Comparison of ovarian reserve as measured by Anti Mullerian hormone and Antral Follicle Count between fertile and Infertile women in India.

AMH levels and AFC are considered the most sensitive and specific markers of ovarian reserve. They are used to predict response to ovarian stimulation by gonadotrophins during in-vitro fertilization. Ovarian reserve depletes with age though there is a great inter-individual variation in the rate of decrease. There is also an ongoing debate regarding the predictive ability of AMH and AFC for pregnancy and live birth outcome in IVF. AMH levels are often used to counsel infertile women on the need for early shift to IVF. Many researchers have brought to light the observation that AMH does not predict fecundity and that women with very low levels of AMH can conceive spontaneously. Ethnicity has been associated with altered age-specific levels of AMH. Women of Chinese, Black African, Hispanic and South Asian descent are reported to have a lower AMH at a given age compared with Caucasian women. Iglesias et al reported a  6-year age difference in ovarian reserve markers and ovarian response between Spanish and Indian women in favor of the Spanish, suggesting ethnic differences in ovarian aging. Whether this ethnic disparity reflects accelerated ovarian ageing or inherent genetic differences is unclear. A recent study by Hvidman et al 2016 looking at the same issue in Caucasian women found that the available number of growing antral follicles and their capability to produce AMH in the early follicular phase is the same in infertile patients and controls.Nutritional factors have been implicated to affect the ovarian reserve. There are conflicting data in literature  regarding the association  of Vitamin D  levels with the ovarian reserve markers .

Our study may elicit differences in ovarian reserve between fertile and infertile population in India and would help us to prepare age specific nomograms for AMH in both the fertile and infertile population .Our results may help clinicians to counsel infertile women when discussing assisted reproductive technology.

We would also like to assess the vitamin D levels in the fertile population and prepare nomograms for the same as it would help us in having an in depth understanding of the association of vitamin D with ovarian reserve markers.