AMH as a Predictor of Follicle Turnover, Embryo Quality, and Pregnancy Outcomes: A Retrospective Analysis

Background/Objectives: Infertility affects ~10–15% of couples of reproductive age, and assisted reproductive technologies (ARTs) increasingly rely on biomarkers to individualize care. This study aimed to investigate the relationship between serum anti-Müllerian hormone (AMH) levels and embryo quality and pregnancy outcomes in patients undergoing intracytoplasmic sperm injection (ICSI). We specifically evaluated whether AMH predicts embryo competence and clinical pregnancy beyond its established role in ovarian reserve assessment. Methods: This retrospective study included 1990 women undergoing ICSI between 2010 and 2023, categorized into three groups (G1–G3) based on antral follicle count (AFC). Embryo morphology was graded using ASEBIR criteria with prospectively maintained lab SOPs. Clinical, embryological, and pregnancy parameters were compared using non-parametric tests, ROC analysis, and logistic regression. The primary outcome was clinical pregnancy; biochemical pregnancy was recorded; live birth was not available and is acknowledged as a limitation. Results: Higher AMH levels correlated with increased AFC and oocyte yield (all p < 0.001) but showed no clinically meaningful association with high-grade embryos (Grade 1–2) or pregnancy. ROC analyses demonstrated limited discrimination for AMH (AUC ≈ 0.49); by contrast, age and FSH showed modest discrimination (AUC 0.56 and 0.55, respectively), and embryo-level features (pronuclear count, Grade 1 and Grade 3 counts) were statistically significant yet of limited clinical utility (AUCs near 0.5) Conclusions: AMH is robust for ovarian reserve and response prediction but is a weak predictor of embryo morphology and clinical pregnancy. Outcome prediction in ART should integrate age, FSH, and embryo morphology (and, where available, sperm quality) rather than AMH alone. Prospective, multicenter studies with live birth as the primary endpoint are warranted.