High anti-Müllerian hormone level as a predictor of poor pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study

ObjectiveTo study the correlation between anti-M & uuml;llerian hormone levels and pregnancy outcomes after in vitro fertilization/intracytoplasmic sperm injection in women with polycystic ovary syndrome, which remains controversial.MethodsThis retrospective cohort study recruited 4,719 women with infertility and polycystic ovary syndrome aged 20-40 years who underwent treatment at the Reproductive Center of Peking University Third Hospital between February 2017 and June 2023. We divided the participants into three groups according to the 25th and 75th percentile cutoffs of serum anti-M & uuml;llerian hormone: low (<= 4.98 ng/mL, n = 1,198), average (4.98 - 10.65 ng/mL, n = 2,346), and high (>= 10.65 ng/mL, n = 1,175). Pregnancy outcomes included live birth rate, miscarriage rate, clinical pregnancy rate, and cumulative live birth rate.ResultsThe live birth rate for fresh embryo transfer was 39.8%, 35.9%, and 30.4% in the low, average, and high anti-M & uuml;llerian hormone groups, respectively. The miscarriage rate was 11.3%, 17.1%, and 21.8% in the low, average, and high anti-M & uuml;llerian hormone groups, respectively. Significant intergroup differences were observed in the live birth rate (P = 0.017) and miscarriage rate (P = 0.018). No significant intergroup difference was observed in the clinical pregnancy rate (P = 0.204) or cumulative live birth rate (P = 0.423). After adjusting the confounders by multivariable logistic regression analysis, anti-M & uuml;llerian hormone was associated with decreased live birth rate in the high anti-M & uuml;llerian hormone group compared with that in the low anti-M & uuml;llerian hormone group (odds ratio: 0.629, 95% confidence interval: 0.460-0.860). Anti-M & uuml;llerian hormone was associated with increased miscarriage rate in the average and high anti-M & uuml;llerian hormone groups compared with that in the low anti-M & uuml;llerian hormone group (average vs. low: odds ratio: 1.592, 95% confidence interval: 1.017-2.490); high vs. low: odds ratio: 2.045, 95% confidence interval: 1.152-3.633).ConclusionHigh anti-M & uuml;llerian hormone is a prognostic factor for reduced live birth rate after fresh embryo transfer in women with polycystic ovary syndrome aged 20-40 years undergoing in vitro fertilization/intracytoplasmic sperm injection, and is associated with increased miscarriage rate in these patients.