Poor Ovarian Reserve (Low AMH)

What is poor ovarian reserve (low AMH)?

Ovarian reserve is the number of eggs remaining in the ovaries. Every woman is born with all the eggs she will ever have, and this number falls steadily with age. Poor or diminished ovarian reserve means fewer eggs remain than expected for a woman's age. Anti-Müllerian hormone (AMH) is a blood test that reflects this reserve. A low AMH tells us mainly about egg quantity, not egg quality, and it does not by itself mean a woman cannot conceive naturally.

Symptoms and signs

Low ovarian reserve usually causes no symptoms. It is often found during fertility tests. Some women notice:

• Shorter menstrual cycles than before
• Periods becoming irregular in the late 30s or earlier
• Few eggs collected or a poor response in a previous IVF cycle
• Hot flushes or night sweats, if reserve is very low

Causes and risk factors

• Increasing age, the most common cause, especially after 35
• Previous ovarian surgery, particularly for endometriomas (chocolate cysts)
• Endometriosis
• Chemotherapy or pelvic radiation
• Genetic factors such as Fragile X (FMR1) premutation or a family history of early menopause
• Autoimmune conditions
• Smoking

In many women no specific cause is found.

How it is diagnosed

• AMH blood test, which can be done on any day of the cycle
• Antral follicle count (AFC) on a transvaginal ultrasound early in the cycle
• Day 2 to 3 FSH and estradiol levels
• Thyroid and prolactin tests, plus tubal assessment and semen analysis for the partner

AMH levels vary between laboratories, so results should be interpreted by a specialist together with age and AFC.

Treatment options

Acting without delay

Because reserve continues to fall over time, specialists usually advise starting evaluation and treatment promptly rather than waiting.

Ovulation induction and IUI

Younger women with open tubes and a reasonable AFC may try ovarian stimulation with IUI for a limited number of cycles.

IVF with individualised stimulation

IVF allows the available eggs to be collected and fertilised in the laboratory. Protocols are tailored to the expected response. Some women need more than one egg collection to build up embryos, which can be frozen. Supplements such as DHEA or growth hormone are sometimes discussed, but evidence for benefit is limited.

Donor eggs

When the woman's own eggs give a very low chance, IVF with donor eggs is an option. Because the donor is young, success depends mainly on the donor's eggs and the recipient's uterus.

Egg freezing

Women not ready for pregnancy who learn they have low AMH may consider freezing eggs sooner rather than later.

Chances of pregnancy

Women with low AMH can and do conceive, especially when they are younger. Age is the strongest predictor, because it affects egg quality. Fewer eggs per IVF cycle usually means fewer embryos, so cumulative chances may need more than one cycle. Your specialist can give you an estimate based on your tests, but no outcome can be guaranteed.

When to see a fertility specialist

See a specialist promptly if your AMH is low, if you are 35 or older and have tried for 6 months, or if you have had ovarian surgery or chemotherapy. Iswarya Fertility has 91+ centres, and EMI options start from ₹9,999 per month for eligible treatments.