A comparison of anti-Müllerian hormone and ultrasound antral follicle count highlights the limits of predicting egg retrieval from a single hormone result.
Using AMH and antral follicle count together performed better for predicting total and mature egg numbers, supporting individualized stimulation planning.
Anti-Müllerian hormone (AMH) is one of the test results women often focus on before IVF. Sometimes described as a test of “ovarian age,” it is more accurately an indirect marker of the quantity of follicles remaining in the ovaries.
Yet women with similar AMH results can have very different egg retrieval outcomes. Some obtain several eggs; others retrieve fewer than expected. What explains the difference?
Researchers including a team at ART Fertility Clinics in the United Arab Emirates analyzed 2,162 IVF and intracytoplasmic sperm injection cycles. Their findings show the limits of explaining ovarian stimulation response through AMH alone.
The study appears in the November 2026 issue of Reproductive BioMedicine Online.
Does higher AMH necessarily mean more eggs?
AMH is produced by granulosa cells surrounding small ovarian follicles. Higher levels generally suggest a greater quantity of remaining follicles.
However, the AMH value is not a direct count of retrievable eggs.
IVF stimulation encourages multiple follicles to grow, but they do not all develop identically. An adequately grown follicle may not yield an egg, and not every retrieved egg is mature.
Ovarian reserve and the actual response to stimulation therefore need to be distinguished.
The study examined AMH relative to antral follicle count
The researchers retrospectively analyzed 2,162 IVF and ICSI cycles performed between May 2015 and October 2023.
Median age was 36 years, median AMH was 1.8 ng/mL, and median antral follicle count (AFC) was 10.
AFC counts small follicles visible on ultrasound and is another widely used measure of ovarian reserve.
The researchers examined the ratio of AMH to AFC to assess how well it reflected the response to stimulation.
The AMH/AFC ratio showed a positive correlation of 0.62 with each of two measures: follicular output rate (FOR) and the follicle-to-oocyte index (FOI), which relate to follicle growth and egg recovery efficiency.
A higher ratio was thus associated with greater relative efficiency on these measures. Correlation does not mean that the exact number of eggs retrieved can be predicted for an individual patient.
Two separate measures performed better for egg-number prediction
The ratio was not the best predictor for every outcome.
When the researchers compared predictions of total retrieved and mature oocyte numbers, using AMH and AFC together as separate variables performed better than using the ratio alone.
The ratio may help characterize responsiveness to stimulation. To predict the number of eggs retrieved, however, the two measures considered together were more informative.
This supports avoiding excessive reliance on a single test result in fertility assessment.
AMH is not a direct test of pregnancy potential
A common misunderstanding is that low AMH necessarily means pregnancy is unlikely, while a high result means a high chance of pregnancy.
AMH primarily informs ovarian reserve and the quantitative response to stimulation. It does not directly measure chromosome normality, fertilization capacity or the ability to support embryo development.
Age, egg quality, sperm factors, embryo development and the uterine environment all contribute to pregnancy outcomes.
This study examined stimulation response and egg retrieval. It did not demonstrate that an AMH/AFC ratio improves pregnancy or live birth rates.
Actual ovarian response adds information beyond test results
Before stimulation, clinicians consider AMH and AFC alongside age and previous treatment results when selecting medication doses and a treatment approach.
Women with similar baseline results may still respond differently. Follicle growth during treatment and results from earlier retrievals also provide important information.
The study supports interpreting several measures together rather than reducing ovarian reserve to one number.
An unexpectedly low AMH result does not settle an individual's chance of pregnancy. Conversely, a reassuring result does not guarantee a large egg yield.
The important question is what the AMH result means in the context of that person's ovarian condition and observed response to stimulation.
Source: “Beyond anti-Müllerian hormone or antral follicle count alone: anti-Müllerian hormone and antral follicle count ratio as marker of ovarian responsiveness to gonadotrophins,” by researchers including ART Fertility Clinics, United Arab Emirates. Reproductive BioMedicine Online, online July 30, 2026; November 2026 issue. DOI: 10.1016/j.rbmo.2026.105893. Individual stimulation plans should be discussed with a fertility specialist.
Related reading: Understanding follicle growth and ovulation timing.
Copyright © 2026 Fertility Information TokTok Fertility News | THE FERTILITY NOTES. All rights reserved. Unauthorized republication, reproduction, redistribution, scraping, AI training and data use of any content, including articles, photographs and images, are strictly prohibited. Violations may result in legal liability.