Markers of ovarian reserve as predictors of future fertility

Fertil Steril. 2023 Jan;119(1):99-106. doi: 10.1016/j.fertnstert.2022.10.014. Epub 2022 Nov 29.


Objective: To determine the association between ovarian reserve biomarkers and future fertility among late reproductive-age women.

Design: Cohort study of participants enrolled in Time to Conceive (TTC), a time-to-pregnancy cohort study of the ovarian reserve biomarkers.

Setting: Community.

Patient(s): Women aged 30-44 years without a history of infertility who provided a blood sample at enrollment in TTC and who agreed to future follow-up.

Intervention(s): Not applicable.

Main outcome measure(s): The primary outcomes were probability of achieving a live birth >3 years after enrollment in TTC, diagnosis of infertility at any time, and time-to-pregnancy in future pregnancy attempts.

Result(s): Women with diminished ovarian reserve, defined as those with an antimüllerian hormone (AMH) level <0.7 ng/mL or follicle-stimulating hormone (FSH) level ≥10 mIU/mL, did not have low risk of future live birth (relative risk [RR], 1.32; 95% confidence interval [CI], 0.95-1.83 and RR, 1.28; 95% CI, 0.97-1.70, respectively) compared with women with normal ovarian reserve after adjusting for age at blood draw, race, obesity, use of hormonal contraception, and year of enrollment in original study. Among women in the cohort that attempted to conceive, there was not a significant association between diminished ovarian reserve, as measured by AMH or FSH, and risk of future infertility (RR, 0.65; 95% CI, 0.21-2.07 and RR,1.69; 95% CI, 0.86-3.31, respectively). Similarly, there was no association between AMH and FSH levels and future fecundability (fecundability ratio, 0.97; 95% CI, 0.59, 1.60; and fecundability ration, 0.86; 95% CI, 0.55-1.36, respectively).

Conclusion: Diminished ovarian reserve is not associated with reduced future reproductive capacity. Given the lack of association, women should be cautioned regarding use biomarkers of ovarian reserve as predictors of their future reproductive capacity.

Keywords: Ovarian reserve; antimüllerian hormone; biomarkers; fertility potential.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Mullerian Hormone
  • Biomarkers
  • Cohort Studies
  • Female
  • Fertility
  • Follicle Stimulating Hormone
  • Humans
  • Infertility, Female* / diagnosis
  • Infertility, Female* / therapy
  • Ovarian Diseases*
  • Ovarian Reserve*
  • Pregnancy
  • Time-to-Pregnancy


  • Follicle Stimulating Hormone
  • Biomarkers
  • Anti-Mullerian Hormone