Association between serum AMH levels and IVF/ICSI outcomes in patients with polycystic ovary syndrome: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of cohort and observational studies
PubMed 37872575 · doi:10.1186/s12958-023-01153-y
What was done
A systematic review and meta-analysis of literature from PubMed, Embase, and the Cochrane Library (searched up to July 11, 2022) examined the association between serum anti-Müllerian hormone (AMH) levels and IVF/ICSI outcomes in women with polycystic ovary syndrome (PCOS). Nineteen studies evaluating outcomes such as clinical pregnancy, live birth, and ovarian hyperstimulation syndrome were included. Quality assessments were performed independently by two groups of researchers. Odds ratios (OR) and standardized mean differences (SMD) were calculated, primarily comparing the highest (75th–100th percentile) versus lowest (0–25th percentile) AMH quartiles.
What was found
Patients in the highest AMH quartile showed significantly lower odds of clinical pregnancy (OR: 0.77, 95% CI: 0.63–0.93) and live birth (OR: 0.71, 95% CI: 0.58–0.87) compared to the lowest quartile. Higher AMH was associated with a greater number of retrieved oocytes (SMD: 0.90, 95% CI: 0.30–1.51) but lower odds of fertilization (OR: 0.92, 95% CI: 0.87–0.98). No statistically significant differences were seen in mature MII oocyte count (SMD: 1.85, 95% CI: -1.07–4.78), peak E2 on hCG day (SMD: 0.12, 95% CI: -0.98–1.23), or implantation rate (OR: 0.82, 95% CI: 0.28–2.39). Significant dose-response associations were identified for clinical pregnancy, live birth, retrieved oocytes, and fertilization.
Why it matters
Although higher AMH levels in PCOS predict greater oocyte retrieval numbers, extremely elevated levels correlate with reduced fertilization, pregnancy, and live birth rates. These results help refine risk stratification and prognostic counseling for PCOS patients undergoing assisted reproduction.
Limits
The abstract does not disclose the total aggregate patient sample size, absolute AMH cutoffs, or results regarding ovarian hyperstimulation syndrome. The underlying observational designs leave potential residual confounding related to stimulation protocols, embryo quality metrics, and assay variability.
Cited by
- supports Women with PCOS typically exhibit a high ovarian reserve (follicle count) but have reduced oocyte quality.