The Role of Anti-Müllerian Hormone (Amh) In the Pathophysiology and Therapeutic Approaches in Female Infertility: A Review
Keywords:
AMH, Female Infertility, TGF-β, PCOSAbstract
Anti-Müllerian Hormone (AMH) is a hormone that belongs to the transforming growth factor beta (TGF-β) superfamily. It is involved in the development and functioning of the reproductive tract and is used as a marker for ovarian reserve. This review aims to outline the current knowledge of the physiology, pathophysiology, and therapeutic applications of AMH in females with infertility focusing on recent molecular and clinical developments. AMH plays a central role in regulation of folliculogenesis, inhibiting primordial follicle recruitment and thereby modifying the sensitivity of reduced number large growing follicles to FSH stimulation. However, as AMH levels are relatively stable throughout the menstrual cycle, it is currently considered one of best reproductive aging biomarkers of ovarian reserve and consequently reproductive lifespan. At physiological levels, AMH plays a major role in ovarian homeostasis, follicular maturation and the maintenance of the ovarian follicular reserve. Changes in AMH synthesis or action are related with multiple reproductive disorders, including polycystic ovary syndrome (PCOS), diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), endometriosis, and granulosa cell tumors. Women with PCOS having increased AMH levels exhibit both follicular arrest and anovulatory infertility while women undergoing ovarian aging have less AMH production with consequent impaired fecundity. In addition, recent advances also postulated possible utilization of AMH in clinical settings ranging from being an ovarian protector during chemotherapy (due to the effects on chemoresistance), to modulating specific pathways linked with reproductive disorders. Despite notable advances, several issues regarding AMH assay standardization, age-dependent reference ranges and the link between circulating AMH concentrations and reproductive health outcomes remain to be resolved. Additionally, the molecular mechanisms of AMH action in endocrine ovarian dysfunction are still poorly understood. Final remarks AMH is a major regulator of the female reproductive system and an important infertility biomarker. Ongoing studies of the physiology and signaling pathways for AMH may help to micro-focus diagnostic and therapeutic strategies in female infertility, as well as improve personalized reproductive medicine.
References
Abbott, D. H., Hutcherson, B. A., & Dumesic, D. A. (2024). Anti-Müllerian Hormone: A Molecular Key to Unlocking Polycystic Ovary Syndrome?. Seminars in reproductive medicine, 42(1), 41–48. https://doi.org/10.1055/s-0044-1787525
Adebisi, O. Y., Singh, M., & Tobler, K. J. (2026, April 12). Female infertility. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556033/
Anderson, R. A., & Wallace, W. H. B. (2013). Antimüllerian hormone, the assessment of the ovarian reserve, and the reproductive outcome of the young patient with cancer. Fertility and Sterility, 99(6), 1469–1475. https://doi.org/10.1016/j.fertnstert.2013.03.014
Barton, A. L. (2008). Anti-Müllerian hormone: A new marker for ovarian function. Annals of Clinical Biochemistry, 45(2), 113–117. https://doi.org/10.1258/acb.2008.200804
Broer, S. L., Broekmans, F. J. M., Laven, J. S. E., & Fauser, B. C. J. M. (2014). Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Human Reproduction Update, 20(5), 688–701. https://doi.org/10.1093/humupd/dmu020
Broer, S. L., Broekmans, F. J., & Laven, J. S. (2014). Anti-Müllerian hormone: Ovarian reserve testing and its potential clinical implications. Human Reproduction Update, 20(5), 688–701. https://doi.org/10.1093/humupd/dmu020
Coccia, M. E., Gabbrielli, B., Cutajar, G., Piazzini, F., Evangelisti, P., Badolato, L., Falcone, P., Fucci, R., & Bulletti, C. (2026). Fertility preservation in women with diminished ovarian reserve: evaluating the AMH criteria. Journal of assisted reproduction and genetics, 43(3), 865–872. https://doi.org/10.1007/s10815-025-03779-w
