Materials and Methods: This multicenter prospective observational study enrolled 120 infertile women aged 20–35 years (AFC ≥ 5, AMH ≥ 0.5 ng/mL, BMI < 30 kg/m²) undergoing a standardized GnRH-antagonist ICSI protocol. Day-2 serum LH, FSH, and AMH levels and transvaginal ultrasound–derived AFC were measured. Ratios (LH/AMH, FSH/AMH, AMH/AFC) were calculated. Outcomes included biochemical pregnancy and clinical pregnancy.

Results: Biochemical and clinical pregnancy rates were 29.2% and 18.3%, respectively. AMH and AFC exhibited positive correlations with mature follicles, oocyte yield, fertilization rate, FOI, OSI, and FORT, whereas LH, FSH, and their AMH-based ratios showed inverse correlations. The AMH/AFC ratio demonstrated a modest association with clinical pregnancy (OR 0.02; 95% CI 0.001–5.39; P = 0.17) and yielded an AUC of 0.59, specificity of 78.6%, and PPV of 85.6% at a cut-off ≤ 0.13, which were not significant.

Conclusions: The AMH/AFC ratio can be a supplementary predictor of ovarian reserve, with potential clinical value in counseling and designing cycles for ICSI.