Anti-Mullerian hormone is a 140kDa glycoprotein that is produced during normal embryogenesis by the Sertoli cells of the embryonic testis. It causes the involution of the mullerian duct and inhibites female gonadogenesis by producing apoptosis of target gonadal cells. It belongs to the transforming growth factor-β super family. AMH causes apoptosis of specific Mullerian inhibiting substance (MIS) receptor-bearing cells, white having no effect on cells without receptors.
Principle of the test
The US AMH/MIS ELISA is a quantitative three-step sandwich type immunoassay. In the first step Calibrators, Controls and unknown samples are added to AMH antibody coated microtiter wells and incubated. After the first incubation, and washing, the wells are incubated with biotinylated AMH antibody solution. After the second incubation and washing, the wells are incubated streptavidin horseradish peroxidase conjugate (SHRP) solution. After the third incubation and washing step, the wells are incubated with substrate solution (TMB) followed by an acidic stopping solution. In principle, the antibody-biotin conjugate binds to the solid phase antibody-antigen complex which in turn binds to the streptavidin-enzyme conjugate. The antibody-antigen-biotin conjugate-SHRP complex bound to the well is detected by enzyme-substrate reaction. The degree of enzymatic turnover of the substrate is determined by dual wavelength absorbance measurement at 450 nm as primary test filter and 630 nm as reference filter. The absorbance measured is directly proportional to the concentration of AMH/MIS in the samples and calibrators.
Benefits of AMH in Reproductive Assistance
Stable AMH levels are not associated with the menstrual cycle, thus enabling tests at any time during the menstrual period. AMH levels decrease with age or declining ovarian function.
• AMH is used as an indicator of ovarian reserve.
• AMH is used to predict poor ovarian response and cycle cancellation.
• AMH is used to predict ovarian response to determine the risks of ovarian hyperstimulation syndrome (OHSS).
• Reference range for the antimullerian hormone Generation II assay : a population study of 10,984 women, with comparison to the established Diagnostics Systems Laboratory nomogram.
• Variation in antimullerian hormone concentration during the menstrual cycle may change the clinical classification of the ovarian response.
• A single-centre evaluation of two new anti-mullerian hormone assays and comparison with the current clinical standard assay