Impact of anti‐Müllerian hormone and antral follicle count discordance on elective fertility preservation outcomes

OBJECTIVE: Anti-Müllerian hormone (AMH) and antral follicle count (AFC) are usually correlated, yet discordance might complicate counseling in elective fertility preservation (EFP). This study evaluated whether discordant ovarian reserve markers affect oocyte yield in healthy women undergoing EFP. METHODS: This retrospective cohort study included 230 healthy women aged 30-41 years undergoing their first EFP cycle at a university-affiliated tertiary fertility unit. Participants were categorized based on AMH (<1.1 or ≥1.1 ng/mL) and AFC (<7 or ≥7) thresholds. Analyses focused on concordant versus discordant AMH-AFC groups. The primary outcomes were the number of oocytes retrieved and vitrified. Multivariable linear regression assessed independent predictors of oocyte yield. RESULTS: The overall discordance rate was 30.43%. Women in Group 1 - Normal AFC (≥7) with low AMH (<1.1 ng/mL) (n = 67) had significantly fewer retrieved (mean 6.7 ± 4.5) and vitrified oocytes (mean 4.9 ± 3.4) than those in Group 4 - Normal AFC (≥7) with normal AMH (≥1.1 ng/mL) (n = 149; 14.6 ± 8.1 and 10.6 ± 6.8, respectively; P < 0.001), which represented the two largest study groups. AMH was the strongest independent predictor of oocyte yield. Discordance independently contributed additional explanatory value for the number of retrieved oocytes, with discordant patients predicted to achieve fewer oocytes than concordant-normal counterparts. The concordance status did not significantly affect the number of vitrified oocytes. CONCLUSION: AMH-AFC discordance (specifically low AMH in the presence of normal AFC) is an independent predictor of reduced oocyte yield in EFP but not of the number of vitrified oocytes. Joint interpretation of both markers might facilitate more accurate patient counseling and expectation management.