Anti-Müllerian Hormone (AMH), a glycoprotein hormone produced by granulosa cells of pre-antral and small antral follicles, has emerged as a pivotal biomarker for assessing ovarian reserve [1]. Unlike traditional markers such as follicle-stimulating hormone (FSH) and estradiol, AMH levels remain relatively stable throughout the menstrual cycle, making it a reliable and convenient indicator of ovarian function. In recent years, AMH has gained widespread acceptance in reproductive medicine for evaluating fertility potential, predicting ovarian response to stimulation, and guiding assisted reproductive techniques (ART) [2]. Ovarian reserve refers to the quantity and quality of a woman's remaining oocytes and is a key determinant of reproductive capacity [3]. With advancing age, ovarian reserve declines, leading to reduced fertility and increased risk of infertility [4]. Early identification of diminished ovarian reserve is crucial for timely intervention and counseling. AMH has demonstrated a strong correlation with antral follicle count (AFC), which is considered a direct ultrasonographic marker of ovarian reserve [5]. Therefore, AMH serves as a non-invasive, biochemical surrogate for assessing ovarian status [6]. Infertility is a growing global health concern, affecting approximately 10–15% of couples worldwide. In developing countries, including Pakistan, the burden is further compounded by limited access to specialized reproductive healthcare services. Identifying cost-effective and reliable diagnostic tools is essential to optimizing fertility evaluation and management [7]. AMH testing provides clinicians with valuable insights into ovarian responsiveness, aiding in individualized treatment planning and improving clinical outcomes [8]. Furthermore, AMH plays a critical role in predicting ovarian response in assisted reproductive procedures, such as in vitro fertilization (IVF). Women with low AMH levels are more likely to exhibit poor ovarian response, while those with high AMH levels may be at risk of ovarian hyperstimulation syndrome (OHSS). Thus, AMH not only predicts ovarian reserve but also helps in tailoring stimulation protocols to minimize risks and enhance success rates [9]. Despite its clinical utility, variations in AMH levels due to age, ethnicity, and underlying conditions such as polycystic ovary syndrome (PCOS) necessitate further study. Additionally, the relationship between AMH levels and actual fertility outcomes, including ovulation and conception rates, remains an area of ongoing investigation [10]. This study aims to evaluate the role of serum AMH in predicting ovarian reserve and its association with fertility outcomes among women presenting with infertility. By correlating AMH levels with antral follicle count and reproductive outcomes, this study seeks to strengthen evidence for its use as a reliable diagnostic and prognostic tool in clinical practice.

Study Design & Setting

This cross-sectional study was conducted at the Department of Obstetrics and Gynecology Gomal Medical College,Dera Ismail Khan from 05 June  2024 05  December  2024  over six months.

Participants

A total of 100 patients aged 20–40 years presenting with primary or secondary infertility were enrolled. Patients were recruited through outpatient clinics. Women with regular and irregular menstrual cycles were included. Detailed history, clinical examination, and baseline investigations were performed for all participants before enrollment in the study.

Sample Size Calculation

The sample size of 100 patients was calculated using a 95% confidence interval, 5% margin of error, and an anticipated prevalence of infertility-related diminished ovarian reserve of 50%. This ensured adequate statistical power to detect significant associations between AMH levels and fertility outcomes.

Inclusion Criteria

• Women aged 20–40 years
• Diagnosed with primary or secondary infertility
• Willing to participate and provide informed consent

Exclusion Criteria

• History of ovarian surgery
• Hormonal therapy within the last three months
• Known endocrine disorders (e.g., thyroid disease, hyperprolactinemia)
• Severe systemic illness.

Diagnostic and Management Strategy

Serum AMH levels were measured using ELISA. Ovarian reserve was assessed via transvaginal ultrasound for antral follicle count. Patients were followed for ovulation and conception outcomes, and appropriate fertility management was advised based on clinical findings.

Statistical Analysis

Data were analyzed using SPSS version 25. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Associations between AMH levels and fertility outcomes were assessed using chi-square and independent t-tests. A p-value ≤0.05 was considered statistically significant.

Ethical Approval Statement

Ethical approval for this study was obtained from the Institutional Review Board/Ethics Committee of the participating tertiary care hospital prior to commencement of the study. All procedures were conducted in accordance with institutional ethical standards and the principles of the Declaration of Helsinki

A total of 100(patients) were included in the study, with a mean age of 29.8 ± 4.6 years. Based on serum AMH levels, 30% of participants had low AMH (<1.0 ng/mL), 50% had normal levels (1.0–3.5 ng/mL), and 20% had high AMH (>3.5 ng/mL). Women with normal AMH levels demonstrated significantly higher antral follicle counts compared to those with low AMH levels (p<0.001). The mean age was significantly higher in the low AMH group (32.1 ± 3.8 years) compared to the normal (28.7 ± 4.2 years) and high AMH groups (27.9 ± 3.9 years), indicating a significant inverse relationship between age and AMH levels (p=0.01). Ovulation rates were highest among women with normal AMH levels (78%), followed by those with high AMH (65%) and low AMH (40%). Similarly, conception rates were significantly higher in the normal AMH group (52%) compared to the low AMH group (20%) (p=0.002). Overall, a statistically significant positive correlation was observed between serum AMH levels, ovarian reserve indicators, and fertility outcomes

Table 1: Baseline Characteristics of Study Participants (n=100)

Values are presented as mean ± standard deviation or frequency (percentage). This table summarizes demographic and clinical baseline characteristics of the study population.

