Serum Antimüllerian Hormone as a Biomarker of Functional Testicular Reserve: A Comparative Analysis

Abstract Context Antimüllerian hormone (AMH) is produced by Sertoli cells and may serve as a biomarker of spermatogenesis, yet the literature lacks comprehensive comparative analyses across male fertility conditions. Objective This work aimed to discover how serum AMH levels differ among men with varying fertility statuses, and the relationship between AMH, spermatogenesis, and functional testicular reserve. Methods A cross-sectional study was conducted of 1085 White European, non-Finnish men with confirmed fertility, primary infertility, or nonazoospermic infertility. Men with confirmed fertility (n = 116), primary infertility (n = 791), and nonobstructive azoospermia (NOA) (n = 178) underwent comprehensive hormonal and semen analyses per World Health Organization 2010 criteria. Kruskal-Wallis and chi-square tests were used for group comparisons. Correlations were assessed using Spearman rank correlation. Multivariable linear regression models identified factors associated with AMH levels and sperm concentration. Results Serum AMH levels were significantly lower in men with NOA compared to fertile controls and NOA infertile men. AMH correlated negatively with age and follicle-stimulating hormone (FSH), and positively with testicular volume and sperm concentration. After adjustment, AMH showed no independent association with sperm concentration. AMH levels were significantly lower in NOA vs fertile men and primary infertility 3.8 (1.6-7.2) vs 5.1 (3.6-7.0) vs 4.9 (3.0-7.8) ng/mL; P less than .001. AMH negatively correlated with age and FSH, positively with testicular volume and sperm concentration. Age, FSH, and testicular volume were independently associated with AMH; FSH and testicular volume, not AMH, were independently associated with sperm concentration. However, the cross-sectional design limits causality, and the study faced limited ethnic generalizability. Conclusion AMH reflects Sertoli cell function and testicular status rather than directly influencing spermatogenesis, potentially serving as a complementary male fertility biomarker.