Beyond anti-Müllerian hormone or antral follicle count alone: anti-Müllerian hormone and antral follicle count ratio as marker of ovarian responsiveness to gonadotrophins.
Level 3 - non-randomized controlled study
Retrospective cohort study
PubMed 42632251 · doi:10.1016/j.rbmo.2026.105893
What was done
Retrospective cohort study analyzing 2162 IVF and intracytoplasmic sperm injection (ICSI) ovarian stimulation cycles using a GnRH antagonist protocol at a single tertiary IVF centre. Evaluated associations between the anti-Müllerian hormone to antral follicle count (AMH–AFC) ratio and dynamic ovarian response metrics—follicular output rate (FOR), follicle-to-oocyte index (FOI), and retrieved oocytes—using multiple regression adjusted for age, body mass index, and gonadotrophin dose.
What was found
The AMH–AFC ratio showed significant positive correlation with both FOI (r = 0.62, 95% CI 0.59 to 0.65) and FOR (r = 0.62, 95% CI 0.59 to 0.65; both P < 0.001), stronger than associations for AMH or AFC alone. Across increasing AMH–AFC quartiles, progressive increases were observed in pre-ovulatory follicles, retrieved oocytes, metaphase II oocytes, FOI, and FOR. In adjusted multivariable models, the ratio explained more variance in FOI and FOR than either single marker, but combined AMH and AFC remained superior for predicting absolute oocyte and metaphase II yield.
Why it matters
The AMH–AFC ratio may serve as an additional marker of ovarian sensitivity to gonadotrophins, helping identify patients with discordant ovarian reserve profiles who under-respond despite adequate baseline follicle counts.
Limits
Retrospective single-centre design restricted to GnRH antagonist protocols. Reported findings evaluate cycles rather than unique patients, and the abstract does not provide live birth, pregnancy, or fertilization outcomes.
Cited by
- context Each 0.1 ng/mL of anti-Müllerian hormone (AMH) corresponds on average to approximately one ovarian follicle.