The Role of Anti-Müllerian Hormone (Amh) In the Pathophysiology and Therapeutic Approaches in Female Infertility: A Review

Abstract

Anti-Müllerian Hormone (AMH) is a hormone that belongs to the transforming growth factor beta (TGF-β) superfamily. It is involved in the development and functioning of the reproductive tract and is used as a marker for ovarian reserve. This review aims to outline the current knowledge of the physiology, pathophysiology, and therapeutic applications of AMH in females with infertility focusing on recent molecular and clinical developments. AMH plays a central role in regulation of folliculogenesis, inhibiting primordial follicle recruitment and thereby modifying the sensitivity of reduced number large growing follicles to FSH stimulation. However, as AMH levels are relatively stable throughout the menstrual cycle, it is currently considered one of best reproductive aging biomarkers of ovarian reserve and consequently reproductive lifespan. At physiological levels, AMH plays a major role in ovarian homeostasis, follicular maturation and the maintenance of the ovarian follicular reserve. Changes in AMH synthesis or action are related with multiple reproductive disorders, including polycystic ovary syndrome (PCOS), diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), endometriosis, and granulosa cell tumors. Women with PCOS having increased AMH levels exhibit both follicular arrest and anovulatory infertility while women undergoing ovarian aging have less AMH production with consequent impaired fecundity. In addition, recent advances also postulated possible utilization of AMH in clinical settings ranging from being an ovarian protector during chemotherapy (due to the effects on chemoresistance), to modulating specific pathways linked with reproductive disorders. Despite notable advances, several issues regarding AMH assay standardization, age-dependent reference ranges and the link between circulating AMH concentrations and reproductive health outcomes remain to be resolved. Additionally, the molecular mechanisms of AMH action in endocrine ovarian dysfunction are still poorly understood. Final remarks AMH is a major regulator of the female reproductive system and an important infertility biomarker. Ongoing studies of the physiology and signaling pathways for AMH may help to micro-focus diagnostic and therapeutic strategies in female infertility, as well as improve personalized reproductive medicine.

Keywords:

AMH, Female Infertility, TGF-β, PCOS

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