PURPOSE: To investigate the associations of anti-Müllerian hormone (AMH) and antral follicle count (AFC) concordance/discordance patterns with embryological and pregnancy outcomes among patients undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle. METHODS: This retrospective cohort study included 6456 patients undergoing their first IVF/ICSI cycle between January 2018 and January 2024. Patients were classified into the concordant normal group (AMH ≥ 1.2 ng/mL and AFC ≥ 5), the concordant reduced group (AMH < 1.2 ng/mL and AFC < 5), and the discordant group (AMH-normal/AFC-reduced: AMH ≥ 1.2 ng/mL with AFC < 5 or AMH-reduced/AFC-normal: AMH < 1.2 ng/mL with AFC ≥ 5). Regression models were used to evaluate their embryological and pregnancy outcomes. RESULTS: Among 6456 patients, 816 (12.64%) exhibited AMH-AFC discordance. Compared with the concordant normal group, the discordant group had lower adjusted numbers of retrieved oocytes (β = - 4.04, 95% CI - 4.44 to - 3.65), MII oocytes (β = - 3.46, 95% CI - 3.83 to - 3.10), 2PN zygotes (β = - 2.57, 95% CI - 2.87 to - 2.26), transferable embryos (β = - 2.23, 95% CI - 2.52 to - 1.95), and high-quality embryos (β = - 1.73, 95% CI - 1.98 to - 1.47) (all P < 0.001). No significant differences in these outcomes remained between the discordant and concordant reduced groups after adjustment. Among the 6188 patients who underwent their first embryo transfer, pregnancy outcomes did not differ significantly between the discordant and concordant normal groups, whereas the discordant group had higher adjusted odds of biochemical pregnancy (OR = 1.38, 95% CI 1.03-1.86, P = 0.031) and live birth (OR = 1.40, 95% CI 1.01-1.95, P = 0.042) than the concordant reduced group. Within the discordant group, the AMH-normal/AFC-reduced subgroup had higher oocyte and embryo yields, but their pregnancy outcomes were comparable. CONCLUSION: AMH-AFC discordance was associated with lower ovarian response and embryo yield than concordant normal ovarian reserve. Among discordant patients, normal AMH with reduced AFC was associated with higher oocyte and embryo yields. The discordant group had modestly higher odds of biochemical pregnancy and live birth than the concordant reduced group, whereas pregnancy outcomes were otherwise broadly comparable across AMH-AFC patterns.