Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 1 ( January-February, 2022 ) > List of Articles

Original Article

A Correlation between Antral Follicle Count and Anti-Müllerian Hormone in Healthy Indian Women of Reproductive Age

Shivi Jain, Ram C Shukla, Madhu Jain, Usha Singh, Tej B Singh

Keywords : Anti-Müllerian hormone, Antral follicle count, Cross-sectional study, Fertile women, Reproductive aging

Citation Information : Jain S, Shukla RC, Jain M, Singh U, Singh TB. A Correlation between Antral Follicle Count and Anti-Müllerian Hormone in Healthy Indian Women of Reproductive Age. J South Asian Feder Obs Gynae 2022; 14 (1):1-5.

DOI: 10.5005/jp-journals-10006-2005

License: CC BY-NC 4.0

Published Online: 13-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To determine which of the two parameters between antral follicle count (AFC) and anti-Müllerian hormone (AMH) had better correlation with age in healthy females, and also to estimate the strength of correlation between AMH and AFC. Materials and methods: This was a prospective, cross-sectional study comprising 1,181 fertile women of age 20–40 years, who were divided into four age groups, i.e., group I (20–24 years), group II (25–29 years), group III (30–34 years), and group IV (35–40 years). AFC and AMH were measured on third day of menstrual cycle. Pearson correlation and linear regression analysis were used. Statistical Package for Social Sciences, trial version 20, was used for the statistical analysis. A p-value of <0.05 was considered statistically significant. Results: The correlation coefficients between AFC and age, AMH and age, AMH and AFC were r = −0.403, r = −0.824 and r = 0.328; p <0.001, respectively. A strong positive correlation (r = 0.986, p <0.001) was noted between AMH and age in group I, while strong negative correlations (p <0.001) were noted in other groups. The correlations between AFC and age (r = −0.177) and AMH and AFC (r = 0.175) were significant (p <0.05) only in group IV. Age accounted for 16.3% variation in AFC and 67.8% variation in AMH. Conclusion: AMH correlated better with age than AFC. There was a weak correlation between AMH and AFC. Clinical significance: The counselling of a woman about her reproductive potential should be based on both AFC and AMH taken together, apart from chronological age, to avoid false sense of security or unnecessary alarm.

