Anti-Müllerian hormone levels and live birth rate in polycystic ovary syndrome patients undergoing assisted reproductive technology: a systematic review and meta-analysis.

BACKGROUND

Anti-Müllerian hormone (AMH) is typically elevated in women with polycystic ovary syndrome (PCOS), but its relationship with assisted reproductive technology (ART) outcomes remains unclear.

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the association between AMH levels and pregnancy outcomes in women with PCOS undergoing ART.

SEARCH

METHODS

Observational studies published between January 2020 and May 2025 were identified from major databases. The search strategy incorporated controlled vocabulary and keywords related to "Polycystic Ovary Syndrome," "anti-Müllerian hormone," and ART outcomes. Eight studies were included.

MAIN OUTCOMES: Higher oocyte yields were observed across ascending AMH subgroups, with significant differences detected in all pairwise comparisons (low vs. high: MD = -3.91, 95% CI: -5.60 to -2.23; Z = 4.55, P < 0.001, I2 = 86%; low vs. medium: MD = -2.33, 95% CI: -2.79 to -1.86; Z = 9.77, P < 0.001, I2 = 50%; medium vs. high: MD = -1.70, 95% CI: -3.31 to -0.09; Z = 2.07, P = 0.04, I2 = 0%). Higher AMH levels were significantly associated with increased risk of ovarian hyperstimulation syndrome (OHSS). Compared with the low AMH group, the high AMH group had a higher OHSS risk (OR = 0.64, 95% CI: 0.47-0.88, Z = 2.77, P = 0.006, I2 = 0%). Similarly, the high AMH group also presented a significantly elevated OHSS risk relative to the medium AMH group (OR = 0.40, 95% CI: 0.23-0.70, Z = 3.19, P = 0.006, I2 = 0%). Paradoxically, reproductive outcomes appear more favorable in participants with lower AMH levels: low AMH was associated with higher live birth rates versus both medium (RR = 1.15, 95% CI: 1.07-1.24; Z = 3.71, < 0.001, I2 = 39%) and high AMH (RR = 1.19, 95% CI: 1.10-1.28; Z = 4.53, P < 0.001, I2 = 27%), as well as a lower miscarriage risk (low vs. medium: RR = 0.60, 95% CI: 0.42-0.86; Z = 2.80, P = 0.005, I2 = 0%; low vs. high: RR = 0.72, 95% CI: 0.53-0.98; Z = 2.10, P = 0.04, I2 = 49%). No significant associations were found between AMH levels and cumulative live birth rates, clinical pregnancy rates, or number of good-quality embryos.

CONCLUSION

The distinct intermediate phenotype of the medium AMH group, exhibiting superior live birth outcomes compared to high AMH, yet inferior to low AMH, underscores the value of finer stratification beyond a simple binary classification.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier [CRD420251089070].