The use of anti-Müllerian hormone (AMH) for controlled ovarian stimulation in assisted reproductive technology and for fertility assessment and -counselling

Ovarian reserve can be determined by serum anti-Müllerian hormone (AMH) level and/or antral follicle count prior to controlled ovarian stimulation. The aim of controlled ovarian stimulation is to achieve an appropriate number of mature follicles and avoid complications such as ovarian hyperstimulation syndrome. Measurement of the ovarian reserve is very useful for the clinicians as it predicts the ovarian response to controlled ovarian stimulation. Further it assists in giving the patient realistic expectations regarding the treatment. By determining the ovarian reserve, the most appropriate stimulation protocol and gonadotrophin dose can be chosen specifically for each woman enabling the so called 'individualized treatment' in line with the personalized treatment concept. Many benefits come with using AMH as a biomarker for ovarian reserve; the hormone is considered fairly cycle independent apart from a small decrease in the late follicular phase and there is no inter-observer variance. However, the use of AMH also has limitations; since the AMH implementation in fertility treatment several AMH assays have been developed. This has made direct comparisons of AMH serum levels complicated. Currently, no international standardised assays exist. AMH is a valid predictor of the ovarian response to controlled ovarian stimulation and to some extent the chance of pregnancy in relation to assisted reproductive technology, but AMH is less optimal in prediction of spontaneous pregnancy and live birth after assisted reproductive technology. Accordingly, AMH can be used to optimize gonadotrophin stimulation in fertility treatment, but is not recommended as a screening tool in the general population. This article is protected by copyright. All rights reserved.