Controlled ovarian stimulation in women with very high AMH-balancing yield, quality and safety: a case series

Abstract

Anti-müllerian hormone (AMH) is widely used as a marker of ovarian reserve and a predictor of ovarian response during controlled ovarian stimulation in assisted reproductive techniques. While its role in predicting oocyte yield is well established, its association with embryo quality and developmental potential remains debated. This retrospective case series describes outcomes in three women undergoing IVF/ICSI with AMH levels >20 ng/ml, aiming to illustrate variability in response despite similar hormonal profiles. All patients underwent antagonist protocols with agonist trigger to reduce the risk of hyperstimulation. High yield of oocytes (19–34) and satisfactory fertilization rates (63–80%) were demonstrated by all. Day 3 conversion rates were high, however, blastocyst yield and quality varied. This reflected differences in oocyte morphology and developmental competence. Variability in oocyte quality and blastocyst formation among patients with similarly elevated AMH levels highlights the multifactorial nature of embryo competence.³ AMH should therefore be interpreted alongside age, oocyte morphology, and stimulation parameters, rather than as a sole predictor of embryological or clinical outcomes.