Impact of Elevated AMH Levels on Maternal and Perinatal Outcomes in IVF Pregnancies with PCOS

<b>Objective:</b> To investigate whether polycystic ovary syndrome (PCOS) is associated with increased maternal and perinatal complications in in vitro fertilization (IVF) pregnancies, and to evaluate the relationship between anti-Müllerian Hormone (AMH) levels and adverse maternal and perinatal outcomes within the PCOS group. <b>Methods:</b> This retrospective cohort included 424 women with singleton IVF pregnancies delivered at Ankara Etlik City Hospital between September 2022 and June 2025. Participants were classified as PCOS (n = 106; AMH ≥ 4.5 ng/mL) or non-PCOS (n = 318; AMH 1.0-4.5 ng/mL). Maternal outcomes were gestational diabetes mellitus (GDM) and preeclampsia, while perinatal outcomes included preterm birth, small-for-gestational-age (SGA), large-for-gestational-age (LGA), 5-min Apgar ≤ 7, and neonatal intensive care unit (NICU) admission. Composite adverse maternal outcomes (CAMO) and composite adverse perinatal outcomes (CAPO) were defined as the occurrence of at least one respective complication. Outcomes were compared between groups, and multivariable logistic regression identified predictors of CAMO and CAPO in the PCOS cohort. <b>Results:</b> Women with PCOS had significantly higher incidences of GDM and preeclampsia compared to controls (<i>p</i> < 0.05 for all). CAMO was more common in the PCOS group (34.0% vs. 11.9%, <i>p</i> < 0.001). Median gestational age at delivery was lower among women with PCOS (<i>p</i> = 0.026). Rates of LGA neonates, low 5-min Apgar scores, and NICU admissions were significantly higher in the PCOS group (<i>p</i> < 0.001 for each). CAPO rates were comparable between groups (<i>p</i> = 0.132). In multivariable models, AMH level remained an independent predictor of both CAMO and CAPO (<i>p</i> = 0.002 and <i>p</i> = 0.014, respectively). <b>Conclusions:</b> Women with PCOS and elevated preconception AMH levels are at increased risk for both maternal metabolic complications and adverse neonatal outcomes following IVF conception. These findings suggest that preconception AMH levels, when interpreted alongside a PCOS diagnosis, may help identify women at higher obstetric and perinatal risk.