A diagnosis of low AMH (Anti-Müllerian Hormone) often raises immediate concerns about IVF success. While low AMH indicates a reduced ovarian reserve, it does not mean there is no chance of pregnancy. However, it does highlight one critical reality: time and strategy become extremely important.

What Does Low AMH Really Mean?

AMH reflects the remaining number of eggs, not necessarily their quality. Younger women with low AMH may still produce good-quality embryos, whereas with increasing age, both egg quantity and quality decline.

This is why IVF success in low AMH is not uniform and depends on:

• Age
• Egg quality
• Sperm parameters
• Endometrial receptivity
• Number of embryos available

In low AMH patients, the challenge is often not fertilisation—but limited embryo numbers.

Why Early IVF Is Important

Many younger women with low AMH can conceive naturally. However, if conception does not happen and treatment is delayed, ovarian reserve may decline further, leading to fewer eggs and reduced chances later.

Early IVF in selected cases helps:

• Capture the existing reproductive potential
• Avoid loss of time
• Create embryos for present or future use

In low AMH, IVF is not just treatment—it is time-sensitive planning.

IVF Success: Quality Over Quantity

Low AMH patients often produce fewer eggs, but success depends on embryo quality rather than number. Even one good embryo can lead to pregnancy.

However, fewer embryos per cycle reduce the overall probability per attempt. This is where strategy becomes crucial.

Embryo Pooling: A Key Advancement

One of the most important emerging strategies in low ovarian reserve is embryo pooling.

In our published study:
Role of Embryo Pooling in Low Ovarian Reserve

we evaluated 46 patients with low ovarian reserve undergoing IVF with embryo accumulation across multiple cycles. The study showed:

• Pregnancy rate: 44.4%
• Clinical pregnancy rate: 35.5%
• Live birth rate: 26.6%

What is embryo pooling?

• Multiple IVF stimulation cycles are performed
• Embryos from each cycle are frozen and accumulated
• Transfer is done after achieving a reasonable number of good-quality embryos

This approach addresses the key limitation in low AMH patients—low egg yield per cycle.

Other studies also suggest that embryo pooling can help achieve cumulative pregnancy outcomes comparable to patients with better ovarian reserve when enough embryos are accumulated.

Individualised IVF Planning

Success in low AMH depends on careful, individualised decisions:

1. Stimulation protocols

Customised protocols aim to maximise egg yield without compromising quality.

2. Multiple cycles

Often, more than one cycle is required to improve cumulative chances.

3. Day of transfer

Blastocyst (Day 5) transfer helps select embryos with higher implantation potential.

4. PGT-A

Useful in selected patients, especially with advancing age, to identify chromosomally normal embryos.

5. Endometrial preparation

A good endometrium is essential for implantation.

Adjunct Therapies: Evolving Role

Some adjunct approaches are being explored:

• Platelet-Rich Plasma (PRP): May help improve endometrial thickness or ovarian response in select cases
• Stem cell therapy: Still experimental, not standard of care

Other evolving strategies include:

• Dual stimulation (DuoStim)
• Advanced embryo selection techniques (including AI-based tools)

These remain promising but are still under study.

Final Takeaway

Low AMH does not mean no success—it means fewer chances per cycle and a narrower time window.

The focus should be on:

• Early decision-making
• Individualised treatment planning
• Maximising cumulative success through strategies like embryo pooling

In low AMH, success is not about a single cycle—it is about building the best possible opportunity over time.

References

1. Banerjee K, Singla B, Verma P. Role of Embryo Pooling in Low Ovarian Reserve. Med Res Arch. 2025.
2. Broer SL, et al. Anti-Müllerian hormone: ovarian reserve testing and clinical implications. Hum Reprod Update. 2014.
3. Sunkara SK, et al. Association between AMH and IVF outcomes. Hum Reprod. 2011.
4. Hu X, et al. Embryo pooling: a promising strategy for managing insufficient embryos. Gynecol Endocrinol. 2017.
5. Poseidon Group. Management of low prognosis patients in IVF. Hum Reprod. 2016.
6. Vaiarelli A, et al. Double stimulation in poor ovarian responders. Fertil Steril. 2018.
7. Practice Committee ASRM. Role of PGT-A in IVF. Fertil Steril. 2018.
8. Kasius A, et al. Endometrial thickness and IVF outcomes. Hum Reprod Update. 2014.
9. Sfakianoudis K, et al. Platelet-rich plasma in reproductive medicine. J Clin Med. 2020.
10. Herraiz S, et al. Stem cell therapy in ovarian insufficiency. Reprod Biol Endocrinol. 2018.