• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Video lecture:

• Q. What are the stages for folliculogenesis in females ?

  • Primordial follicles --> early primary follies → primary follicles → secondary follicles → graffian follicles
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• Q. Of the above, which of them produce AMH ?

  • Mainly the Primary follicles (Preantaral and small Antaral follicles)
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• Q. When does the AMH production begin and when does it end ?

  • Begins at 36 weeks of life and ends at menopause

• Q. What happens due to mutation in AMH or AMHR2 gene in men ?

  • Absence of AMH or AMHR2 gene leads to persistent Mullerian duct syndrome ie normal men with Mullerian structures

• Q. What is the Half-life of AMH ?

  • Strangely this is not known and there is no consensus on the same

• Q. Are AMH receptors present outside the ovaries ?

  • Yes
  • They are present in multiple organs- the exact effect of the same is not known

• Regulation of AMH

• Q. What is the impact of FSH on AMH ?

  • FSH directly stimulates AMH
  • But FSH also increases estrogen which suppresses AMH
  • Hence there is a bidirectional relationship
  • The presence of androgens in the system cuts off the positive impact of FSH on AMH
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• Q. What is the impact of LH on AMH ?

  • LH does not impact AMH
  • But LH suppresses the expression of AMH receptor (AMHR2)
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• Q. What is the impact of estrogen on AMH ?

  • Estrogen suppresses both the AMH and AMHR2 expression

• Q. What is the impact of insulin on AMH ?

  • Insulin up-regulates AMH mRNA

• Q. What is the impact of stress on AMH ?

  • Hardy found that stress downregulates the AMH

• Q. What is the impact of AMH on folliculogenesis ?

  • Basically AMH prevents recruitment of primordial follicles and prevents FSH based development of these follicles
  • The idea is to prevent multiple follicles from developing simultaneously
  • It also prevents the early follicles from atresia so as to maintain a good pool of the same from further recruitment
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  • "In vivo and in vitro studies showed that AMH has an inhibitory effect on primordial follicle recruitment and it decreases the sensitivity of follicles for the FSH-dependent selection for dominance"

• Q. What is the impact of AMH on breast and uterus ?

  • AMH induces apoptosis of breast cancer cell lines
  • it has impact on the growth of uterine endometrium

CLINICAL IMPORTANCE OF AMH

• Also see: Diagnosis of PCOS

• Q. Does lack of AMH or AMH receptor lead to any disease in women ?

  • Interestingly, no
  • hence AMH is more of a marker in women then a disease-causing protein

• Q. What happens to AMH levels in women with PCOS ?

  • The AMH is elevated

• Q. Is AMH elevated in daughters of women with PCOS ?

  • yes

• Q. Does Hyperandrogenism contribute to high AMH in women with PCOS ?

  • Yes
  • There is a positive correlation between hyperandrogenism and AMH levels

• Q. What is the relationship between LH and AMH in PCOS ?

  • In normal circumstances LH has little impact on AMH levels
  • But in women with PCOS it is shown that LH levels upregulate AMH expression
  • LH levels correlate with AMH levels in women with PCOS

• Q. In which type of tumors is AMH expression increased ?

  • Granulosa cell tumors
  • These are important tumors because they have high rate of malignancy and poor prognosis
  • AMH may also be involved in the pathogenesis of the same
  • It is useful for detected recurrence after surgery
  • The AMH expression is size-dependent, larger tumors (>10cm) are AMH negative

• Q. What happens to AMH levels in Endometriosis ?

  • AMH levels are lower in Endometriosis

• Q. Does AMH needs to be measured during a particular time of the day or during a particular time of the cycle ?

  • AMH can be measured at any time of the day
  • Can be measured during any part of the menstrual cycle

• Q. What are the changes in the AMH levels in women as per age ?

  • AMH levels start increasing at birth
  • Peak is at around 15 years
  • Remain stable up to 25 years
  • then start declining

• Q. What method is commonly used for assaying AMH levels ?

  • ELISA

• Q. Does the ELISA measure AMH alone ?

  • No
  • It also measures AMH precursor
  • So basically what you get from the report is AMH which is active+ AMH precursor which is inactive

• Q. Can we measure the active AMH alone ?

  • Yes
  • if you pretreat the sample with Sodium dodecyl sulphate or deoxycholate

• Q. Is there a correlation between AMH and metabolic precursors ?

  • At present there is poor correlation
  • But it is thought that this is probably because of the inactive AMH precursor which muddies the picture
  • If we could measure the active AMH there is correlation between that and metabolic parameters

26-May-2022

#Updates

• Q. Does AMH reflect the chances of fertility ?
  • AMH is a marker of ovarian reserve and not a marker of ferility
  • A women with low AMH can still be fertile
  • Basically AMH reflects the period of ferility- lower AMH means lower shorter reproductive duration ^[1]