Association between serum AMH levels and IVF/ICSI outcomes in patients with polycystic ovary syndrome: a systematic review and meta-analysis

Abstract

Context Anti-Müllerian hormone (AMH) levels are increased in polycystic ovary syndrome (PCOS) patients and are associated with PCOS severity. Objective To evaluate the associations between serum AMH levels and in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) outcomes in patients with PCOS. Data sources PubMed, Embase, and the Cochrane Library were searched on 11 July 2022. Study selection Studies reporting the association between serum AMH levels and IVF/ICSI outcomes in PCOS patients were considered for inclusion. The primary outcomes were clinical pregnancy, live birth, and ovarian hyperstimulation syndrome. Data extraction Data were extracted using a standardized data extraction form. Study quality was assessed independently by two groups of researchers. Data synthesis Nineteen studies were included in this review. Meta-analyses demonstrated that PCOS patients with a serum AMH level within the 75-100th percentile had a decreased odds of clinical pregnancy (OR: 0.77, 95% CI: 0.63–0.93) and livebirth (OR: 0.71; 95% CI: 0.58–0.87) compared to those within the 0-25th percentile. An increased AMH level was also correlated with an increased number of oocytes retrieved (SMD: 0.90, 95% CI: 0.30–1.51) and a lower odds of fertilization (OR: 0.92, 95% CI: 0.87–0.98). There was no significant difference in the number of MII oocytes (SMD: 1.85, 95% CI: -1.07–4.78), E2 on the day of hCG (SMD: 0.12; 95% CI: -0.98–1.23), or implantation (OR: 0.82, 95% CI: 0.28–2.39) between the two groups. In addition, we found significant dose–response associations between serum AMH level and clinical pregnancy, live birth, number of oocytes retrieved, and fertilization in PCOS patients. Conclusion AMH may have clinical utility in counseling regarding IVF/ICSI outcomes among women with PCOS who wish to undergo fertility treatment. More large-scale, high-quality cohort studies are needed to confirm these findings.

Elevated Anti-Müllerian Hormone as a Prognostic Factor for Poor Outcomes of In Vitro Fertilization in Women with Polycystic Ovary Syndrome

“…In sum, the present study confirms that high AMH levels may impair the ovarian response in women with PCOS undergoing IVF, and could be of clinical utility to predict treatment outcomes, as recently shown by a systematic review and meta-analysis which suggested that AMH could be useful for counseling women with PCOS, who wish to undergo fertility treatments, on the expected IVF outcomes, although large-scale, highquality cohort studies are still needed to confirm these findings [56]. To gain a deeper understanding on the impact of AMH on folliculogenesis and the oocyte quality of women with PCOS, additional clinical studies and molecular biology experiments are needed.…”

Influence of state-of-the-art laboratory techniques on the phenotyping of women with polycystic ovary syndrome in the clinical setting

“…There is no doubt that serum AMH measurement would simplify PCOS phenotyping in the routine practice, avoiding explorations that may not only be considered unpleasant by women, but may also lead to misdiagnoses derived from untrained observers or obsolete point-of-care US equipment. Furthermore, serum AMH may play a role in clinical counseling regarding assisted reproductive therapy outcomes among women with PCOS undergoing fertility treatment [24]. Nevertheless, if an elevated serum AMH concentration and US-PCOM define the same PCOS phenotype in the clinical setting is unclear in view of our current findings.…”

Effect of oral glucose tolerance test-based insulin resistance on embryo quality in women with/without polycystic ovary syndrome

“…Besides, in patients with PCOS, the miscarriage rate seemed to increase with AMH, which is controversial in previous studies (56). Future studies could focus on this issue.…”