Anti-Mullerian hormone--is it a crystal ball for predicting ovarian ageing?

Several studies have demonstrated that anti-Müllerian hormone (AMH) is a better marker of ovarian reserve than age, basal FSH, estradiol and inhibin. AMH is very good in (i) predicting both over- and poor-response in the controlled ovarian stimulation environment, (ii) determining the most appropriate stimulation regimen and (iii) pre-treatment counselling for couples to make an appropriate and informed choice. Recent reports are exploring the use of AMH in various other indications, including (i) predicting long-term fertility and guiding how long a woman can delay childbearing without facing the risk of reduced ovarian reserve, (ii) predicting the age of menopause, (iii) prediction of ovarian ageing in women prior to or following chemotherapy, (iv) prediction of long-term fertility following ovarian surgery and (v) screening for polycystic ovaries. However, widespread use of AMH for indications not proved by evidence-based medicine can lead to either false reassurance or distress, leading to unnecessary medical interventions . It also has huge implications for costs. We evaluated the evidence basis for using AMH for various indications to decide how justified it is to promote AMH as a crystal ball, until more evidence is available.