# Impact of Elevated Serum Anti-Müllerian Hormone Levels on Ovulation Induction and Intrauterine Insemination Outcomes in Infertile Women with Polycystic Ovary Syndrome After Failure of ≥3 Clomiphene Citrate Cycles

## TL;DR

This study explores how high levels of a hormone called AMH may predict treatment success for infertility in women with PCOS who did not respond to standard medication.

## Contribution

The study identifies a potential AMH threshold (>4.5 ng/mL) as a predictor of ovulation and insemination outcomes in CC-resistant PCOS patients.

## Key findings

- AMH levels above 4.5 ng/mL predicted successful treatment outcomes with 56% sensitivity and 69% specificity.
- Pregnant women had shorter infertility durations and longer ovarian stimulation periods compared to non-pregnant women.
- AMH was found to be an independent predictor of pregnancy in multivariate analysis.

## Abstract

Background/Objectives: Although anti-Müllerian hormone (AMH) is a strong biomarker of ovarian reserve and oocyte pools, it is unknown whether high AMH levels can be a reliable predictor of oocyte quality, ovulation, and embryo quality. We aimed to determine whether there is any AMH threshold value that can be used to predict treatment success in women with clomiphene citrate (CC) resistance or failure in polycystic ovary syndrome (PCOS). Methods: This retrospective cohort study included 93 infertile women with PCOS who had been previously diagnosed with CC failure or CC resistance between May 2017 and June 2018. Prior to treatment, AMH concentration was measured in all women. The participants were divided into 2 groups according to their conception after ovulation induction (OI) and intrauterine insemination (IUI). At the end of a one-year period, the medical files were assessed retrospectively. Those with and without pregnancy were compared in terms of treatment protocols, infertility periods, laboratory parameters and AMH levels. Results: Clinical and biochemical characteristics of 36 pregnant women were compared with those of 57 non-pregnant women. The results showed that the pregnant group had significantly shorter infertility periods and longer ovarian stimulations than the non-pregnant group (p < 0.05). Serum AMH levels > 4.5 ng/mL can predict OI and IUI outcome in this specific patient population, with a sensitivity of 56% and a specificity of 69%. Multivariate logistic regression analysis showed that only AMH was identified as an independent predictor of pregnancy [OR = 1.151 (95% CI: 1.034–1.280), p = 0.010]. Conclusions: Serum AMH may serve as an adjunct predictor of OI and IUI outcomes in infertile women with PCOS who failed to conceive after ≥3 cycles of CC. However, its predictive value appears to be context-dependent and should be interpreted cautiously in clinical practice. Given the distinct clinical characteristics of this patient population, individualized treatment strategies and consideration of earlier alternative therapeutic approaches may be warranted to optimize reproductive outcomes.