ANTI-MULLERIAN HORMONE (AMH) AFTER LAPAROSCOPIC
SURGERY OF THE OVARIES
Dr. Kamala Selvaraj MD DGO PhD
GG Hospital
Fertility Research Centre
6E, NH Road, Chennai – 34
Ph : 91-44-28277563 / 28277694.
E-mail : drkamala@gghospital.in
Operative laparoscopy is the gold standard for surgical approach in treating pathological
ovaries presenting with infertility. Common ovarian pathology related to infertility is
endometriosis, simple cysts, dermoid and ovarian surface coagulation for PCOS. Any
conservative or surgical approach has possible effect on ovarian reserve and response to
therapy. There are several methods to assess this reserve commonly like FSH, LH, AFC and
AMH. Recently AMH has been taken into consideration for providing very accurate
assessment and ease of testing unrelated to period of cycle.
The Anti mullerian hormone is a dimeric glycoprotein, belonging to the transforming
growth factor beta - family and is produced solely by the granulosa cells of the recruited
follicles until they become sensitive to FSH.
The serum level of AMH declines with age, is menstrual cycle independent and is
unaffected by gonadotropin or GnRH agonist administration. Therefore, it may represent
the most reliable serum marker to indicate the number of growing follicles and reflect
ovarian follicular reserve.
Circulating AMH concentrations decline with increasing reproductive age in a manner
optimally described by a quadratic equation. This validated age related AMH nomogram
will enable counseling of infertility patients regarding reproductive performance in a
particular cycle.
According to literature review, following laparoscopic cystectomy versus coagulation for
ovarian endometriomas, there was a postoperative decline in serum AMH levels. Hence
serum AMH could be a reliable indicator to assess the performance in ART in these group
of patients.
Should it be deemed a gold standard or is it one among the evaluative process remains to
be answered. However it is worthwhile to remember that the ultimate testing or an
ovarian response is when these ovaries are suspected to hyperstimulation. Every other
reliable marker is only a predictor of that performance.