Anti-Mullerian hormone as a seminal marker for spermatogenesis in non-obstructive azoospermia

Anti-Mullerian hormone (AMH) also known as Mullerian inhibiting substance o r factor, is a Sertoli cell-secreted glycoprotein responsible in male embry os for Mullerian duct regression. However, its role in adults remains unkno wn. AMH seminal concentrations have been evaluated using an enzyme-linked i mmunoassay in three groups of young men: group 1, fertile donors (It = 18); group 2, obstructive azoospermia (n = 9) after vasectomy or associated wit h deferent duct agenesia; and group 3, nonobstructive azoospermia with sper matogenesis deficiency and normal karyotype (n = 23), AMH was present in se minal plasma of most fertile donors at concentrations ranging from undetect able (<3.5 pmol/l) up to 543 pmol/l (geometric mean: 153 pmol/l), higher th an the serum level (range <3.5 up to 67 pmol/l, geometric mean: 10.7 pmol/l , n = 13), Seminal AMH concentrations were undetectable in all obstructive azoospermic patients, confirming its testicular origin. In non-obstructive azoospermia (group 3), seminal AMH concentration was lower (range <3.5-68.5 pmol/l, geometric mean: 17 pmol/l) than in fertile donors (P < 0.003) with out correlation with plasma follicle stimulating hormone values. In group 3 , comparison of seminal AMH concentration and the results of histological a nalysis of testicular biopsies revealed that undetectable AMH found in 14 c ases was associated in 11 of them with lack of spermatozoa, while detectabl e concentrations of AMH (10-68.5 pmol/l) found in nine cases were associate d in seven of them with persistent spermatogenesis, In the adult, AMH is se creted preferentially towards the seminiferous lumen. Although its relation ship with spermatogenesis requires further investigation, our results sugge st that seminal AMH may represent a non-invasive marker of persistent hypos permatogenesis in cases of non-obstructive azoospermia which may indicate t he likely success of testicular spermatozoa recovery before intracytoplasmi c sperm injection.