ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)

Peculiarities of laboratory diagnostics of anti-Müllerian hormone levels

Yarmolinskaya M.I., Cherkashina S.A.

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia

The assessment of a woman’s reproductive potential using the serum anti-Müllerian hormone (AMH) level remains an important clinical issue. Various laboratory techniques are used to determine the concentration of AMH. However, the results obtained from these techniques are not standardized or consistent. This can lead to different numerical values when the same sample is studied using various analytical systems.
The threshold values indicated in clinical guidelines are often provided without any information about the specific research methodology and a comment on possible differences between laboratory methods. It is important for clinicians to pay attention to the differences in results obtained using various techniques.
The review examines issues related to ovarian reserve and folliculogenesis, the chemical structure of AMH as well as the characteristics of fluctuations in its levels. It also compares modern methods for detecting AMH in blood and considers the opportunity of their practical application.
Conclusion: The absence of an international standard for measuring AMH and the presence of different immunoassay methods which are used to determine its level emphasize the need to take into consideration the analytical system factor. This factor is especially important in the development of clinical strategies and search for optimal approaches to measurement standardization.

Authors’ contributions: Yarmolinskaya M.I., Cherkashina S.A. – developing the concept and design of the study, data collection, analysis of data and drawing conclusions, preparation of the manuscript.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: This work was performed within the Basic Scientific Research FGWN-2025-0004 1024032800068-4-3.2.2.
For citation: Yarmolinskaya M.I., Cherkashina S.A. Peculiarities of laboratory diagnostics of anti-Müllerian hormone levels. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (8): 223-228 (in Russian)
https://dx.doi.org/10.18565/aig.2025.189

