Anti-Müllerian Hormone (AMH) and Vitamin D: Can There Be a Correlation?

Anti-Müllerian Hormone (AMH) is an ovarian biomarker that plays an important role in folliculogenesis. It is the most sensitive marker of ovarian reserve, widely used clinically in reproductive medicine. While some studies have observed significant AMH fluctuations within a menstrual cycle, AMH is considered relatively stable throughout the menstrual cycle. There are pathological situations, however, where AMH levels do not correlate with ovarian reserve. For example, in PCOS and hypothalamic amenorrhea, AMH levels can be abnormally high and abnormally low, respectively, which reflects the specific stage of arrest in follicular development rather than the size of the primordial follicular pool.

Currently, there is considerable debate in the field about whether vitamin D has the capacity to influence ovarian folliculogenesis, as indicated by AMH levels, as well as the direction this influence might take. This question is of particular importance given the increasing attention that vitamin D supplementation has recently received from the reproductive medicine community, based on accumulating evidence that vitamin D may be beneficial for fertility and pregnancy.

In a meta-analysis, evidence is provided that the effects of vitamin D supplementation on AMH appear to depend on the woman's ovulatory status. Interestingly, vitamin D supplementation seems to decrease AMH levels in anovulatory women with PCOS, whereas vitamin D supplementation appears to increase AMH levels in ovulatory women without PCOS. In PCOS, where AMH is abnormally elevated, this likely reflects vitamin D's ability to improve folliculogenesis and is consistent with evidence from several clinical trials showing improvement in clinical manifestations following vitamin D supplementation. More importantly, since AMH is produced by granulosa cells of pre-antral and small antral follicles, but not primordial follicles, it is only an approximation of "ovarian reserve." Therefore, it has not yet been determined whether any changes in AMH levels induced by vitamin D supplementation may be a reflection of local changes in folliculogenesis within the ovarian microenvironment or, conversely, may be indicative of true changes in a woman's ovarian reserve. Nevertheless, vitamin D is a relatively safe and inexpensive oral supplement, and accumulated evidence suggests its potential benefit for various aspects of human reproduction, including increased rates of pregnancy and live births in assisted reproductive technology, decreasing the risk of pregnancy loss, as well as various pregnancy complications.

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