Table 2: Distribution of Participants According to Serum AMH Levels

Participants were categorized based on serum AMH levels into low, normal, and high groups for comparison of ovarian reserve and fertility outcomes.

Table 3: Comparison of Ovarian Reserve Indicators by AMH Levels

Comparison of ovarian reserve indicators among different AMH groups. Higher AMH levels were significantly associated with increased antral follicle count and lower mean age.

Table 4: Fertility Outcomes According to AMH Levels

Fertility outcomes across AMH groups. Women with normal AMH levels had significantly higher ovulation and conception rates compared to those with low AMH levels.

The present study evaluated the role of serum Anti-Müllerian Hormone (AMH) as a predictor of ovarian reserve and fertility outcomes among infertile women. Our findings demonstrated a strong positive association between AMH levels and antral follicle count (AFC), along with significantly improved ovulation and conception rates in women with normal AMH levels. These results reinforce the growing body of evidence supporting AMH as a reliable biomarker of ovarian reserve and reproductive potential. Recent studies (2024–2025) have consistently shown that AMH correlates strongly with the ovarian follicular pool and AFC. A histological validation study confirmed that AMH and AFC accurately reflect the primordial follicle pool, establishing their reliability as non-invasive markers of ovarian reserve [11,12]. Similarly, another 2025 study reported a significant positive correlation between AMH and AFC (p<0.001), supporting our observation that women with higher AMH levels had better ovarian reserve indicators [13]. Our study also demonstrated a significant inverse relationship between age and AMH levels (p=0.01), with lower AMH observed in older individuals. This finding aligns with multiple recent studies showing that AMH declines progressively with advancing age and can predict ovarian aging and menopausal timing [14]. Large-scale analyses have further confirmed that diminished ovarian reserve increases significantly after the mid-30s, with AMH levels dropping below critical thresholds [15].In terms of fertility outcomes, our results indicated that women with normal AMH levels had significantly higher ovulation and conception rates compared to those with low AMH (p=0.002). These findings are consistent with a recent study demonstrating that low AMH levels are associated with reduced chances of pregnancy and poor ovarian response [16]. However, some studies suggest that while AMH is predictive of oocyte quantity and ovarian response, its role in predicting live birth or embryo quality remains limited [17]. For example, a large IVF-based study reported no significant association between AMH levels and embryo euploidy or live birth rates, highlighting that AMH primarily reflects ovarian quantity rather than quality [18].Interestingly, our findings showed relatively moderate fertility outcomes even in the high AMH group, which may be explained by underlying conditions such as polycystic ovary syndrome (PCOS), where elevated AMH does not always translate into improved fertility. This observation is supported by recent literature suggesting that AMH levels can be influenced by various physiological and pathological factors, necessitating cautious interpretation [19]. Comparatively, earlier studies (2020–2021) also reported similar findings, emphasizing AMH as a superior marker compared to traditional hormones like FSH due to its stability and stronger correlation with AFC [20]. However, some discrepancies exist, as certain studies have reported weaker correlations between AMH and AFC, possibly due to methodological differences or population variability [21]. Overall, our study findings are in agreement with most contemporary studies, confirming that AMH is a valuable tool for assessing ovarian reserve and predicting ovarian response. However, its role as a standalone predictor of fertility outcomes remains limited, and it should be interpreted in conjunction with clinical, biochemical, and ultrasonographic parameters. Future studies should focus on integrating AMH with other biomarkers to enhance its predictive accuracy in reproductive medicine [22].

Limitations

This study has several limitations, including a relatively small sample size and a single-center design, which may limit generalizability. The short follow-up period restricted the assessment of long-term fertility outcomes such as live birth rates. Additionally, potential confounding factors like lifestyle, hormonal variations, and underlying conditions such as PCOS were not fully controlled.,

Serum AMH is a reliable marker for assessing ovarian reserve and predicting fertility outcomes. Women with normal AMH levels show better reproductive performance. Incorporating AMH into routine infertility evaluation can facilitate early diagnosis, guide personalized treatment strategies, and improve clinical decision-making in reproductive medicine.

ACKNOWLEDGEMENT

The authors acknowledge the support of the Gomal Medical College,Dera Ismail Khan for facilitating data collection and diagnostic procedures.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

FUNDING

No external funding was received for this study.

INFORMED CONSENT

Written informed consent was obtained from all participants prior to enrollment in the study.

DATA AVAILABILITY STATEMENT

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

DISCLAIMER

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the affiliated institution.

Author Contributions

Rubina Baber contributed to the conception and design of the study, data interpretation, and critical revision of the manuscript. Uzma Zamancontributed to data collection, statistical analysis, and drafting of the manuscript. Nayyer Latif contributed to study supervision, manuscript review, and final approval of the version to be published. All authors meet the ICMJE authorship criteria and approved the final manuscripte

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