The baseline characteristics of the non-PCOS infertility patients were notable for having a lower mean AMH of 2.8 ng/ml compared to 6.1 ng/ml in the patients with PCOS. The baseline characteristics of non-PCOS and PCOS patients are summarized in Table 1. The etiology of infertility was documented according to the type of infertility field in the SART CORS database. The etiologies of infertility included in the analysis were diminished ovarian reserve, male factor, tubal factor, endometriosis, uterine factor, PCOS related infertility, and unexplained infertility. The patient distribution of each etiology is summarized in Table 1.

Cycle specific data was also collected. Specifically, the number of oocytes retrieved per cycle and the number of embryos transferred per cycle were analyzed. The summary of stimulation responses including number of oocytes retrieved and embryos transferred are summarized in Table 2.

In the combined analysis of all patients with infertility which included 66,793 cycles (non-PCOS and PCOS cycles), patient’s mean age was 34.3 years with a mean BMI of 26.3 kg/m2. The mean AMH was 3.2 ng/ml, and the mean number of embryos transferred was 1.8. AMH levels were not associated with increased miscarriage rates for AMH < 1 ng/ml (OR 1.1, CI 0.9–1.4, p = 0.3) independent of age, BMI and number of embryos transferred when examining all patient cycles regardless of etiology of infertility.

Of the non-PCOS patients alone which included 58,303 cycles, the mean age was 34.6 years with a mean BMI of 26 kg/m2. The mean AMH was 2.8 ng/ml, and the mean number of embryos transferred was 1.8. In non-PCOS cycles, there was a significant difference in miscarriage rates for AMH < 1 ng/ml (OR 1.2, CI 1.1–1.3, p < 0.01) independent of age, BMI and number of embryos transferred, unadjusted means are summarized in Table 3. This statistical significance did not persist at higher thresholds of AMH ≥ 1 ng/ml, see Appendix Supplementary Table 1. The overall miscarriage rate for all index cycles, and cycles with or without PCOS was 16%.

Of the PCOS patients alone, which included 8,490 cycles, the mean age was 32.4 years with a mean BMI of 28.1 kg/m [2]. The mean AMH was 6.1 ng/ml, and the mean number of embryos transferred was 1.7. AMH levels were not associated with increased miscarriage rates for AMH < 1 ng/ml (OR 0.8, CI 0.5–1.1, p = 0.2) independent of age, BMI and number of embryos transferred.

When analyzed as a continuous variable AMH was a statistically significant predictor of miscarriage for non-PCOS patients (OR 0.97, CI 0.96–0.98). Receiver operating characteristic (ROC) curves were performed, the area under the curve (AUC) were calculated with 95% confidence interval (CI). The 95% confidence interval for AUC for non-PCOS patients was 0.56–0.58 and PCOS patients was 0.53–0.58. Thus, the ROC analysis suggested that AMH was a weak independent predictor of miscarriage after ART (Appendix: Figure 1).