PDF Share
  1. Jirge PR. Ovarian reserve tests. J Hum Reprod Sci 2011;4(3):108–113. DOI: 10.4103/0974-1208.92283.
  2. Balasch J, Gratacós E. Delayed childbearing: effects on fertility and the outcome of pregnancy. Curr Opin Obstet Gynecol 2012;24(3):187–193. DOI: 10.1097/GCO.0b013e3283517908.
  3. Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol 2017;217(2):129–140. DOI: 10.1016/j.ajog.2017.02.027.
  4. Practice Committee of the American Society for Reproductive Medicine. Electronic address:; Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2020;114(6):1151–1157. DOI: 10.1016/j.fertnstert.2020.09.134.
  5. Wang X, Jin L, Mao YD, et al. Evaluation of ovarian reserve tests and age in the prediction of poor ovarian response to controlled ovarian stimulation: a real-world data analysis of 89,002 patients. Front Endocrinol (Lausanne) 2021;12:702061. DOI: 10.3389/fendo.2021.702061.
  6. de Vet A, Laven JS, de Jong FH, et al. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril 2002;77(2):357–362. DOI: 10.1016/s0015-0282(01)02993-4.
  7. van Rooij IA, Broekmans FJ, Scheffer GJ, et al. Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study. Fertil Steril 2005;83(4):979–987. DOI: 10.1016/j.fertnstert.2004.11.029.
  8. Alebic MŠ, Stojanovic N, Dewailly D. Discordance between serum anti-Müllerian hormone concentrations and antral follicle counts: not only technical issues. Hum Reprod 2018;33(6):1141–1148. DOI: 10.1093/humrep/dey098.
  9. Zhang Y, Xu Y, Xue Q, et al. Discordance between antral follicle counts and anti-Müllerian hormone levels in women undergoing in vitro fertilization. Reprod Biol Endocrinol 2019;17(1):51. DOI: 10.1186/s12958-019-0497-4.
  10. Broekmans FJ, de Ziegler D, Howles CM, et al. The antral follicle count: practical recommendations for better standardization. Fertil Steril 2010;94(3):1044–1051. DOI: 10.1016/j.fertnstert.2009.04.040.
  11. Magnusson Å, Oleröd G, Thurin-Kjellberg A, et al. The correlation between AMH assays differs depending on actual AMH levels. Hum Reprod Open 2017;2017(4):hox026. DOI: 10.1093/hropen/hox026.
  12. Moolhuijsen LME, Visser JA. Anti-Müllerian hormone and ovarian reserve: update on assessing ovarian function. J Clin Endocrinol Metab 2020;105(11):3361–3373. DOI: 10.1210/clinem/dgaa513.
  13. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81(1):19–25. DOI: 10.1016/j.fertnstert.2003.10.004.
  14. La Marca A, Spada E, Sighinolfi G, et al. Age-specific nomogram for the decline in antral follicle count throughout the reproductive period. Fertil Steril 2011;95(2):684–688. DOI: 10.1016/j.fertnstert.2010.07.1069.
  15. Bozdag G, Calis P, Zengin D, et al. Age related normogram for antral follicle count in general population and comparison with previous studies. Eur J Obstet Gynecol Reprod Biol 2016;206:120–124. DOI: 10.1016/j.ejogrb.2016.09.013.
  16. Wiser A, Shalom-Paz E, Hyman JH, et al. Age-related normogram for antral follicle count in women with polycystic ovary syndrome. Reprod Biomed Online 2013;27(4):414–418. DOI: 10.1016/j.rbmo.2013.06.016.
  17. Bentzen JG, Forman JL, Johannsen TH, et al. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab 2013;98(4):1602–1611. DOI: 10.1210/jc.2012-1829.
  18. Broer SL, Eijkemans MJ, Scheffer GJ, et al. Anti-mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab 2011;96(8)2532–2539. DOI: 10.1210/jc.2010-2776.
  19. Kelsey TW, Wright P, Nelson SM, et al. A validated model of serum anti-müllerian hormone from conception to menopause. PLoS One 2011;6(7):e22024. DOI: 10.1371/journal.pone.0022024.
  20. Tehrani FR, Mansournia MA, Solaymani-Dodaran M, et al. Age-specific serum anti-Müllerian hormone levels: estimates from a large population-based sample. Climacteric 2014;17(5):591–597. DOI: 10.3109/13697137.2014.912262.
  21. Cui L, Qin Y, Gao X, et al. Antimüllerian hormone: correlation with age and androgenic and metabolic factors in women from birth to postmenopause. Fertil Steril 2016;105(2):481–485.e1. DOI: 10.1016/j.fertnstert.2015.10.017 [Erratum in: Fertil Steril 2018;109(5):942. PMID: 26549157].
  22. Nelson SM, Messow MC, Wallace AM, et al. Nomogram for the decline in serum antimüllerian hormone: a population study of 9,601 infertility patients. Fertil Steril 2011;95(2):736–741.e1–e3. DOI: 10.1016/j.fertnstert.2010.08.022.
  23. Seifer DB, Baker VL, Leader B. Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril 2011;95(2):747–750. DOI: 10.1016/j.fertnstert.2010.10.011.
  24. Lee JY, Jee BC, Lee JR, et al. Age-related distributions of anti-Müllerian hormone level and anti-Müllerian hormone models. Acta Obstet Gynecol Scand 2012;91(8):970–975. DOI: 10.1111/j.1600-0412.2012.01448.x.
  25. Doroftei B, Mambet C, Zlei M. It's Never over until It's over: how can age and ovarian reserve be mathematically bound through the measurement of serum AMH—a study of 5069 Romanian women. PLoS One 2015;10(4):e0125216. DOI: 10.1371/journal.pone.0125216.
  26. Lie Fong S, Visser JA, Welt CK, et al. Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab 2012;97(12):4650–4655. DOI: 10.1210/jc.2012-1440.
  27. Okunola OT, Ajenifuja OK, Loto MO, et al. Age-specific nomograms for follicle stimulating hormone and anti-Mullerian hormone: a pilot study in Ile-Ife, Nigeria. Int J Reprod Biomed 2016;14(12):777–782. PMID: 28066837.
  28. Iyer S, Kallathikumar K, Sinkar P, et al. Anti-Mullerian Hormone (AMH) and Age–an Indian laboratory retrospective analysis. Asian J Health Sci 2019;5(1):7. DOI: 10.15419/ajhs.v5i1.449.
  29. Kotlyar AM, Seifer DB. Ethnicity/race and age-specific variations of serum AMH in women—a review. Front Endocrinol (Lausanne) 2021;11:593216. DOI: 10.3389/fendo.2020.593216.
  30. de Kat AC, van der Schouw YT, Eijkemans MJ, et al. Back to the basics of ovarian aging: a population-based study on longitudinal anti-Müllerian hormone decline. BMC Med 2016;14(1):151. DOI: 10.1186/s12916-016-0699-y.
  31. Freeman EW, Sammel MD, Lin H, et al. Anti-mullerian hormone as a predictor of time to menopause in late reproductive age women. J Clin Endocrinol Metab 2012;97(5):1673–1680. DOI: 10.1210/jc.2011-3032.
  32. de Kat AC, Broekmans FJM, Lambalk CB. Role of AMH in prediction of menopause. Front Endocrinol (Lausanne) 2021;12:733731. DOI: 10.3389/fendo.2021.733731.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.