Anti-Müllerian hormone versus antral follicle count as first-choice biomarkers in a low-resource setting: A cross-sectional study in Kumasi, Ghana
Francis Jojo Moses Kwadzo Damalie, Kweku Bedu-Addo, Charles Mawunyo Senaya, Edward Tieru Dassah, Alexander Anning, Phillip Kweku Baidoo, Kofi Owusu-Daaku, Patrick Addo-FordjourObjective
To evaluate age-related variations in ovarian reserve among women in Kumasi, Ghana, and determine the preferred first-choice biomarker, either anti-Müllerian hormone or antral follicle count, in a low-resource setting.
Methods
A cross-sectional study was conducted at a private fertility hospital in Kumasi from July 2023 to June 2024. A total of 372 women undergoing fertility assessment were enrolled. Both anti-Müllerian hormone and antral follicle count were measured, stratified by age group, and used to generate age-related nomograms. Correlations between age and each biomarker were assessed.
Results
The median age was 23 years for oocyte donors and 33 years for self-cycle patients, with 80% classified as overweight/obese. Anti-Müllerian hormone and antral follicle count showed polynomial, nonlinear declines with age, peaking in the mid-20s, and approaching 0 by 45 years of age. Diminished ovarian reserve was observed at 38 years by antral follicle count and at 40 years by anti-Müllerian hormone. This disparity was also reflected in the poor agreement between antral follicle count and anti-Müllerian hormone in classifying participants as having normal ovarian reserve or diminished ovarian reserve (kappa = 0.167). Antral follicle count detected more diminished ovarian reserve cases (38%) than anti-Müllerian hormone (33%) and demonstrated a stronger negative correlation with age (r = −0.34, p = 0.00) than anti-Müllerian hormone (r = −0.30, p = 0.00). The biomarkers were positively correlated (r = 0.42, p = 0.00).
Conclusions
Ovarian reserve decline among Ghanaian women appears to be more gradual, leading to diminished ovarian reserve at least 3 years later than in reference models. Antral follicle count showed higher sensitivity and a stronger correlation with age, supporting its use as the preferred first-line biomarker for decision-making in low-resource settings.