AMH Its role in Folicular development

Q.1: Where from AMH secreted?? Ans: AMH is secreted mostly by the small antral follicles in the ovary that are between 5-8 mm in size. AMH (Antimullerian Hormone) is a key hormone and  it is secreted by the follicles which covers the oocytes .

Q.2: What is the relevance of AMH level? Ans: It’s thought that AMH levels correlate with the number of viable eggs remaining in a woman’s ovary.  In women who suffer from a condition known as diminished ovarian reserve (DOR), this number can often be quite low, indicating that there are few remaining follicles within the ovary.

Q 3: Mode of action of AMH?? Ans:  AMH works to slow and prevent the premature development of the follicles before such  are mature - keeping the ovary from developing eggs prematurely.   

Q.4. How exactly this action this  executed by AMH?  What is the exact  mode of action of AMH ?  Ans:-  AMH works by reducing the ovary’s receptors to FSH, that causes an oocyte  to develop each cycle. When the AMH is too high, as it is in PCOS one  can imagine that this effect can go too far and the production of a healthy egg every cycle can be halted because premature follicles are called in to respond and such unripe eggs incises in size. ,

Q.5:  In PCO: FSH receptor pleomorphism: What is meant by mutation of  AMH gene  or receptors for AMH in PCO women?? Ans:: We are now aware of FSH receptor pleomorphism may be a rare cause of poor responders and possibly in PCO as well. Many of us  have witnessed  that low dose of FSH have to be given for long 15-20 days to observe the  growing follicle( Chr low dose protocol).

Q.6: PCO:- mutation in the AMH gene or AMH receptors in women with PCOS Why too much AMH??? Ans: Another theory which has come up frequently is the possibility of slight mutation in the AMH gene or AMH receptors in women with PCOS. Most cases of PCO there is increased production of AMH by the individual follicle cells. Coincidentally, too much AMH may actually be a major culprit in stopping ovulation in PCO.

Q.7: Use os AMH as an important Lab marker for PCO Ans: Many of us are the testing of AMH can also be a useful test for women with PCOS, particularly in those who are struggling with receiving a diagnosis.

AMH  is secreted mostly by the small antral follicles in the ovary that are between 5-8 mm in size. In many women with PCOS, there is an increase in the number of this type of follicles. In essence, the follicles begin to develop and then stall before they are ovulated. Recent research also suggests that in addition to the increased number of antral follicles in the ovary of women with PCOS, there is also an increased production of AMH by the individual follicle cells.

Coincidentally, too much AMH may actually be a major culprit in stopping ovulation from happening. In clinical practice many a senior practioner  have seen many women who have gone undiagnosed with PCOS for years - running a simple AMH test and correlating the results with other aspects of the case has brought clarity to the cases of these many women who have struggled with undiagnosed hormonal problems throughout their lives. Fortunately, AMH is a simple blood test that can be done on any cycle day.

Q.8: What is the explanation of raised LH? Ans: Cause of hypersecretion of LH is  not known exactly. But many researchers consider high LH may be a factor in schisis of AMH. .

Q.9: Do you know that  AMH levels also directly correlate to blood levels of testosterone ?? Ans: The logic : Normally LH is released in a strong surge that triggers ovulation - but when it is too high for too long  a period it can inhibit ovulation and cause the overproduction of testosterone from theca cells. AMH levels also directly correlate to blood levels of testosterone, however it’s difficult to know whether this is cause or effect. It’s thought that perhaps there may even be an slight mutation in the AMH gene or AMH receptors in women with PCOS.

Q. 10: Age related nomogram of AMH ?? In women who don’t necessarily have the other obvious signs of PCOS, or who are lean, this one test can often help to differentiate the condition. It’ s important to know that AMH levels decrease with age and as such one  should correlate these results with her  age. Another important thing to note is that there are two different units commonly used for measuring AMH - so please check carefully as to the unit your measurement was taken in.