Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed in women of reproductive age, yet their potential effects on ovarian reserve and reproductive endocrine function remain uncertain. Limited data are available from low- and middle-income countries, including Pakistan, where psychiatric medication history is not routinely incorporated into fertility evaluation. This study aimed to assess the association of SSRI use with ovarian reserve markers and ovulatory function in women undergoing fertility evaluation in Pakistan. The study included 60 women aged 20–40 years visiting four different private sector fertility centers in Lahore, Pakistan, from January to June 2025. Thirty women with major depressive disorder receiving SSRIs for at least 6 months were compared with 30 age-matched women without psychiatric illness or SSRI exposure. Group comparisons were performed using independent samples t-tests and chi-square tests. Multivariable linear regression was used to evaluate the association between SSRI use and AMH after adjustment for age and body mass index (BMI). Compared with controls, SSRI users had significantly lower mean AMH (1.8 ± 0.6 vs 3.2 ± 0.9; ) and AFC (8.4 ± 2.3 vs 12.1 ± 3.1; ), and significantly higher mean FSH (9.2 ± 2.1 vs 6.8 ± 1.7; ) and prolactin levels (28.4 ± 6.7 vs 19.6 ± 5.3; ). LH and estradiol levels were similar between groups. Ovulation was observed in 56.7% of SSRI users compared with 83.3% of controls (). In multivariable regression, SSRI use remained independently associated with lower AMH (, SE = 0.32, ) after adjustment for age and BMI. SSRI use was associated with lower ovarian reserve markers, higher prolactin and FSH levels, and reduced ovulation in women of reproductive age undergoing fertility evaluation. These findings suggest that SSRI exposure may be linked to altered reproductive endocrine function and warrant further prospective investigation.