Anti-Mullerian Hormone: Use and Mis-use in Current Reproductive Medicine Practice: A Clinically Oriented Review

Abstract Anti-mullerian hormone (AMH) was originally discovered because of its role in suppressing uterine and tubal structures during male sexual development. It has since become a valuable adjunct to the practice of reproductive endocrinology in several venues. The ability of AMH to provide useful, albeit indirect information about the size of the ovarian follicle pool has been utilized successfully in the prediction of ovarian reserve, forecasting of time to menopause, supporting the diagnosis of polycystic ovary syndrome and predicting response to treatment, and assisting in dose selection for women undergoing ART. However, enthusiasm for AMH as a relatively new tool in the armamentarium of the reproductive endocrinologist must be tempered by its limitations. Although AMH is helpful is ascertaining the quantity of remaining ovarian follicles, it does not provide information about follicle quality. Therefore using AMH to forecast fertility potential can be fraught with error and drive unwarranted medical treatment. Certain conditions and medications can also result in falsely low AMH determinations, which can again lead to inappropriate treatment recommendations. Knowledge of the proven usefulness of AMH and its limitations is therefore critical for optimal clinical practice.