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Association between High AMH Levels in PCOS Patients and IVF/ICSI Outcomes: a systematic review and meta-analysis
Angélica Martins1, Renato Ferreira-da-Silva1,2,3, Ana Margarida Póvoa1,4,5
1University of Porto Faculty of Medicine Porto Portugal Faculty of Medicine of the University of Porto, Porto, Portugal.
Objective:
To evaluate the association between high Anti-Müllerian Hormone (AMH) levels and key outcomes of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) in women with Polycystic Ovary Syndrome (PCOS).
Data Sources:
A systematic search was performed in MEDLINE (via PubMed), Web of Science, and Scopus, on September 17, 2024.
Selection Of Studies:
We included observational studies in PCOS patients stratified by AMH levels that reported any of the IVF/ICSI outcomes of interest, namely: live birth rate, clinical pregnancy rate, miscarriage rate, oocytes retrieved, MII oocytes and fertilization rate.
Data Collection:
Two reviewers independently extracted data and assessed risk of bias using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool. Discrepancies were resolved by consensus. Data were pooled using meta-analysis when appropriate. Sensitivity analyses were conducted using a leave-one-out approach.
Data Synthesis:
Thirteen studies met the inclusion criteria. Ten were rated as low risk of bias, two as unclear, and one as high risk, indicating overall fair to strong methodological quality. Women with high AMH levels had a lower live birth rate (odds ratio [OR]: 0.85; 95%CI: 0.71-1.02), which became significant after leave-one-out analysis (OR: 0.80; 95%CI: 0.64-0.99). Clinical pregnancy rates were 2% lower in women with elevated AMH levels (OR: 0.98; 95%CI: 0.82-1.17). Miscarriage rates showed a non-significant 25% increase in women with high AMH levels (OR: 1.25; 95%CI: 0.88-1.76). High AMH levels were associated with more retrieved oocytes in the overall meta-analysis (mean difference: 3.52; 95%CI: 1.70-5.33), with consistent findings in sensitivity analyses. There was no significant difference in fertilization rate between the two groups.
Conclusion:
While high AMH levels indicate greater ovarian reserve, they negatively influence reproductive outcomes in PCOS patients. These findings highlight the need for individualized ART strategies and further research to clarify underlying mechanisms.PROSPERO: CRD42024596056.
