Anti-Müllerian Hormone (AMH) is a diagnostic tool used in fertility treatment to estimate a woman’s remaining egg supply. A low AMH level is a frequent and significant concern for individuals considering or undergoing in vitro fertilization (IVF) or egg freezing. This marker directly influences how fertility specialists predict the outcome of ovarian stimulation and egg retrieval procedures. Understanding the precise link between a low AMH level and the number of eggs retrieved is a crucial first step in navigating modern fertility options.
Understanding AMH and Ovarian Reserve
AMH is a hormone secreted by the granulosa cells surrounding the small, growing follicles within the ovaries. It acts as a reliable proxy for the quantitative aspect of the ovarian reserve, which is the pool of potential eggs remaining in the ovaries. Higher AMH levels indicate a larger pool of these small follicles, while lower levels suggest a diminishing reserve.
AMH is considered a superior marker of ovarian reserve compared to Follicle-Stimulating Hormone (FSH) because its levels remain relatively stable throughout the menstrual cycle. FSH, in contrast, fluctuates significantly, often rising only later in the aging process when the ovarian reserve is already severely depleted. An AMH level falling under 1.0 nanogram per milliliter (ng/mL) is generally classified as low, indicating a reduced capacity for egg production. This measurement helps doctors anticipate a woman’s potential response to the stimulating medications during an IVF cycle.
Low AMH and the Expected Number of Eggs Retrieved
A low AMH level is strongly predictive of a reduced yield during egg retrieval, a condition often categorized as Poor Ovarian Response (POR). Patients with an AMH concentration below 0.7 ng/mL are frequently classified as poor responders, meaning they are likely to produce fewer than four to five eggs following high-dose ovarian stimulation. The relationship between AMH and retrieval quantity is proportional; as the AMH level decreases, the average number of retrieved eggs drops concurrently.
For women with very low AMH, such as levels below 0.5 ng/mL, the mean number of eggs retrieved per cycle often falls into the range of approximately two to eight. Retrieval attempts are still worthwhile, even with ultralow levels below 0.16 ng/mL, although the cycle cancellation rate before retrieval can be high. Fertility specialists use the Antral Follicle Count (AFC)—a direct ultrasound count of the small follicles—in conjunction with AMH to refine this prediction. AFC provides a real-time visual assessment, and combining the two offers a more accurate forecast of the number of mature eggs that can be collected. Low AMH signals that the ovaries will not respond robustly to hormonal stimulation, requiring specialized treatment approaches.
Strategies for Maximizing Ovarian Response
Fertility specialists employ tailored medical interventions and protocols aimed at encouraging the maximum possible ovarian response in patients with low AMH.
One common approach is the Microdose Flare protocol, which uses a small dose of a GnRH agonist (like Lupron) at the start of the cycle to create a temporary surge, or “flare,” of the body’s own FSH and Luteinizing Hormone (LH). This natural boost is intended to enhance the recruitment of the few remaining follicles before the subsequent addition of high-dose injectable gonadotropins. Another strategy is the Antagonist protocol, which is favored for its flexibility and ability to prevent the premature ovulation of follicles without overly suppressing ovarian function.
Some clinics also utilize Mild Stimulation protocols, sometimes referred to as Mini-IVF, which pair low doses of injectable hormones with oral medications such as Clomid or Letrozole. This gentler approach focuses on collecting a smaller number of high-quality eggs while reducing cost and medication burden.
In addition to stimulation protocols, some patients may undergo pretreatment with adjuvant therapies like Dehydroepiandrosterone (DHEA) or Coenzyme Q10 (CoQ10). DHEA is a mild steroid hormone that some studies suggest may improve the ovarian micro-environment and increase the antral follicle count, while CoQ10 is an antioxidant thought to enhance mitochondrial function within the egg cells. These supplements typically require two to three months before a stimulation cycle begins. For many patients, the strategy of “egg banking” or “embryo banking” is recommended, involving multiple retrieval cycles to accumulate a sufficient number of eggs or embryos for a future successful pregnancy.
Why Egg Quality Matters More Than Quantity
While a low AMH level accurately predicts a reduced number of eggs retrieved, this metric alone does not determine the success of an IVF cycle. The primary determinant of viability is the egg’s quality, which is overwhelmingly governed by the patient’s age rather than the AMH value.
A younger woman with low AMH often has a better chance of success than an older woman with a similar or even slightly higher AMH, simply because her few retrieved eggs are more likely to be chromosomally normal. The goal shifts from collecting a large quantity to securing even one or two high-quality, genetically sound eggs. A single high-quality egg that successfully fertilizes and develops into a viable embryo holds far greater value than many eggs that are genetically abnormal. Advanced techniques, such as Preimplantation Genetic Testing for Aneuploidy (PGT-A), are sometimes used to assess the chromosomal health of the resulting embryos.