Discrepancies between anti-Müllerian hormone and age: Their combined impact on intracytoplasmic sperm injection results

Objective: To investigate the impact of anti-Müllerian hormone (AMH) levels on the outcomes of intracytoplasmic sperm injection (ICSI) cycles in women of advanced age and also to explore the effect of age on the ICSI results in patients with low AMH levels. Methods: This retrospective cohort study involved 143 infertile couples undergoing ICSI cycles at a fertility clinic in Iran from November 2021 to November 2023. Women aged <37 years with AMH <1 ng/mL and those aged ≥37 years were included. A standardized ovarian stimulation protocol was followed, leading to oocyte retrieval and ICSI on mature oocytes. Key oocyte quality indexes, including the maturation rate, fertilization rate, and embryo quality metrics, were evaluated. Poisson regression analyses were also employed to investigate the association between AMH levels and oocyte quality parameters in the advanced age groups, as well as the association between age and oocyte quality parameters in patients with low AMH. Results: We analyzed 143 ICSI cycles from 143 infertile couples. The mean ages of the women and their partners were (38.2±4.7) years and (40.6±5.9) years, respectively, with a median (IQR) AMH level of 0.7 (0.4–2.0) ng/mL. Younger women with low AMH levels (<1 ng/mL) showed significantly better outcomes in terms of the number of ME oocytes [adjusted odds ratio (a OR ) 1.89, 95% CI 1.31-2.71; P =0.001], fertilized (2PN) oocytes (a OR 1.97, 95% CI 1.36-2.86; P <0.001), embryo number (a OR 2.16, 95% CI 1.44-3.24; P <0.001), and embryos suitable for freezing (a OR 2.88, 95% CI 1.80-4.61; P <0.001) compared to advanced-age women. Furthermore, among women of advanced age, those with normal AMH levels exhibited a significantly higher number of ME oocyte (a OR 3.55, 95% CI 2.31-5.44; P <0.001), fertilized (2PN) oocytes (aOR 3.54, 95% CI 2.29-5.49; P <0.001), embryo number (a OR 3.89, 95% CI 2.48-6.10; P <0.001), and embryos suitable for freezing (a OR 4.75, 95% CI 2.79-8.09; P <0.001) compared to those with low AMH levels. Conclusions: AMH level is a significant predictor of oocyte and embryo number and quality in infertile women of advanced age undergoing ICSI cycles. Our findings suggest that maternal age markedly impacts the quality of oocytes and embryos in low AMH-level patients.