Lab Update 67 – Anti-Müllerian Hormone (AMH)
Authors: Dr Devina Govender & Dr Marita du Plessis
Published: August 2025
Overview of AMH
In male embryos, AMH is secreted by Sertoli cells in the testes and plays a key role in the regression of Müllerian ducts. Without AMH, these ducts develop into female reproductive organs.
In females, AMH is secreted by granulosa cells of primary and pre-antral ovarian follicles and serves as a predictor of ovarian follicular reserve.
AMH in PCOS Diagnosis
The 2023 International Evidence-based Guideline for Polycystic Ovary Syndrome (PCOS) recommends using the 2003 Rotterdam criteria, which require two of the following:
- Clinical or biochemical hyperandrogenism
- Ovulatory dysfunction (e.g., anovulation)
- Polycystic ovaries on ultrasound — or alternatively, AMH levels can now be used instead of ultrasound.
In adolescents, only criteria 1 and 2 are recommended.
Polycystic ovarian morphology (PCOM) is typically assessed via transvaginal ultrasound (TVUS), defined as an antral follicular count (AFC) >20 per ovary or ovary volume ≥10ml. However, using AMH as a blood test alternative is advantageous due to limited access and training for TVUS.
PCOS is the most common endocrine disorder in women, with reproductive, metabolic, and psychological implications. A reliable blood test like AMH offers a low-cost, convenient diagnostic option without increasing overdiagnosis.
AMH Cutoff for PCOM Diagnosis
A study by De Loos et al established a serum AMH cutoff of 3.2 ng/mL (23 pmol/L) using the Roche AMH Plus immunoassay. This threshold showed high sensitivity (88.6%) and specificity (84.6%) for diagnosing PCOM, regardless of race or PCOS phenotype. It applies to women aged 25–45 years.
Ampath now offers the AMH Plus assay on the Roche platform.
Sample type: Serum (SST)
AMH in IVF Treatment
Circulating AMH levels reflect ovarian reserve and the capacity to produce eggs for fertilization. AMH is a better predictor of clinical pregnancy outcomes in IVF than age, serum FSH, inhibin B, or oestradiol.
Elevated AMH levels can identify women at risk of ovarian hyperstimulation syndrome following gonadotrophin administration. An individualized dosing regimen of recombinant FSH—based on AMH level and patient weight—is used in controlled ovarian stimulation for assisted reproductive technology.
For further reading, refer to AmpathChat 28.1 – Anti-Müllerian Hormone (AMH) Physiology and Clinical Utility.