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

Hosseini S, Salehpour S, Amiresmaili N, Meshkat M, Karimi F
International journal of reproductive biomedicine · 2026 · doi:10.18502/ijrm.v24i3.21114 · PMID:42200091 · PMC13199918
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This cross-sectional study of 172 women with polycystic ovary syndrome undergoing assisted reproductive technology found that serum anti-Müllerian hormone levels nonlinearly predict ART outcomes, with mid-range concentrations yielding the most favorable results.

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This cross-sectional study analyzed clinical records from 172 women with polycystic ovary syndrome undergoing assisted reproductive technology to evaluate the association between serum anti-Müllerian hormone levels and ovarian stimulation outcomes. The researchers found a significant nonlinear, inverted-U relationship where intermediate AMH levels (2.5–6.5 ng/mL) correlated with optimal responses, including higher mature oocyte counts and embryo yields with moderate gonadotropin requirements. Conversely, both low and high AMH extremes were associated with poorer laboratory results, such as increased stimulation duration or reduced embryo quality despite rapid follicular response. Relevance to endometriosis: this paper is not centrally about endometriosis; participants with endometriosis were explicitly excluded from the study cohort to isolate the effects of PCOS on ART outcomes.

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Abstract

BackgroundPolycystic 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.ObjectiveThis 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 methodsIn 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 ( 6.5 ng/mL).ResultsSerum 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.ConclusionAMH 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.
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S. Hosseini: Contributed to the conception and design of the study, acquisition and interpretation of data, and critically revised the manuscript for important intellectual content. S. Salehpour: Assisted in study design, supervised the research process, contributed to data analysis and interpretation, and revised the manuscript. N. Amiresmaili: Participated in statistical analysis, interpretation of results, and manuscript drafting. Provided critical revision and approved the final version. M. Meshkat: Assisted with data collection, literature review, and initial drafting of the manuscript. Approved the final version and agrees to be accountable for all aspects of the work. F. Karimi: Led the conception and design of the study, coordinated data acquisition, performed data analysis and interpretation, drafted and revised the manuscript, and managed all correspondence. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Coi Statement

The authors declare that there is no conflict of interest.

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