Dewailly, D., Andersen, C. Y., Balen, A., Broekmans, F., Dilaver, N., Fanchin, R., ... & La Marca, A. (2014). The physiology and clinical utility of anti-Müllerian hormone in women. Human Reproduction Update, 20(3), 370–385. https://doi.org/10.1093/humupd/dmt062
di Clemente, N., et al. (2021). Anti-Müllerian hormone in female reproduction. Endocrine Reviews, 42(5), 753–782. https://doi.org/10.1210/endrev/bnab012
Dumont, A., Robin, G., Catteau‐Jonard, S., & Dewailly, D. (2015). Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of polycystic ovary syndrome: A review. Reproductive Biology and Endocrinology, 13(1), 137. https://doi.org/10.1186/s12958-015-0134-9
Durlinger, A. L., Visser, J. A., & Themmen, A. P. (2002). Regulation of ovarian function: The role of anti-Müllerian hormone. Reproduction, 124(5), 601–609. https://doi.org/10.1530/rep.0.1240601
Hirano, M., Onodera, T., Takasaki, K., Takahashi, Y., Ichinose, T., Nishida, H., Hiraike, H., & Nagasaka, K. (2025). Ovarian aging: pathophysiology and recent developments in maintaining ovarian reserve. Frontiers in endocrinology, 16, 1619516. https://doi.org/10.3389/fendo.2025.1619516
Iwase, A., Nakamura, T., Osuka, S., Takikawa, S., Goto, M., & Kikkawa, F. (2015). Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?. Reproductive medicine and biology, 15(3), 127–136. https://doi.org/10.1007/s12522-015-0227-3
Josso, N., di Clemente, N., & Gouédard, L. (2013). Anti-Müllerian hormone and its receptors. Molecular and Cellular Endocrinology, 211(1–2), 25–29. https://doi.org/10.1016/j.mce.2003.09.008
Kano, M., Sosulski, A. E., Zhang, L., Saatcioglu, H. D., Wang, D., Nagykery, N., ... & Lawson, M. A. (2017). AMH/MIS as a contraceptive that protects the ovarian reserve during chemotherapy. Proceedings of the National Academy of Sciences, 114(9), E1688–E1697. https://doi.org/10.1073/pnas.1620729114
Ke, Y., Tang, D., Yang, Q., Zhao, H., Zheng, J., & Zhu, C. (2025). Anti-Müllerian hormone in PCOS: Molecular regulation and emerging therapeutic strategies. Biomolecules & biomedicine, 26(2), 173–185. https://doi.org/10.17305/bb.2025.12070
La Marca, A., & Sunkara, S. K. (2014). Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: From theory to practice. Human Reproduction Update, 20(1), 124–140. https://doi.org/10.1093/humupd/dmt037
La Marca, A., & Volpe, A. (2006). Anti-Müllerian hormone (AMH) in female reproduction: Is measurement of circulating AMH a useful tool? Clinical Endocrinology, 64(6), 603–610. https://doi.org/10.1111/j.1365-2265.2006.02533.x
Laven, J. (2025). Polycystic ovary syndrome: Anti-Müllerian hormone and its role in the pathophysiology of the syndrome. Fertility and Sterility, 124(5, Part 2), 910–918. https://doi.org/10.1016/j.fertnstert.2025.08.023
Li, H. W. R., Robertson, D. M., Burns, C., & Ledger, W. L. (2021). Challenges in Measuring AMH in the Clinical Setting. Frontiers in endocrinology, 12, 691432. https://doi.org/10.3389/fendo.2021.691432
Li, J., Zhu, W., Bu, Y., Li, L., Wei, H., & Zhang, S. (2026). Molecular mechanisms and multi-organ regulatory roles of anti-Müllerian hormone in female reproduction. Communications Biology, 9, 658. https://doi.org/10.1038/s42003-026-10273-1
Li, Y., Wei, L. N., & Liang, X. Y. (2011). Follicle-stimulating hormone suppressed excessive production of antimullerian hormone caused by abnormally enhanced promoter activity in polycystic ovary syndrome granulosa cells. Fertility and sterility, 95(7), 2354–2358.e1. https://doi.org/10.1016/j.fertnstert.2011.03.047
Moolhuijsen, L. M. E., & Visser, J. A. (2020). Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. The Journal of clinical endocrinology and metabolism, 105(11), 3361–3373. https://doi.org/10.1210/clinem/dgaa513
Muharam, R., Prasetyo, Y. D., Prabowo, K. A., Putri, Y. I., Maidarti, M., & Hestiantoro, A. (2022). IVF outcome with a high level of AMH: a focus on PCOS versus non-PCOS. BMC women's health, 22(1), 172. https://doi.org/10.1186/s12905-022-01756-4
