Correlation between serum AMH, AFC, AND histologically quantified primordial follicles: a prospective study in premenopausal women.

OBJECTIVE

To evaluate the relationship between serum Anti-Mullerian hormone (AMH) levels, antral follicle count (AFC), and histologically quantified primordial follicle numbers in premenopausal women, in order to validate the clinical accuracy of AMH and AFC as surrogate markers of true ovarian reserve.

METHODS

This prospective cross-sectional study included 89 healthy, menstruating women aged 35-48 years who underwent unilateral or bilateral oophorectomy for benign gynecological conditions. Preoperative serum levels of AMH, follicle-stimulating hormone (FSH), and estradiol (E2) were measured, and AFC was assessed by transvaginal ultrasonography during the early follicular phase. Excised ovarian tissues were processed for histological evaluation, and primordial follicles were counted by a blinded pathologist.

RESULTS

AMH and AFC were both positively correlated with primordial follicle count (ρ = 0.75 and ρ = 0.85, respectively; p < 0.001). AMH also showed strong inverse correlations with FSH (ρ = - 0.89) and moderate inverse correlation with E2 (ρ = - 0.62). AFC was moderately negatively correlated with FSH (ρ = - 0.67). Among all tested biomarkers, AMH and AFC demonstrated the strongest associations with histologically determined follicular reserve.

CONCLUSION

AMH and AFC are strongly associated with the histological size of the primordial follicle pool and represent reliable, non-invasive markers of ovarian reserve. These findings provide histological validation for their continued use in reproductive assessment and individualized fertility planning.