[Usefulness and indications of AMH assay in women]

Anti-mullerian hormone (AMH) is expressed in women in the granulosa cells, in growing follicles. There is a high correlation between antral follicle count and AMH assay, which therefore makes it a good marker of ovarian reserve. Its indications are the fertility work-up, and the menstrual cycle disorders, to detect polycystic ovarian syndrome (PCOS) or premature ovarian failure on the opposite. During assisted reproductive techniques, AMH assay is very useful choosing the ovarian stimulation protocol and the dose of gonadotropins to begin with, in order to limit the risks of ovarian hyperstimulation syndrome or on the other hand, cancellation of cycles due to poor ovarian response. Finally, with the development of fertility preservation in the context of cancer, AMH assay is useful in evaluating the ovarian reserve after treatments that can be toxic for the ovaries, and the impact of the treatments on ovarian function, as well as organizing fertility preservation. AMH assays techniques are evolving, leading to a better homogeneisation of the results, and allowing the determination of thresholds used by everyone. Furthermore, we have to know that the AMH assay doesn't belong to the official definition of PCOS or premature ovarian failure for the moment, although it is useful in daily practice.