1. Ovarian
reserve
Basal
endocrine
profile
Thyroid
function

2. Ovarian reserve screening
• Basal FSH
•Inhibin
• Clomiphene citrate challenge test
• Antral follicle count
• AMH
•Genetics

3. Anti Mullerian Hormone
• AMH is a protein hormone structurally related to inhibin and activin, and a member
of the transforming growth factor-β (TGF-β) family
• In humans the gene for AMH is AMH, on chromosome 19p13.3, while the gene
AMHR2 codes for its receptor on chromosome
• In mammals AMH is secreted by Sertoli cells of the testes during embryogenesis of
the fetal male and prevents the development of the mullerian ducts into the uterus
and other mullerian structures
• While AMH is measurable in males during childhood and adulthood, AMH cannot be
detected in women until puberty. AMH is expressed by granulosa cells of the ovary
in the reproductive age and controls the formation of primary follicles by inhibiting
excessive follicular recruitment by FSH

4. Observations
Age, FSH,
inhibin B, AMH
(n = 60)
Age, FSH, AMH
(n = 120)
Age, AMH
(n = 132)
AMH
(n = 132)
Sensitivity (true positive rate) 0.79 0.69 0.76 0.97
Specifity (true negative rate) 0.83 0.66 0.65 0.41
Correct prediction
‘poor response’
0.58 0.42 0.42 0.36
Correct prediction
‘normal response’
0.93 0.85 0.88 0.98
Table I. Detection and prediction of poor responders (n = 33 with 4 oocytes, calculated cut-off AMH 1.26
ng/ml) in 132 oocyte retrievals.
Gnoth et al., 2008 Hum Reprod

5. Serum anti-müllerian hormone and estradiol levels as predictors of
ovarian hyperstimulation syndrome (OHSS) in assisted reproduction
technology cycles
Lee et al, 2008 Human Reproduction
A total of 262 patients undergoing the above-
described IVF treatment were included in this
study
Twenty-one (8.0%) patients developed
moderate to severe OHSS

6. Antral follicle
count
FSH starting dose
BMIAMH GENETICS