A comprehensive analysis of the impact of low AMH on ART outcomes in young patients

Introduction: The aim of the study was to investigate the value of anti-Müllerian hormone (AMH) as a predictor of implantation and/or clinical pregnancy rate per started intracytoplasmic sperm injection (ICSI) cycle in a young patient population with decreased versus normal ovarian reserve. Material and methods: This retrospective case-control cohort study utilized data extracted from participants’ electronic medical records. Patients were subsequently grouped into AMH < 1.1 [decreased ovarian reserve group (DOR)] and AMH ≥ 1.1 [normal ovarian reserve group (NOR)]. The groups were organized to be age-compatible to evaluate specifically the role of AMH in the outcomes. Prediction performance was examined with receiver operating characteristic (ROC) curves. Results: A total of 716 women were analyzed, including 298 (41.6%) with diminished ovarian reserve (DOR) and 418 age-matched women with normal ovarian reserve (NOR) serving as controls (58.4%). AMH levels below 1.1 ng/mL and 0.47 ng/mL were associated with an increased likelihood of embryo transfer (ET) cancellation. Among women who proceeded to ET, higher AMH levels were associated with positive implantation (all p < 0.001). An AMH cut-off value of ≥ 1.1 ng/mL significantly predicted clinical pregnancy and live birth, and overall AMH levels were significantly higher in women who achieved ET, implantation, clinical pregnancy, and live birth than in those who did not (all p < 0.001). Conclusions: Higher AMH levels were associated with better ET, implantation, and clinical pregnancy, especially in NOR patients; however, we also showed that the rates of pregnancy outcomes after the development of a transferable embryo in younger cases are similar to those in cases with NOR. Low but not severely diminished AMH levels in young patients may not necessarily indicate poor oocyte quality.