Antimüllerian hormone use and misuse in current reproductive medicine practice: a clinically oriented review

Antimüllerian hormone (AMH) was originally discovered because of its role in suppressing the uterine and tubal structures during male sexual development. It has since become a valuable adjunct to the practice of reproductive endocrinology in several avenues. The ability of AMH to provide useful, albeit indirect, information regarding the size of the ovarian follicle pool has been used successfully for predicting ovarian reserve, forecasting the time to menopause, supporting the diagnosis of polycystic ovary syndrome and predicting the response to treatment, and assisting in dose selection for women undergoing assisted reproductive technology. However, the enthusiasm for AMH as a relatively new tool in the armamentarium of the reproductive endocrinologist must be tempered by its limitations. Although AMH is helpful in ascertaining the quantity of remaining ovarian follicles, it does not provide information about follicle quality. Therefore, using AMH to forecast fertility potential can be fraught with error and can drive unwarranted medical treatment. Certain conditions and medications can also result in falsely low AMH determinations, which can again lead to inappropriate treatment recommendations. The knowledge of the proven usefulness of AMH and its limitations is therefore critical for optimal clinical practice.