ArticleThe Journal of international medical research2026
Anti-Müllerian hormone versus antral follicle count as first-choice biomarkers in a low-resource setting: A cross-sectional study in Kumasi, Ghana.
Article in The Journal of international medical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
ObjectiveTo 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.MethodsA 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.ResultsThe 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).ConclusionsOvarian 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.
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