstrual cycle and complements ultrasound-based measures such as antral follicle count. AMH testing aids evaluation of disorders of sex development, including distinguishing undescended testes from anorchia and consideration of persistent Müllerian duct syndrome. It contributes to the differential diagnosis of obstructive versus nonobstructive azoospermia and serves as a marker for granulosa-cell and Sertoli-cell tumors for both diagnostic assessment and treatment monitoring.
Limitations
AMH secretion by Sertoli cells begins at approximately the seventh week of gestation and drives regression of the Müllerian ducts during male sexual differentiation. Deficiency of AMH or defects in its receptor can lead to persistence of Müllerian duct derivatives despite otherwise normal male internal and external genitalia. AMH contributes to testicular descent; low or undetectable AMH supports anorchia in the evaluation of cryptorchidism, whereas a measurable level indicates the presence of testicular tissue. In males, circulating AMH is high in infancy, declines through childhood and adolescence, and remains low in adulthood. In females, AMH is produced by granulosa cells of growing follicles, where it inhibits primordial follicle recruitment and modulates follicular sensitivity to FSH. Concentrations are very low in infancy and childhood, rise modestly at puberty, and decline progressively with age, becoming undetectable after menopause. Serum AMH reflects the pool of growing follicles and correlates with functional ovarian reserve, which diminishes with advancing age and after gonadotoxic therapies. Clinically, AMH helps select and monitor assisted reproduction protocols by identifying predicted poor responders and hyper-responders. It is also useful in the diagnosis and longitudinal monitoring of granulosa-cell ovarian tumors and rarer Sertoli-cell tumors, which can present with hyperestrogenism.
| Unit | ng/mL |
|---|---|
| Reference interval | — |
| Indications | Workup of cryptorchidism in male infants, including distinction between undescended testes and anorchia, Assessment of ambiguous genitalia and broader disorders of sex development, Differentiation of obstructive versus nonobstructive azoospermia, Evaluation of ovarian reserve and projection of reproductive lifespan, including the timing of infertility and menopause, Stratification of expected ovarian response to controlled ovarian stimulation and estimation of ovarian hyperstimulation syndrome risk in ART, Investigation of hyperestrogenic states (eg, abnormal uterine bleeding in women; gynecomastia in men) |
Specimen Requirements
| Specimen | Serum |
|---|---|
| Container | Gold/Tiger Top (SST, Gel Separator) |
| Volume | 5 mL (min 2.3 mL) |
| Storage Instructions | Room temperature, Refrigerated, Frozen |
References
Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol. 2017 Feb;1-12. PubMed 28235465 10.1016/j.ajog.2017.02.027
Practice Committee of the American Society for Reproductive Medicine (ASRM). Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2015 Mar;103(3):e9-e17. PubMed 25585505 10.1016/j.fertnstert.2014.12.093
Zegers-Hochschild F, Adamson GD, Dyer S, et al. The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. July 2017:1-15. PubMed 28760517 10.1016/j.fertnstert.2017.06.005
Leader B, Hegde A, Baca Q, et al. High frequency of discordance between antimullerian hormone and follicle stimulating hormone levels in serum from estradiol confirmed days 2 to 4 of the menstrual cycle from 5,354 women in U.S. fertility centers. Fertil Steril. 2012 Oct;98(4):1037-1042. PubMed 22771028 10.1016/j.fertnstert.2012.06.006
Ahmed SF, Rodie M. Investigation and initial management of ambiguous genitalia. Best Pract Res Clin Endocrinol Metab. 2010 Apr;24(2):197-218.
Visser JA, Themmen AP. Anti-Müllerian hormone and folliculogenesis. Mol Cell Endocrinol. 2005 Apr 29;234(1–2):81–6.
Lambalk CB, van Disseldorp J, de Koning CH. Testing ovarian reserve to predict age at menopause. Maturitas. 2009 Aug 20;63(4):280-91.
La Marca A, Volpe A. The Anti-Mullerian hormone and ovarian cancer. Hum Reprod Update. 2007 May-Jun;13(3):265-73.
Rey R, Sabourin JC, Venara M. Anti-Müllerian hormone is a specific marker of sertoli- and granulosa-cell origin in gonadal tumors. Hum Pathol. 2000 Oct;31(10):1202-8.