Publication:

Follicle-stimulating hormone versus anti-Müllerian hormone: age related relevance to intracytoplasmic sperm injection results

Background Maternal age significantly impacts ovarian reserve and intracytoplasmic sperm injection (ICSI) outcomes. This study evaluated the influence of maternal age on ovarian reserve parameters and ICSI treatment results.

Methods This prospective observational cohort study enrolled 100 infertile women (aged 20-43) undergoing ICSI in Baghdad (March 2025-February 2026), stratified by age: Group A (<35 years, n=65) and group B (≥35 years, n=35). Baseline anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2), and AFC were evaluated on cycle day 2-3. All patients received a standardized fixed antagonist protocol.

Results Women aged <35 years had significantly higher baseline AMH levels than those ≥35 years (2.06±0.94 vs. 1.51±0.82 ng/ml, p=0.004). No significant differences were found in basal FSH (p=0.876), AFC (p=0.070), or E2 (p=0.326). Women aged ≥35 required significantly higher gonadotropin doses (41.0±5.05 vs. 29.3±6.72 ampoules, p<0.001) and longer stimulation (10.4±1.09 vs. 9.63±1.32 days, p=0.003). Retrieved oocytes (6.86±3.59 vs. 7.57±3.09, p=0.302), MII oocytes (p=0.097), and fertilized oocytes (p=0.136) were lower in older women but these differences did not reach statistical significance.

Conclusions Ovarian responsiveness declines with maternal age, requiring higher gonadotropin doses and prolonged stimulation. Serum AMH is a more sensitive marker than basal FSH for detecting early age-related ovarian decline in ICSI candidates.