Özcan, P., Varlı, B., Sarıdoğan, E., Oral, E., Mabrouk, M., Usta, T., & Constantin, A. S. (2025). Mechanisms of Endometrioma-Mediated Ovarian Damage: Myths and Facts. Journal of clinical medicine, 14(7), 2147. https://doi.org/10.3390/jcm14072147
Pellatt, L., Hanna, L., Brincat, M., Galea, R., Brain, H., Whitehead, S., & Mason, H. (2007). Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. The Journal of Clinical Endocrinology & Metabolism, 92(1), 240–245. https://doi.org/10.1210/jc.2006-1582
Pelosi, E., Simonsick, E., Forabosco, A., Garcia-Ortiz, J. E., & Schlessinger, D. (2015). Dynamics of the ovarian reserve and impact of genetic and epidemiological factors on age of menopause. Biology of reproduction, 92(5), 130. https://doi.org/10.1095/biolreprod.114.127381
Raffi, F., Metwally, M., & Amer, S. (2012). The impact of excision of ovarian endometrioma on ovarian reserve: A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 97(9), 3146–3154. https://doi.org/10.1210/jc.2012-1558
Ran, Y., Yi, Q., & Li, C. (2021). The Relationship of Anti-Mullerian Hormone in Polycystic Ovary Syndrome Patients with Different Subgroups. Diabetes, metabolic syndrome and obesity : targets and therapy, 14, 1419–1424. https://doi.org/10.2147/DMSO.S299558
Regan, S. L. P., Knight, P. G., Yovich, J. L., Leung, Y., Arfuso, F., & Dharmarajan, A. (2018). Granulosa Cell Apoptosis in the Ovarian Follicle-A Changing View. Frontiers in endocrinology, 9, 61. https://doi.org/10.3389/fendo.2018.00061
Robertson, D. M. (2008). Anti-Müllerian hormone as a marker of ovarian reserve: An update. Women’s Health, 4(2), 137–141. https://doi.org/10.2217/17455057.4.2.137
Rodgers, R. J., Abbott, J. A., Walters, K. A., & Ledger, W. L. (2021). Translational physiology of anti-Müllerian hormone: Clinical applications in female fertility preservation and cancer treatment. Frontiers in Endocrinology, 12, 689532. https://doi.org/10.3389/fendo.2021.689532
Rudnicka, E., Kunicki, M., Calik-Ksepka, A., Suchta, K., Duszewska, A., & Smolarczyk, R. (2021). Anti-Müllerian hormone in pathogenesis, diagnostic and treatment of PCOS. International Journal of Molecular Sciences, 22(22), 12507. https://doi.org/10.3390/ijms222212507
Russell, N., Gilmore, A., & Roudebush, W. E. (2022). Clinical utilities of Anti-Müllerian hormone. Journal of Clinical Medicine, 11(23), 7209. https://doi.org/10.3390/jcm11237209
Shrikhande, L., Shrikhande, B., & Shrikhande, A. (2020). AMH and Its Clinical Implications. Journal of obstetrics and gynaecology of India, 70(5), 337–341. https://doi.org/10.1007/s13224-020-01362-0
Sinha, N., Driscoll, C. S., Qi, W., Huang, B., Roy, S., Knott, J. G., Wang, J., & Sen, A. (2022). Anti-Müllerian hormone treatment enhances oocyte quality, embryonic development and live birth rate†. Biology of reproduction, 107(3), 813–822. https://doi.org/10.1093/biolre/ioac116
Sonigo, C., Beau, I., Binart, N., & Grynberg, M. (2019). Anti-Müllerian Hormone in Fertility Preservation: Clinical and Therapeutic Applications. Clinical medicine insights. Reproductive health, 13, 1179558119854755. https://doi.org/10.1177/1179558119854755
Sun, T. C., Chen, X., Shi, C., Tian, L., & Zhou, S. J. (2022). The Predictive Levels of Serum Anti-Müllerian Hormone and the Combined Index of the Number of Retrieved Oocytes and Good-Quality Embryos in Advanced-Age Infertile Women. International journal of endocrinology, 2022, 4224417. https://doi.org/10.1155/2022/4224417
Visser, J. A., de Jong, F. H., Laven, J. S., & Themmen, A. P. (2012). Anti-Müllerian hormone: A new marker for ovarian function. Reproduction, 131(1), 1–9. https://doi.org/10.1530/rep.1.00529
von Wolff, M., Imboden, S., & Stute, P. (2025). Fertility preservation in females requiring gonadotoxic therapy should be more than freezing measures before therapy - secondary fertility preservation and menopause care management after therapy should also be considered. Archives of gynecology and obstetrics, 312(5), 1539–1541. https://doi.org/10.1007/s00404-025-08104-5
Wang, L., Guo, Y., Yan, R., Yu, Y., Zhao, H., & Yan, Y. (2026). Recent Advances in Anti-Mullerian Hormone (AMH)-Related Osteoporosis Research. Biomedicines, 14(2), 428. https://doi.org/10.3390/biomedicines14020428
