Objective To investigate the relationship between clinical markers of ovarian reserve and the true ovarian reserve as determined by the ovarian primordial follicle number. Design Prospective investigation. Setting Academic medical center. Patient(s) Forty-two healthy women (aged 26–52 years) undergoing oophorectomy for benign gynecologic indications. Intervention(s) Transvaginal ultrasound examination for the determination of the ovarian antral follicle count (AFC) and serum measurements of clinical markers of ovarian reserve. All measurements were obtained within 2 weeks of surgery, irrespective of cycle day. Ovarian primordial follicle count was then determined using a validated fractionator/optical disector method. Main Outcome Measure(s) Univariate and partial correlations between ovarian reserve markers and ovarian primordial follicle count. Result(s) There were significant correlations between the ovarian primordial follicle count and AFC ( r = 0.78), anti-Müllerian hormone (AMH; r = 0.72), FSH ( r = −0.32), inhibin B ( r = 0.40), and chronological age ( r = −0.80). After adjusting for age, significant correlations were identified between the ovarian primordial follicle count and AFC ( r = 0.53) and AMH ( r = 0.48). Conclusion(s) The ovarian AFC and serum levels of AMH correlate with the ovarian primordial follicle number even after adjustment for chronological age.