ESPE Yearbook of Paediatric Endocrinology

Brief summary: This long-term longitudinal study of 437 Danish girls shows that AMH level measured in infancy is a useful tool to predict future ovarian activity.

Anti-Müllerian hormone (AMH) is produced by granulosa cells in small ovarian follicles and thus reflects the ovarian reserve of resting primordial follicles (1). High AMH concentrations are observed in women with polycystic ovarian syndrome (PCOS) (2), while low age-specific AMH could be associated with an increased risk of early menopause (3), although longitudinal studies are needed to confirm this hypothesis.

The first aim of this study was to evaluate the potential correlation between AMH concentrations in infancy (median age 0.3 yrs) and mid-childhood (7.2 yrs) and concentrations in puberty (11.3 yrs) and adolescence (15.9 yrs). Participants needed at least two AMH measurements to be included in the study (n=437). Some of these girls were also assessed for reproductive hormones and underwent transabdominal ultrasound (TAUS) and magnetic resonance imaging (MRI) of the ovaries at puberty (TAUS n=83 and MRI n=78) and adolescence (TAUS, n=137) to evaluate ovarian morphology.

Each girl maintained her relative AMH concentration over time. AMH serum concentrations in mid-childhood predicted the number of ovarian follicles during puberty and adolescence.

Because AMH levels in childhood could predict hypergonadotropic hypogonadism at time of expected puberty (4), the authors propose to monitor early AMH levels in patients at risk of premature ovarian insufficiency to offer early fertility preservation strategies. Another potential clinical application relies on the demonstration that AMH in early childhood was associated with adolescent hormone concentrations, ovarian morphology and menstrual cycle patterns resembling PCOS in adulthood.

In conclusion, this article documents a strong correlation between AMH concentrations in infancy/mid-childhood and concentrations in puberty/adolescence. In mid-childhood, AMH concentrations also reflected the number of ovarian follicles in puberty and adolescence, and could therefore be used as a clinical tool to predict future ovarian activity.

References: 1. Jeppesen JV, Anderson R a, Kelsey TW, et al. Which follicles make the most anti-Mullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19:519–527. 2. Lauritsen MP, Bentzen JG, Pinborg a, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod. 2014;0:1–11. 3. Depmann M, Eijkemans MJC, Broer SL, et al. Does AMH relate to timing of menopause? results of an individual patient data metaanalysis. J Clin Endocrinol Metab. 2018;103:3593–3600. 4. Lunding SA, Aksglaede L, Anderson R a, et al. AMH as predictor of premature ovarian insufficiency: a longitudinal study of 120 turner syndrome patients. J Clin Endocrinol Metab. 2015;100:E1030– E1038.