The IVF/ICSI Pregnancy Outcomes and Influencing Factors of Low AMH Patients with High and Low Basal FSH

Purpose: To investigate the IVF/ICSI outcomes and influencing factors of low basal AMH level young patients with elevated and decreased basal FSH levels. Methods: This retrospective cohort study included 70,644 IVF/ICSI cycles performed at a tertiary hospital reproductive center between January 2017 and December 2022. After 1:2 propensity score matching for age and AMH of low basal AMH level patients (AMH < 1.1ng/mL) aged 20-39 years, 298 low basal FSH level cycles (FSH < 5mIU/ml) and 149 high basal FSH level cycles (FSH > 25mIU/ml) were included. Results: The clinical pregnancy rates (35.07% vs. 23.81%, P = 0.007), live birth rates (28.36% vs. 16.67%, P = 0.007), cumulative clinical pregnancy rates (19.80% vs. 8.05%, P = 0.001), and cumulative live birth rates (16.78% vs. 6.04%, P = 0.002) were all higher in the low FSH level group. After adjusting for BMI and ovulation induction protocol, a high basal FSH level was negatively associated with the number of good-quality embryos ( P = 0.007), cumulative clinical pregnancy (OR 0.430 (0.216, 0.854), P = 0.016) and cumulative live birth (OR 0.396 (0.183, 0.855), P = 0.018). AFC was positively correlated with clinical pregnancy (OR 1.151 (1.050, 1.262), P = 0.003), live birth (OR 1.121 (1.013, 1.241), P = 0.027), cumulative clinical pregnancy (OR 0.430 (0.216, 0.854), P = 0.016) and cumulative live birth (OR 0.396 (0.183, 0.855), P = 0.018). Conclusion: Low basal AMH level young patients with low basal FSH level had more AFCs and showed better pregnancy outcomes. A high basal FSH level was negatively associated with the number of good-quality embryos, cumulative clinical pregnancy and live birth rates. AFC was positively correlated with pregnancy outcomes.