title: Anti-Mullerian hormone as a predictor of follicular reserve in ovarian insufficiency: special emphasis on FSH-resistant ovaries.
abstract: BACKGROUND
  Anti-Müllerian hormone (AMH) is secreted by ovarian granulosa cells and its serum levels reflect ovarian follicle reserve. The main objective of this study was to test the use of AMH assay in identifying women with primary amenorrhea (PA) and existing follicles and to study follicle phase dependent AMH secretion.
  
  
  METHODS
  Serum levels of AMH were measured in subjects with FSH-resistant ovaries (FSHRO, n= 12), primary ovarian insufficiency (POI) with PA (n= 11) or secondary amenorrhea (SA n= 20) of unknown etiology, and controls (n= 23), and in Turner syndrome (TS) [45,X (n= 18), mosaicism (n= 7), structural X chromosome abnormalities (SCA, n= 10)], and healthy controls (n= 34).
  
  
  RESULTS
  Serum levels of AMH in women with FSHRO were comparable with those in control women (2.76 ± 2.37 versus 3.77 ± 2.36 ng/ml) and significantly higher than in women with PA (0.05 ± 0.04 ng/ml; P < 0.001) or SA of unknown origin (0.12 ± 0.20 ng/ml; P < 0.001). TS girls/women with 45,X or SCA had low serum AMH levels (0.13 ± 0.09 and 0.27 ± 0.19 ng/ml) compared with their controls (3.34 ± 2.23 ng/ml) or subjects with mosaicism (2.33 ± 2.81 ng/ml). AMH expression was detected in granulosa cells of women with FSHRO but not in any of the 45,X fetal ovarian specimens.
  
  
  CONCLUSIONS
  A serum AMH assay could be used to identify patients with decreasing ovarian reserves and POI. Moreover, our results support the notion that AMH is secreted mainly by small non-selected follicles, since follicular granulosa cells were AMH-positive and serum AMH levels were normal/low normal in women with FSHRO, who lack follicle development beyond the small antral stage.
authors.affiliation: Department of Obstetrics and Gynecology and Clinical Research Center, Oulu University Hospital, PO Box 5000, Oulu FIN-90014, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Kallio
authors.forename: K
authors.initials: K
authors.lastname: Aittomäki
authors.forename: T
authors.initials: T
authors.lastname: Piltonen
authors.forename: R
authors.initials: R
authors.lastname: Veijola
authors.forename: A
authors.initials: A
authors.lastname: Liakka
authors.forename: T E
authors.initials: TE
authors.lastname: Vaskivuo
authors.forename: L
authors.initials: L
authors.lastname: Dunkel
authors.forename: J S
authors.initials: JS
authors.lastname: Tapanainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000378:metabolism; D054304:Anti-Mullerian Hormone / Q000097:blood* / Q000378:metabolism; D002648:Child; D041321:Chromosomes, Human, X; D005260:Female; D005640:Follicle Stimulating Hormone / Q000494:pharmacology*; D006801:Humans; D009030:Mosaicism; D006080:Ovarian Follicle / Q000187:drug effects / Q000473:pathology / Q000502:physiology*; D012729:Sex Chromosome Aberrations; D014424:Turner Syndrome / Q000097:blood / Q000378:metabolism
chemical_list: D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone