The ovaries of women of reproductive age may show specific histological structures that may relate to the maintenance of primordial follicles and the regulation of early follicular development, which are keys to understanding the dynamics of ovarian reserve. The pelvic environment of women is frequently exposed to physiological or pathological inflammatory stimuli. Endometriosis is a disorder that should be viewed as a chronic inflammatory disease manifested by pelvic pain and infertility. Inflammation surrounding the normal ovarian cortex may alter the histological structure which possesses primordial and early growing follicles. Fibrotic changes in histological niches in the nest of primordial follicles may provoke activation of dormant follicles and concomitant atresia. Along with decline in AMH, which is produced by early growing follicles, fibrotic changes may accelerate the demise of primordial follicles which has been described as “burn-out by inflammation”. As a result, women with endometriosis may suffer from diminished ovarian reserve, a possible cause of endometriosis-related infertility.
Abstract: Anti-Müllerian hormone (AMH) was originally discovered as the factor responsible for the regression of the Müllerian duct during male sexual differentiation. Through studies of AMH knockout mice, AMH has also been found to regulate primordial follicle recruitment and FSH-dependent cyclic recruitment. However, the details of how AMH influences follicular growth have not been elucidated. Since the early 2000s, when serum AMH concentration was found to be a reliable biochemical marker of ovarian reserve, AMH has been in the spotlight in reproductive medicine. Several studies of AMH have led to new insights on the mechanism of AMH-regulated follicular growth. Here, we review from the earliest studies to the latest findings, AMH regulation of follicle growth with reference to the potential clinical uses of AMH and AMH inhibitors.
