Correlation between serum AMH, AFC, AND histologically quantified primordial follicles: a prospective study in premenopausal women.
Level 4 - case-series / case-control
Prospective cross-sectional validation study
PubMed 41108002 · doi:10.1186/s13048-025-01807-y
What was done
Eighty-nine healthy, menstruating women aged 35–48 years undergoing unilateral or bilateral oophorectomy for benign gynecological conditions were enrolled in a prospective cross-sectional study. Preoperative serum levels of AMH, FSH, and estradiol (E2) were measured, and AFC was assessed using early-follicular-phase transvaginal ultrasound. Primordial follicles in excised ovarian tissue were histologically quantified by a blinded pathologist to test the validity of clinical biomarkers against true ovarian reserve.
What was found
Both AMH (ρ = 0.75, p < 0.001) and AFC (ρ = 0.85, p < 0.001) showed strong positive correlations with histological primordial follicle count. AMH also showed a strong negative correlation with FSH (ρ = -0.89) and a moderate negative correlation with E2 (ρ = -0.62). AFC demonstrated a moderate negative correlation with FSH (ρ = -0.67).
Why it matters
This study provides direct histological validation that non-invasive markers AMH and AFC accurately reflect the actual primordial follicle pool in premenopausal women.
Limits
The study was restricted to women aged 35–48 undergoing surgery for benign conditions, limiting generalizability to younger women or healthy non-surgical populations. The sample size was modest (n = 89), confidence intervals were not reported in the abstract, and the cross-sectional design cannot measure individual rates of follicular decline over time.
Cited by
- supports Serum anti-Müllerian hormone (AMH) levels reflect a woman's remaining ovarian follicle reserve.