The anti-Müllerian hormone (AMH) in assessment of ovarian reserve has specific biological properties. Which of the following correctly describes the cell type producing AMH and its regulatory control?

• A AMH is produced by antral follicle granulosa cells; production is strongly FSH-dependent and cycles with menstrual gonadotropin fluctuations
• B AMH is produced by theca cells under LH stimulation and reflects the androgen-producing reserve
• C AMH is produced by primordial follicle oocytes and directly measures the non-growing follicle pool
• D AMH is produced by preantral and small antral follicle granulosa cells; production is largely gonadotropin-independent, making serum AMH a stable, cycle-independent marker ✓

Explanation

AMH is secreted by granulosa cells of preantral (primary and secondary) and small antral follicles (2–8 mm). Its production is largely independent of gonadotropin (FSH/LH) stimulation because these small follicles are in the gonadotropin-independent phase of development. This property gives AMH its key clinical advantage: unlike FSH and estradiol (which fluctuate significantly during the menstrual cycle), AMH levels are relatively stable across the cycle and can be measured at any cycle day. AMH reflects the number of small growing follicles and hence the size of the remaining primordial follicle pool. Very low or undetectable AMH indicates poor ovarian reserve. AMH also inhibits primordial-to-primary follicle activation, acting as a 'brake' on follicle recruitment.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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