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

Abstract

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.