Purpose of review: To review the role of mullerian inhibiting substance in the context of female reproduction.
Recent findings: Serum and follicular fluid mullerian inhibiting substance can be measured by commercially available enzyme-linked immunosorbent assay kits. Mullerian inhibiting substance is secreted from small antral follicles with minimal fluctuation throughout the menstrual cycle. The exact biological functions of mullerian inhibiting substance are uncertain; however, mullerian inhibiting substance most likely mediates follicle recruitment and selection, and may inhibit aromatase activity. Most data suggests an interaction between follicle-stimulating hormone, and mullerian inhibiting substance although the exact nature of the relationship is unknown. Mullerian inhibiting substance is characteristically elevated in polycystic ovarian syndrome, and may be associated with other features of polycystic ovary syndrome such as insulin resistance, hyperandrogenemia, and the degree of anovulation. Mullerian inhibiting substance changes have also been associated with functional hypothalamic amenorrhea, premature ovarian failure, endometriosis and obesity. Mullerian inhibiting substance has been studied extensively in the context of in-vitro fertilization and has been correlated with several outcome parameters.
Summary: Mullerian inhibiting substance is gaining acceptance as a useful marker of female reproductive function, especially with ovulatory disorders and IVF outcomes. Mullerian inhibiting substance offers several advantages to existing screening tests, but establishment of an assay standard should be considered before widespread clinical implementation becomes viable.