Impact of anti-Müllerian hormone on pregnancy outcomes in in vitro maturation: a retrospective cohort study

In vitro maturation (IVM) presents a potential alternative to conventional IVF for special subgroups of infertile couples. Anti-Müllerian Hormone (AMH) is widely regarded as the most robust biomarker for assessing ovarian reserve. However, the relationship between AMH and subsequent pregnancy success rates following IVM remains poorly characterized. This was a retrospective cohort study. Infertile patients undergoing IVM treatment at Peking University Third Hospital Reproductive Medicine Center between January 2016 and June 2024. Participants were stratified by AMH (ng/ml) quartiles: Group A (1 < AMH ≤ 7.77, n = 99), B (7.77 < AMH ≤ 11.91, n = 98), C (11.91 < AMH ≤ 17.53, n = 100), and D (AMH > 17.53, n = 96). The primary outcome was cumulative live birth rate. While baseline characteristics (age, BMI, infertility duration/type, FSH) were comparable across groups, Group D demonstrated significantly higher immature oocyte yield (P < 0.001), and embryological parameters (transferable/high-quality embryos: P < 0.001) versus other groups. Paradoxically, Group A achieved superior clinical outcomes, including: cumulative live birth rate (48.8% vs. 29.1% vs. 37.7% vs. 21.6%, P = 0.009), cumulative clinical pregnancy rate (67.4% vs. 40.0% vs. 42.6% vs. 36.1%, P = 0.006), and clinical pregnancy rate (68.4% vs. 39.1% vs. 44.4% vs. 37.5%, P = 0.015). Multivariate analysis also indicated that excessively high AMH levels (> 17.53ng/ml) may be related to reduced clinical pregnancy rate compared to low AMH levels (OR = 0.281, 95% CI: 0.108–0.728, P = 0.009). No significant differences emerged between fresh versus frozen-thawed transfers. Elevated AMH levels (> 17.53ng/ml) predict enhanced follicular recruitment but paradoxically associate with diminished reproductive success compared to moderate AMH levels (1 < AMH ≤ 7.77 ng/ml) in IVM cycles. Elevated AMH levels (> 17.53 ng/mL) predict higher oocyte yield but paradoxically result in lower pregnancy rates compared to moderate AMH levels (1-7.77 ng/mL) in IVM cycles.