TOG - The role of AMH as a predictor of ovarian function Flashcards
What type of molecule is AMH?
Glycoprotein
Transforming growth factor beta family
Where is AMH expressed?
Male - Sertoli cells of the testes (Mullerian regression)
Female - Granulosa cells of the ovary
When is AMH produced by females?
From 36/40 until menopause
What is the AMH pattern of expression in ovarian follicles?
Mainly expressed by pre-antral and small antral follicles
Declines in dominant follicles
Equivocal in atretic follicles
What is the primary physiological function of ANH in the ovary?
Inhibition of recruitment of primordial follicles into the antral follicle pool
Also reduces sensitivity of growing follicles to FSH
What is the advantage of measuring AMH over FSH?
Minimal intra- and inter-cycle variation
What is the effect of oral contraceptives and GnRH analogues on AMH concentrations?
Reversibly reduces AMH concentrations
What is the significance of low and high AMH levels?
Low - reduced antral follicle pool and therefore ovarian reserve (independent of age)
High - suggests polycystic ovaries (esp anovulatory PCOS)
Which markers have shown better correlation with ovarian primordial follicle pool?
AMH and antral follcle count over FSH/inhibin
What is the role of AMH and response to fertility treatment?
- Predicting over-response to hyperstimulation/OHSS and altering protocols to prevent
- Predicting poor response to stimulation and altering stimulation protocols
- Counselling re:poor response to avoid distress/disappointment
