Infertility affects millions of people of reproductive age worldwide and is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. It is estimated that one in six couples is affected by infertility at least once throughout their lives (WHO). The unfulfilled desire to have children can have significant negative impacts on the life of those affected. However, a variety of treatment options known as assisted reproductive technology (ART) are available, including procedures such as in vitro fertilisation (IVF).
Physical causes of infertility can be on the male side (20% to 30%), on the female side (20% to 35%) or can be a combination of both (25% to 40%). Examples include abnormal sperm function and quality, disorders of the ovaries such as polycystic ovarian syndrome (PCOS) and other follicular disorders as well as sex-specific hormonal disorders. Lifestyle factors such as smoking, body weight and stress can also affect fertility. One of the most common reasons in women of advanced age is a reduced number of follicles capable of maturation.
The anti-Mullerian hormone (AMH), also known as Mullerian-duct repression hormone (MRH), is produced by maturing follicle cells in the ovaries. There is a direct correlation between the number of follicles capable of maturation – the so-called functional ovarian reserve – and the AMH concentration in the blood. The AMH level decreases, for example, with age as the ovarian reserve declines. This correlation means that AMH is an excellent marker of ovarian reserve. An advantage of AMH as compared to other fertility parameters such as follicle-stimulating hormone (FSH) or oestradiol is that its concentration in the blood only fluctuates slightly throughout the menstrual cycle, meaning that blood can be collected at any point in the cycle to determine the number of follicles capable of maturation.
In clinical practice, the AMH value is used not only to assess the functional ovarian reserve but also to determine the success of hormonal treatment during ART. ART are time- and cost-intensive procedures that are mentally and physically stressful for the patient and carry risks such as ovarian hyperstimulation syndrome (OHSS), which in severe cases can involve clinical complications such as abnormal internal fluid collections or thromboembolic events. Therefore, AMH concentration can be a useful predictive factor for choosing a suitable and safe treatment for the women concerned.
As the age at which the ovarian reserve is depleted (menopause) varies greatly between women, the AMH value – as a marker of the ovarian reserve – might also be used to determine the right time for starting a family.
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is one of the primary reasons for infertility as well as one of the most frequent endocrine diseases of reproductive-aged women. PCOS is caused by an imbalance of the sex hormones, manifesting as menstrual disorders, anovulation and other metabolic disorders. Because of the accumulation of immature follicles in the ovaries, AMH secretion is significantly higher from polycystic ovaries (75 times) than from ovaries of women without PCOS. In recent years, AMH determination has thus gained importance in suspected PCOS cases (Link zum Blogartikel) and is discussed as an additional marker for PCOS diagnostics.
Test systems for the determination of AMH and other hormones
For the quantitative determination of the AMH concentration in serum and plasma, EUROIMMUN offers a precise and straightforward ELISA, which is also suitable for fully automated processing.
In addition to the AMH ELISA, EUROIMMUN’s portfolio includes other products to determine the concentration of various infertility- and/or PCOS-associated hormones.