Abstract:
Anti-Müllerian Hormone (AMH) is a 140 kDa homodimeric glycoprotein consisting of two
identical subunits linked by disulphide bonds and is synthesised by the testes and ovaries.
Its clinical applications are prediction of ovarian response and gonadotropin dose
selection upon in vitro fertilization. In males, AMH is used to investigate sexual
developmental disorders and gonadal function. AMH is commonly assayed by enzymelinked
immunosorbent assay or automated immunoassay formats that show variation
between methods. This review applies fundamental chemical pathology concepts to
explain the observed analytical variation of AMH measurement. We examine the lack of
standardisation between AMH assays, the impact of antibody design on variable
measurements, consider the analytical detection of AMH isoforms, review analytical
interference in AMH measurement, and briefly assess systematic bias between AMH
assays. The improved attempt at standardising AMH measurement by the recent
approval of a WHO Reference Reagent offers promise for harmonising immunoassay
results and establishing consensus medical cut-off points for AMH in disease.
Standardisation, however, will need to redress the issue of poor commutability of
standard reference material and further assign a standard reference procedure to
quantify AMH standard reference material. The improvement of the analytical phase of
AMH testing will support harmonised method development and patient care.
