Higher follicular fluid anti-Müllerian hormone concentration in women with clinical pregnancy after IVF: a systematic review and meta-analysis

Abstract

Anti-Müllerian hormone (AMH), produced by follicular granulosa cells, is a potential marker of granulosa cell function and may influence reproductive outcomes. A low concentration of AMH in follicular fluid (ffAMH) has been associated with granulosa cell dysfunction, but data on its association with the clinical pregnancy rate (CPR) after IVF remain limited and inconclusive. In order to address this research gap, the study question was formulated as follows: What is the association between ffAMH concentration and CPR after IVF? A systematic literature search was conducted in Medline, Embase and Cochrane databases until January 2024, including observational studies examining the association between ffAMH and CPR after IVF. Sixteen studies with 638 pregnant and 1069 non-pregnant women were analysed, encompassing both stimulated (95.1%) and non-stimulated (4.9%) IVF protocols. The meta-analysis revealed a significantly higher mean ffAMH concentration in pregnant women compared with non-pregnant women (standardized mean difference = 0.76, 95% CI 0.27-1.25; I² = 83%, P < 0.01). This finding suggests that ffAMH could serve as a marker for granulosa cell function and a potential indicator of oocyte quality. While ffAMH shows promise as a prognostic and selection marker for oocytes, the substantial heterogeneity across studies underscores the need for further research before clinical implementation.

Keywords: Anti-Müllerian hormone; Follicular fluid; In-vitro fertilization; Live birth rate; Natural cycle; Pregnancy rate.