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Updated: Jul 2, 2026

Z-Scores for Assessing Ovarian Reserve in Young Patients Undergoing Fertility Preservation
Published on: October 25, 2024
Ovarian reserve markers in World Health Organization type 1 anovulatory disorders: a systematic review and
Sterre M H de Jong1, Annelien C de Kat1, Linda J Schoonmade2
1Department of Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.
Abstract:
Ovarian reserve markers such as anti-Müllerian hormone (AMH) and antral follicle count (AFC) are widely used in fertility assessment. However, to the authors' knowledge, no systematic reviews to date have evaluated these markers specifically for World Health Organization (WHO) type 1 (hypogonadotropic hypogonadism) anovulation. This review examines the relationship between ovarian reserve markers and WHO type 1 anovulation. A systematic search was conducted in PubMed, Embase, Web of Science, Scopus and the Cochrane Library up to 9 July 2025 using the term 'anti-Müllerian hormone' combined with synonyms of 'hypothalamic amenorrhoea'. Out of 769 identified studies, 29 met the inclusion criteria, and 14 (n = 920 participants) were included in the meta-analysis. Risk of bias was assessed using Joanna Briggs Institute critical appraisal checklists. The remaining 15 studies were synthesized narratively and presented in a summary table. AMH concentration and AFC varied widely in women with WHO type 1 anovulation compared with normo-ovulatory controls. The pooled standardized mean difference for AMH was 0.23 (95% CI -0.06 to 0.51). Notably, ovarian reserve markers tended to decrease with longer anovulatory periods. In this population, low AMH concentration and/or AFC may not provide an accurate reflection of true ovarian reserve. Prolonged hypothalamic suppression likely contributes to underestimation of these markers, emphasizing the need for cautious clinical interpretation.
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