Ovarian Reserve Markers and Menstrual Pattern in Women Presenting with Primary Infertility

Background: Primary infertility requires timely evaluation of ovarian reserve, but advanced fertility testing may not be affordable or immediately available in resource-limited settings. Menstrual-cycle history is a simple clinical tool that may help identify women who require earlier ovarian reserve assessment. Objective: To assess the association between menstrual-cycle pattern and ovarian reserve markers among women presenting with primary infertility. Methods: This prospective observational study included 150 women with primary infertility attending a gynecology and infertility clinic in Islamabad, Pakistan. Menstrual-cycle pattern was categorized as regular, short, long, or irregular. Ovarian reserve was assessed using serum anti-Müllerian hormone, basal follicle-stimulating hormone, and antral follicle count. Diminished ovarian reserve was defined using predefined biochemical or ultrasound-based criteria. Group comparisons and crude secondary analyses were performed using the available aggregated data. Results: The mean age was 29.4 ± 4.8 years, mean infertility duration was 3.7 ± 2.1 years, and mean body mass index was 25.8 ± 3.9 kg/m². Diminished ovarian reserve was present in 36 women (24.0%). Women with short cycles had the lowest anti-Müllerian hormone (1.02 ± 0.71 ng/mL), lowest antral follicle count (5.6 ± 2.3 follicles), highest follicle-stimulating hormone (11.4 ± 3.9 IU/L), and highest frequency of diminished ovarian reserve (55.6%). Compared with regular cycles, short cycles showed higher crude odds of diminished ovarian reserve (OR 5.22, 95% CI 2.07–13.17). Conclusion: Short menstrual cycles were associated with an adverse ovarian reserve profile in women with primary infertility. Menstrual history may help prioritize early ovarian reserve testing but should not replace standard biochemical and ultrasound assessment