Serum anti-Müllerian hormone and ovarian stimulation parameters in women with polycystic ovary syndrome undergoing assisted reproductive technology: A cross-sectional study.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder and a major cause of anovulatory infertility. Serum anti-Müllerian hormone (AMH), a marker of ovarian reserve, is often elevated in PCOS. However, its predictive value for assisted reproductive technology (ART) outcomes remains unclear due to nonlinear associations.

Objective: This study aimed to evaluate the relationship between serum AMH levels and ART outcomes in women with PCOS undergoing in vitro fertilization or intracytoplasmic sperm injection.

Materials and methods: In this cross-sectional study, clinical and laboratory data of 204 infertile women with PCOS who underwent ART cycles between March 2023 and March 2025 at Taleghani hospital, Tehran, Iran, were extracted from their medical records. After excluding 32 cases, AMH of 172 women were assessed both continuously and categorically ( $<$ 2.5, 2.5-6.5, $>$ 6.5 ng/mL).

Results: Serum AMH was inversely correlated with gonadotropin dose (r = -0.39) and stimulation days (r = -0.98) and positively correlated with metaphase II oocyte count (r = 0.64) and embryo formation (r = 0.59) (p $<$ 0.0001 for all). Multivariable regression analysis confirmed a nonlinear, inverted-U relationship between AMH and these outcomes, with the most favorable ART. Results observed in women with mid-range AMH levels (2.5-6.5 ng/mL). In addition, outcome measures differed significantly across the 3 AMH categories.

Conclusion: AMH is a robust yet nonlinear predictor of ART response in PCOS. Mid-range levels produce the best outcomes. Stratifying by AMH may enhance personalized protocols and ART effectiveness.