Keywords

anti-Müllerian hormone
AMH
diagnostics
ovarian reserve
immunoassay

References

  1. Bruno-Gaston J., Jung J., Kumar T., Zarutskie P., Gibbons W., Devaraj S. Association of ovarian response with picoAMH in women undergoing controlled ovarian hyperstimulation. Clin. Biochem. 2021; 95: 34-40. https://dx.doi.org/10.1016/j.clinbiochem.2021.05.007
  2. Josso N., Rey R.A. What does AMH tell us in pediatric disorders of sex development? Front. Endocrinol. (Lausanne). 2020; 11: 619. https://dx.doi.org/10.3389/fendo.2020.00619
  3. Dietz de Loos A., Hund M., Buck K., Meun C., Sillman J., Laven J.S.E. Antimüllerian hormone to determine polycystic ovarian morphology. Fertil. Steril. 2021; 116(4): 1149-57. https://dx.doi.org/10.1016/j.fertnstert.2021.05.094
  4. Nelson S.M., Davis S.R., Kalantaridou S., Lumsden M.A., Panay N., Anderson R.A. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Hum. Reprod. Update. 2023; 29(3): 327-46. https://dx.doi.org/10.1093/humupd/dmac045
  5. Geerts I., Vergote I., Neven P., Billen J. The role of inhibins B and antimüllerian hormone for diagnosis and follow-up of granulosa cell tumors. Int. J. Gynecol. Cancer. 2009; 19(5): 847-55. https://dx.doi.org/10.1111/IGC.0b013e3181a702d1
  6. Всемирная организация здравоохранения. ВОЗ: Бесплодием страдает каждый шестой человек в мире. 4 апреля 2023. [World Health Organization. 1 in 6 people globally affected by infertility: WHO. 4 April 2023]. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
  7. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Женское бесплодие. М.; 2024. 63 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Female infertility. Moscow; 2024. 63 p. (in Russian)].
  8. Gleicher N., Weghofer A., Barad D.H. Defining ovarian reserve to better understand ovarian aging. Reprod. Biol. Endocrinol. 2011; 9: 23. https://dx.doi.org/10.1186/1477-7827-9-23
  9. Moolhuijsen L.M.E., Visser J.A. Anti-müllerian hormone and ovarian reserve: update on assessing ovarian function. J. Clin. Endocrinol. Metab. 2020; 105(11): 3361-73. https://dx.doi.org/10.1210/clinem/dgaa513
  10. Di Clemente N., Racine C., Pierre A., Taieb J. Anti-müllerian hormone in female reproduction. Endocr. Rev. 2021; 42(6): 753-82. https://dx.doi.org/10.1210/endrev/bnab012
  11. Rudnicka E., Kunicki M., Calik-Ksepka A., Suchta K., Duszewska A., Smolarczyk K. et al. Anti-müllerian hormone in pathogenesis, diagnostic and treatment of PCOS. Int. J. Mol. Sci. 2021; 22(22): 12507. https://dx.doi.org/10.3390/ijms222212507
  12. Lie Fong S., Visser J.A., Welt C.K., de Rijke Y.B., Eijkemans M.J., Broekmans F.J. et al. Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J. Clin. Endocrinol. Metab. 2012; 97(12): 4650-5. https://dx.doi.org/10.1210/jc.2012-1440
  13. Meczekalski B., Czyzyk A., Kunicki M., Podfigurna-Stopa A., Plociennik L., Jakiel G. et al. Fertility in women of late reproductive age: the role of serum anti-müllerian hormone (AMH) levels in its assessment. J. Endocrinol. Invest. 2016; 39(11): 1259-65. https://dx.doi.org/10.1007/s40618-016-0497-6
  14. Nelson S.M., Aijun S., Ling Q., Tengda X., Wei X., Yan D. et al. Ethnic discordance in serum anti-müllerian hormone in healthy women: a population study from China and Europe. Reprod. Biomed. Online. 2020; 40(3): 461-7. https://dx.doi.org/10.1016/j.rbmo.2019.11.013
  15. Bleil M.E., Gregorich S.E., Adler N.E., Sternfeld B., Rosen M.P., Cedars M.I. Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women. Fertil. Steril. 2014; 101(1): 199-207. https://dx.doi.org/10.1016/j.fertnstert.2013.09.015
  16. Iglesias C., Banker M., Mahajan N., Herrero L., Meseguer M., Garcia-Velasco J.A. Ethnicity as a determinant of ovarian reserve: differences in ovarian aging between Spanish and Indian women. Fertil. Steril. 2014; 102(1): 244-9. https://dx.doi.org/10.1016/j.fertnstert.2014.03.050
  17. Ji M., Kim K.R., Kim H.K., Lee W., Yun Y.M., Chun S. et al. Age group-specific reference intervals for the elecsys anti-müllerian hormone assay in healthy Korean women: a nationwide population-based study. Ann. Lab. Med. 2022; 42(6): 621-9. https://dx.doi.org/10.3343/alm.2022.42.6.621
  18. Khodavirdilou R., Pournaghi M., Rezaei Y.R., Hajizadeh K., Khodavirdilou L., Javid F. et al. Does anti-müllerian hormone vary during a menstrual cycle? A systematic review and meta-analysis. J. Ovarian Res. 2022; 15(1): 78. https://dx.doi.org/10.1186/s13048-022-01006-z
  19. Bungum L., Tagevi J., Jokubkiene L., Bungum M., Giwercman A., Macklon N. et al. The impact of the biological variability or assay performance on AMH measurements: a prospective cohort study with AMH tested on three analytical assay-platforms. Front. Endocrinol. (Lausanne). 2018; 9: 603. https://dx.doi.org/10.3389/fendo.2018.00603
