In the previous two issues, we introduced the basic physiological role of anti-Müllerian hormone (AMH) and its role in predicting ovarian reserve function, which also has a wide range of applications in assisted pregnancy due to its accumulation in early anterior sinus follicles. In this issue, we provide a brief overview of the use of AMH in assisted pregnancy. Predicting ovarian responsiveness In assisted pregnancy, artificial cycles are often used to help patients produce mature follicles and AMH levels are often consistent with ovarian responsiveness In 2009, a team of researchers from St. Mary’s Hospital in the UK found a significant positive correlation between basal serum AMH levels and ovarian responsiveness in 165 women under 40 years of age who underwent ovulation with artificial cycles. Moreover, AMH was a better predictor of ovarian responsiveness than FSH and E2. After observing 49 women over 40 years of age undergoing IVF for the first time, the 2013 Kawasaki research team in Japan found that AMH levels were consistent with the number of eggs obtained, and that ovarian responsiveness was significantly lower in those with AMH levels below 1.0 ng/ml. In a larger observational study in the Netherlands in 2015, it was concluded that pre-intervention AMH levels accurately predicted ovarian responsiveness in those using a GnRH antagonist ovulation regimen, with AMH levels greater than 4.5 ng/ml suggesting good ovarian responsiveness, while levels less than 0.8 ng/ml suggesting no ovarian response. Predicting ovarian hyperstimulation However, a higher AMH level is not always better. In 2008, a team of Taiwanese researchers first found that pre-intervention AMH was higher in OHSS patients than in non-OHSS patients, and AMH greater than 3.36 ng/ml indicated a high risk of OHSS. A team from Istanbul University Hospital in Turkey reported similar results in 2011 and suggested that AMH above 3.3 ng/ml suggested an increased risk of OHSS. 2015 a team from Tongji Medical College in Wuhan, China, found in a mouse model that a deficiency in the action of AMH receptor protein 2 (AMHR2) was one of the important pathological causes of OHSS. It can be seen that the high AMH in OHSS patients may be a negative feedback effect for the AMH-AMHR2 signaling pathway. Deciding on an ovulation promotion protocol? Since AMH levels prior to assisted pregnancy are consistent with the patient’s ovarian response, can it be used clinically as an indicator to determine ovulation protocols?A 2009 UK study in 538 patients found that ovulation protocols with GnRH antagonists in patients with high AMH levels (AMH >15 pmol/L) reduced the incidence of OHSS, whereas patients with normal AMH levels (AMH between 5 and 15 pmol/L) (A 2012 Italian study found that the ovulation regimen could be determined by a combination of patient age, AMH and FSH levels, with the younger the patient and the higher the AMH level, the lower the FSH dose in the ovulation regimen. It appears that reference to AMH levels may be useful in selecting the most appropriate ovulation regimen for the individual patient. Predicting pregnancy rates? Can AMH levels predict the success rate after assisted pregnancy? The results of studies are mixed, but in 2013 the Kawasaki research team in Japan found that AMH levels were not associated with clinical pregnancy rates in women over 40 years of age undergoing IVF. While another Dutch study in the same year found that in women with FSH >10ng/ml on day 3 of menstruation, AMH 0.2ng/ml appeared to be the cut-off for IVF/ICSI clinical pregnancy rates, with women with AMH below 0.2ng/ml having significantly lower clinical pregnancy rates than other women. In contrast, a 2015 meta-analysis showed that AMH levels were not associated with IVF/ICSI clinical pregnancy rates. Anti-Mullerian hormone is widely used in assisted reproduction, and AMH measurement prior to assisted pregnancy intervention can help physicians understand the patient’s ovarian reserve function in a timely manner, predict the risk of ovarian hyperstimulation sign, and even help physicians to make a comprehensive assessment to decide the decision of ovulation promotion protocol.