Anti-Mullerian Hormone and Ovarian Function
Anti-Mullerian Hormone and Ovarian Function
Much of the data on AMH has been from women during the later reproductive years when its concentration is clearly declining. AMH is detectible throughout childhood, and recent data have described the pattern of changes in AMH during childhood and adolescence. There is a transient rise in AMH in the neonatal period followed by a more sustained rise through childhood and adolescence. The neonatal rise therefore demonstrates that girls as well as boys do have a transient activation of the reproductive axis at that time. A cross-sectional analysis indicated that there is a plateau or even a decline in AMH during puberty, and this has now been confirmed in a longitudinal study (Figure 2). This is in the face of rising FSH concentrations and is an intriguing insight into ovarian maturation at that time. It would seem likely that the rise in FSH concentrations of early puberty stimulates larger numbers of follicles to reach later stages of maturation, progressively establishing the normal follicular hierarchy characteristic of the adult ovary. This promises to give us valuable insights into ovarian function during that time. AMH continues to rise after adolescence, with peak concentration at, approximately, the age of 24. This rise in AMH during childhood, adolescence and early adulthood is despite a declining primordial follicle pool emphasizing the inappropriateness of uncritically regarding AMH as a marker of ovarian reserve – and the need for more accurate use of that term. Furthermore, assessment of AMH in young women should be with the understanding that it may still be rising. As in adults, AMH is likely to be a useful indicator of chemotherapy-induced gonadotoxicity in children and adolescents.
AMH in Childhood and Adolescence
Much of the data on AMH has been from women during the later reproductive years when its concentration is clearly declining. AMH is detectible throughout childhood, and recent data have described the pattern of changes in AMH during childhood and adolescence. There is a transient rise in AMH in the neonatal period followed by a more sustained rise through childhood and adolescence. The neonatal rise therefore demonstrates that girls as well as boys do have a transient activation of the reproductive axis at that time. A cross-sectional analysis indicated that there is a plateau or even a decline in AMH during puberty, and this has now been confirmed in a longitudinal study (Figure 2). This is in the face of rising FSH concentrations and is an intriguing insight into ovarian maturation at that time. It would seem likely that the rise in FSH concentrations of early puberty stimulates larger numbers of follicles to reach later stages of maturation, progressively establishing the normal follicular hierarchy characteristic of the adult ovary. This promises to give us valuable insights into ovarian function during that time. AMH continues to rise after adolescence, with peak concentration at, approximately, the age of 24. This rise in AMH during childhood, adolescence and early adulthood is despite a declining primordial follicle pool emphasizing the inappropriateness of uncritically regarding AMH as a marker of ovarian reserve – and the need for more accurate use of that term. Furthermore, assessment of AMH in young women should be with the understanding that it may still be rising. As in adults, AMH is likely to be a useful indicator of chemotherapy-induced gonadotoxicity in children and adolescents.
Source...