The glycoprotein hormone Anti-Müllerian hormone (AMH) is produced by granulosa cells within small ovarian follicles to serve an essential function in female reproductive biology. The transforming growth factor-β (TGF-β) superfamily includes AMH as one of its members. Without AMH the Müllerian ducts will form into the uterus and fallopian tubes as well as the upper vagina in both males and females.
Anti-Müllerian Hormone (AMH)
Anti-Müllerian hormone (AMH) belongs to the transforming growth factor-β (TGF-β) family of hormones.
Regulating Follicular Recruitment
AMH functions to protect primordial follicles from early activation to maintain the follicle pool longer. The hormone acts to control follicle maturation speed through its ability to decrease follicle sensitivity to follicle-stimulating hormone (FSH).
Predicting Ovarian Reserve Function
The measurement of AMH levels provides essential information about the remaining follicles in the ovaries and serves as a vital tool for assessing female fertility potential and assisting reproductive therapies like IVF.
Role in Development
During male embryonic development, testicular supporting cells secrete AMH which triggers the regression of the Müllerian ducts to block female reproductive organ formation. During embryonic development in females AMH levels stay extremely low which allows the Müllerian ducts to develop into female reproductive organs because there is no inhibition.
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The Role and Expression of AMH in Ovarian Physiology
AMH is mainly secreted by ovarian granulosa cells in women, especially the granulosa cells in the primary follicle to small antral follicle stage formed after the activation of the primordial follicle. The AMH expression starts to decline when follicle diameter hits 8mm and becomes nearly undetectable in ovulatory follicles.
AMH Physiological Function
Inhibit the Activation of Primordial Follicles
AMH is one of the key factors for the dormancy of primordial follicles, preventing them from being recruited into the growth pathway too early, thereby protecting the follicle reserve.
Regulate the Sensitivity of Preantral Follicles to FSH
AMH reduces the responsiveness of follicles to follicle-stimulating hormone (FSH), limits the synchronous development of too many follicles, and maintains the normal follicle selection mechanism.
Maintain the Stability of Follicle Growth
Regulate the growth rate of follicles in the early stage of development to ensure that only one dominant follicle is selected in each menstrual cycle.
Fig 1. AMH can inhibit the recruitment of primary follicles and FSH-stimulated follicular growth (La Marca, A., et al. 2006).
AMH Receptor
| Receptor name |
Type |
Expression location |
| AMHR2 (AMH Receptor Type 2) |
Transmembrane receptor (TGF-β receptor family) |
Ovarian granulosa cells, male reproductive ducts, etc. |
| AMHR1 (Type 1 Receptors: such as ALK2/ALK3, etc.) |
Co-receptor (requires AMHR2 activation) |
Cooperates with AMHR2 to activate downstream signaling pathways |
AMH Signaling Mechanism
- AMH binds to AMHR2
- Activates AMHR1 (such as ALK2/ALK3)
- Initiates SMAD protein pathway
Role in ART
| Projects |
Description |
| Predicting ovarian response |
AMH can predict the response to ovulation-inducing drugs and guide drug dosage |
| Screening patients with low or high ovarian response |
Low AMH indicates poor ovarian reserve; high AMH is common in PCOS and indicates a high risk of response |
| Evaluating IVF success rate |
Although it cannot directly predict pregnancy outcomes, it is related to the number of eggs available |
AMH as a Marker of Ovarian Reserve in Older Women
AMH levels change with age, starting to be expressed soon after birth, peaking during puberty, gradually declining after age 30, and approaching the lower limit of detection after age 45. AMH is the earliest marker of ovarian reserve to decline in the years before menopause.
Application in Older Women
| Application direction |
Description |
| Prediction of menopause time |
AMH level can be used to predict the age of menopause of an individual |
| Evaluation of fertility window |
Even if menstruation is normal, low AMH may indicate reduced fertility |
| Evaluation of hormone replacement therapy (HRT) |
Determine whether you have entered perimenopause and assist in formulating treatment plans |
Anti-Müllerian Hormone (AMH) Application
| Application areas |
Description |
| Fertility assessment |
Reflects ovarian reserve and helps determine the possibility of natural conception |
| Polycystic ovary syndrome (PCOS) |
Patients usually have elevated AMH levels |
| Menopause prediction |
AMH levels can predict menopause |
| Assisted reproduction |
Guide ovarian stimulation regimens and predict ovarian response |
| Abnormal puberty |
Determine gonadal development function |
Anti-Mullerian hormone (AMH) is an important hormone indicator for evaluating ovarian function and female fertility. It is not only widely used in reproductive medicine, but also plays an important role in the diagnosis and treatment of gynecological endocrine diseases.
References
- La Marca, A., et al. Anti‐Müllerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool?. Clinical endocrinology. 2006, 64(6): 603-610.
- La Marca, A., et al. Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Human reproduction update. 2010, 16(2): 113-130.
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