  20. Şükür Y.E., Aslan B., Kaplan N.B., Doğru M., Özmen B., Sönmezer M. et al. Inter-cycle variability of anti-müllerian hormone: implications for predicting controlled ovarian stimulation cycle outcomes. J. Ovarian Res. 2024; 17(1): 209. https://dx.doi.org/10.1186/s13048-024-01517-x
  21. Moslehi N., Shab-Bidar S., Ramezani Tehrani F., Mirmiran P., Azizi F. Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause. 2018; 25(9): 1046-55. https://dx.doi.org/10.1097/GME.0000000000001116
  22. Dennis N.A., Houghton L.A., Pankhurst M.W., Harper M.J., McLennan I.S. Acute supplementation with high dose vitamin D3 increases serum anti-müllerian hormone in young women. Nutrients. 2017; 9(7): 719. https://dx.doi.org/10.3390/nu9070719
  23. Li H.W.R., Robertson D.M., Burns C., Ledger W.L. Challenges in measuring AMH in the clinical setting. Front. Endocrinol. (Lausanne). 2021; 12: 691432. https://dx.doi.org/10.3389/fendo.2021.691432
  24. Li H.W., Wong B.P., Ip W.K., Yeung W.S., Ho P.C., Ng E.H.Y. Comparative evaluation of three new commercial immunoassays for anti-müllerian hormone measurement. Hum. Reprod. 2016; 31(12): 2796-2802. https://dx.doi.org/10.1093/humrep/dew248
  25. Moolhuijsen L.M.E., Louwers Y.V., Laven J.S.E., Visser J.A. Comparison of 3 different AMH assays with AMH levels and follicle count in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2022; 107(9): e3714-22. https://dx.doi.org/10.1210/clinem/dgac370
  26. Plociennik L., Nelson S.M., Lukaszuk A., Kunicki M., Podfigurna A., Meczekalski B. et al. Age-related decline in AMH is assay dependent limiting clinical interpretation of repeat AMH measures across the reproductive lifespan. Gynecol. Endocrinol. 2018; 34(2): 115-9. https://dx.doi.org/10.1080/09513590.2017.1358708
  27. Jeong H.G., Kim S.K., Lee J.R., Jee B.C. Correlation of oocyte number with serum anti-Müllerian hormone levels measured by either access or elecsys in fresh in vitro fertilization cycles. Clin. Exp. Reprod. Med. 2022; 49(3): 202-9. https://dx.doi.org/10.5653/cerm.2022.05211
  28. Anderson R.A., Anckaert E., Bosch E., Dewailly D., Dunlop C.E., Fehr D. et al. Prospective study into the value of the automated elecsys antimüllerian hormone assay for the assessment of the ovarian growing follicle pool. Fertil. Steril. 2015; 103(4): 1074-80.e4. https://dx.doi.org/10.1016/j.fertnstert.2015.01.004
  29. Iliodromiti S., Salje B., Dewailly D., Fairburn C., Fanchin R., Fleming R. et al. Non-equivalence of anti-müllerian hormone automated assays-clinical implications for use as a companion diagnostic for individualised gonadotrophin dosing. Hum. Reprod. 2017; 32(8): 1710-15. https://dx.doi.org/10.1093/humrep/dex219
  30. Берестовская В.С., Эмануэль А.В., Скибо И.И., Эмануэль В.Л. Интерпретация референтных интервалов и порогов клинических решений. Медицинский алфавит. 2024; 20: 79-82. [Berestovskaya V.S., Emanuel A.V., Skibo I.I., Emanuel V.L. Interpretation of reference intervals and clinical decision limits. Medical Alphabet. 2024; 20: 79-82 (in Russian)]. https://dx.doi.org/10.33667/2078-5631-2024-20-79-82
  31. Barbagallo F., van der Ham K., Willemsen S.P., Louwers Y.V., Laven J.S. Age-related curves of AMH using the gen II, the picoAMH, and the elecsys assays in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2024; 109(10): 2561-70. https://dx.doi.org/10.1210/clinem/dgae153
  32. Ferguson J., Hockley J., Rigsby P., Burns C. Establishment of a WHO reference reagent for anti-mullerian hormone. Reprod. Biol. Endocrinol. 2020; 18(1): 86. https://dx.doi.org/10.1186/s12958-020-00641-9

Received 10.07.2025

Accepted 28.07.2025

About the Authors

Maria I. Yarmolinskaya, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Head of the Department of Gynecology and Endocrinology, Head of the Center of Diagnostics and Treatment of Endometriosis, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology,
199034, Russia, St. Petersburg, Mendeleevskaya line, 3, m.yarmolinskaya@gmail.com, SPIN-код: 3686-3605, Researcher ID: P-2183-2014, Scopus Author ID: 7801562649, https://orcid.org/0000-0002-6551-4147
Sofya A. Cherkashina, doctor at the Consultative and Diagnostic Department No. 2, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology,
199034, Russia, St. Petersburg, Mendeleevskaya line, 3, sonyach@list.ru, https://orcid.org/0009-0005-7208-3575
Corresponding author: Maria I. Yarmolinskaya, m.yarmolinskaya@gmail.com

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.