Anti-Müllerian hormone levels and live birth rate in polycystic ovary syndrome patients undergoing assisted reproductive technology: a systematic review and meta-analysis.

BACKGROUND: Anti-Müllerian hormone (AMH) is typically elevated in women with polycystic ovary syndrome (PCOS), but its relationship with assisted reproductive technology (ART) outcomes remains unclear. OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the association between AMH levels and pregnancy outcomes in women with PCOS undergoing ART. SEARCH METHODS: Observational studies published between January 2020 and May 2025 were identified from major databases. The search strategy incorporated controlled vocabulary and keywords related to "Polycystic Ovary Syndrome," "anti-Müllerian hormone," and ART outcomes. Eight studies were included. MAIN OUTCOMES: Higher oocyte yields were observed across ascending AMH subgroups, with significant differences detected in all pairwise comparisons (low vs. high: MD = -3.91, 95% CI: -5.60 to -2.23; Z = 4.55, P < 0.001, I2 = 86%; low vs. medium: MD = -2.33, 95% CI: -2.79 to -1.86; Z = 9.77, P < 0.001, I2 = 50%; medium vs. high: MD = -1.70, 95% CI: -3.31 to -0.09; Z = 2.07, P = 0.04, I2 = 0%). Higher AMH levels were significantly associated with increased risk of ovarian hyperstimulation syndrome (OHSS). Compared with the low AMH group, the high AMH group had a higher OHSS risk (OR = 0.64, 95% CI: 0.47-0.88, Z = 2.77, P = 0.006, I2 = 0%). Similarly, the high AMH group also presented a significantly elevated OHSS risk relative to the medium AMH group (OR = 0.40, 95% CI: 0.23-0.70, Z = 3.19, P = 0.006, I2 = 0%). Paradoxically, reproductive outcomes appear more favorable in participants with lower AMH levels: low AMH was associated with higher live birth rates versus both medium (RR = 1.15, 95% CI: 1.07-1.24; Z = 3.71, < 0.001, I2 = 39%) and high AMH (RR = 1.19, 95% CI: 1.10-1.28; Z = 4.53, P < 0.001, I2 = 27%), as well as a lower miscarriage risk (low vs. medium: RR = 0.60, 95% CI: 0.42-0.86; Z = 2.80, P = 0.005, I2 = 0%; low vs. high: RR = 0.72, 95% CI: 0.53-0.98; Z = 2.10, P = 0.04, I2 = 49%). No significant associations were found between AMH levels and cumulative live birth rates, clinical pregnancy rates, or number of good-quality embryos. CONCLUSION: The distinct intermediate phenotype of the medium AMH group, exhibiting superior live birth outcomes compared to high AMH, yet inferior to low AMH, underscores the value of finer stratification beyond a simple binary classification. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier [CRD420251089070].