Evaluation of Serum AMH and FSH Levels as Biomarkers for the Diagnosis of Female Infertility: A Case-control Study in Al-Diwaniyah, Iraq

Abstract

Infertility presents a significant global and local health challenge, with substantial personal and societal costs. In Iraq, over 82,000 cases were reported in 2024, underscoring the need for reliable diagnostic tools. This study aimed to evaluate and compare the diagnostic performance of serum Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) as biomarkers for female infertility. A case-control study was conducted at the Infertility Unit of Al-Diwaniyah Maternity and Children Hospital, Iraq, from 25-9-2025 to 25-1-2026. It involved 120 women (60 infertile cases and 60 fertile controls). Serum levels of AMH and FSH were measured using standardized immunoassays, and data were analyzed using independent t-tests, Spearman correlation, and Receiver Operating Characteristic (ROC) curve analysis. The results showed that infertile women were significantly older (32.80 vs. 29.62 years, p<0.05) and had markedly lower AMH levels (1.28 vs. 3.43 ng/ml, p<0.000) and higher FSH levels (11.73 vs. 6.69 miu/ml, p<0.000). A significant negative correlation was found between AMH and FSH (rho = -0.459, p<0.05). ROC analysis revealed that AMH had superior diagnostic accuracy (AUC = 0.948) compared to FSH (AUC = 0.845). An AMH cutoff of ≤2.36 ng/ml yielded a sensitivity of 92% and specificity of 87%. In conclusion, serum AMH demonstrated excellent diagnostic performance, outperforming FSH in identifying women with infertility, supporting its role as a primary biomarker in ovarian reserve assessment within the studied population.