Low AMH Treatment in Ahmedabad

“In my 15 years of treating fertility patients, the cases I find most rewarding are the women who arrive having been told their AMH is ‘too low’ for IVF. Low AMH is one of the most misunderstood reports in fertility medicine. A low number does not mean poor- quality eggs. I have seen women with AMH of 0.3 ng/mL achieve successful pregnancies with their own eggs through careful, personalised protocols. The answer is never to give up on your own eggs without a genuine effort.” — Dr. Pranay Shah, MS (ObGy), Director, Wellspring IVF & Women’s Hospital

Anti-Müllerian Hormone (AMH) is a protein hormone produced by the small follicles in the ovaries. Because these follicles contain the eggs that will eventually be recruited for ovulation, the level of AMH in the blood gives us an indirect measurement of how many eggs remain in the ovarian reserve — what fertility specialists call the ‘ovarian reserve.’

AMH is one of the most useful fertility blood tests because, unlike FSH or oestrogen, it does not fluctuate significantly during the menstrual cycle. This means it can be tested on any day of your cycle and gives a consistent, reliable picture of your remaining egg quantity.

The Most Important Thing to Understand: AMH Measures Quantity, NOT Quality

This is the most critical distinction in low AMH management, and one that is frequently  misunderstood — even by some clinicians.

AMH tells us how many eggs you have remaining. It does not tell us about the genetic quality or developmental potential of those eggs. A woman with AMH of 0.4 ng/mL may have 3–4 eggs retrieved in an IVF cycle — but if those eggs fertilise normally and develop into good-quality embryos, the success rate per embryo transferred is not significantly different from a woman with a higher AMH.

The challenge with low AMH is not egg quality — it is egg quantity per cycle. Fewer eggs means fewer chances per stimulation. This is precisely why our advanced protocols (Dual Stimulation and Embryo Banking) exist: to maximise the total number of eggs collected, cycle by cycle, until we have enough good-quality embryos to attempt transfer.

Low AMH can result from several different factors. Understanding the underlying cause matters, because it may influence the treatment approach:

• Age: The most common cause. AMH levels decline naturally and progressively from a woman’s mid-20s, with the steepest decline occurring from the mid-30s onward. This is a biological reality, not a disease.
• Endometriosis and Endometriomas: Chocolate cysts on the varies directly damage the surrounding follicular tissue, reducing AMH. Poorly performed cyst surgery can further reduce reserve. See our Endometriosis page for detail on reserve-protecting surgical approach.
• Previous Ovarian Surgery: Any surgery on the ovary — including cystectomy, ovarian drilling for PCOS, or surgery for torsion — can reduce the ovarian cortex and lower AMH. 
• Cancer Treatment: Chemotherapy and pelvic radiotherapy are toxic to follicles and can cause rapid, severe reduction in AMH — sometimes leading to premature ovarian insufficiency.
• Autoimmune Conditions: The immune system can attack ovarian tissue in certain autoimmune conditions, reducing AMH over time.
• Genetics: A family history of early menopause (before age 45) is a significant predictor of earlier-than-normal decline in ovarian reserve.
• Idiopathic (Unknown Cause): In some women, particularly those under 35 with low AMH and no other identifiable cause, the reduction in reserve is unexplained. This is sometimes called Diminished Ovarian Reserve (DOR) and requires specialist management.

When a woman with low AMH comes to Wellspring IVF, the onversation does not begin with donor eggs. It begins with a thorough assessment of what her ovaries are genuinely capable of — and then with a protocol specifically designed to maximise that capability.

Dr. Pranay Shah has developed a structured approach for poor esponders that is used before any discussion of alternative options. This approach has two defining techniques:

Protocol 1: Dual Stimulation (DuoStim) — Two Chances in One Month

Dual Stimulation is one of the most significant advances in fertility treatment for poor responders in the past decade. It is based on a scientific observation: follicles do not grow only in the follicular phase of the cycle (days 1–14). The ovary can be stimulated to produce
additional eggs in the luteal phase (days 15–28) of the same cycle. 

In a standard IVF cycle, stimulation is performed once — typically in the follicular phase. For a woman with low AMH who produces only 1–2 eggs in a standard cycle, this provides very limited material for embryo development.

In a DuoStim cycle, we stimulate twice:

• First stimulation: Standard follicular phase stimulation (days 1–14), egg collection, embryo development and vitrification (freezing).
• Second stimulation: Luteal phase stimulation begins approximately 5 days after the first egg collection (days 20–26 of the same cycle), collecting a second batch of eggs from the same month.

The result: in a single calendar month, we may collect double the number of eggs compared to a conventional single-stimulation cycle. For a poor responder, this can mean the difference between having 1–2 embryos and having 4–5 — a significant increase in the
cumulative probability of a successful pregnancy.

Current evidence shows that luteal phase-derived eggs have comparable fertilisation rates and embryo quality to follicular phase eggs. There is no compromise on quality — we are simply using a biological window that was previously left unexploited.

Protocol 2: Embryo Banking — Accumulating Your Best Chances
Embryo Banking (also called Embryo Accumulation) is a strategy where, rather than attempting an embryo transfer after every stimulation cycle, we vitrify (freeze) all embryos obtained across multiple cycles and accumulate them into a single cohort before any
transfer is attempted.

The logic is straightforward: for a woman with low AMH who produces 1–2 eggs per cycle, a single cycle may not yield enough embryos to achieve a transfer. But if we perform 2–3 stimulation cycles — often using DuoStim to maximise each month — and bank all the resulting blastocysts, we may accumulate 4–6 high-quality frozen embryos.

We then perform a single Frozen Embryo Transfer (FET) cycle in a well-prepared uterine environment, choosing the best embryo from the banked cohort. This strategy improves outcomes in several ways:

• Improves cumulative live birth rate compared to multiple single-embryo transfer attempts from individual cycles.
• Allows optional PGT-A (preimplantation genetic testing) on the banked embryo cohort before transfer, identifying the chromosomally normal embryo for transfer.
• Eliminates the risk of transferring into a stimulated uterine environment, which can be suboptimal for implantation after high-dose stimulation.
• Reduces patient anxiety by ensuring there is a good-quality embryo waiting before any transfer is attempted.

At Wellspring IVF, Dr. Pranay Shah carefully counsels each patient on whether DuoStim, Embryo Banking, or a combination of both is the most appropriate strategy for their specific AMH level, age, antral follicle count, and previous response history.

Beyond Dual Stimulation and Embryo Banking, Dr. Shah uses a comprehensive set of evidence-based interventions for women with low AMH:

• Individualised stimulation protocols: Standard antagonist protocols are often not optimal for poor responders. Dr. Shah may use modified protocols such as the ‘Bologna criteria’ protocol, mini-IVF, or modified natural cycle IVF depending on AMH level and previous response.
• DHEA supplementation: Dehydroepiandrosterone (DHEA), typically 25–75 mg daily for 6–12 weeks before an IVF cycle, has evidence supporting improved ovarian response and egg quality in poor responders. It is prescribed selectively based on individual assessment.
• CoQ10 supplementation: Coenzyme Q10 supports mitochondrial function in oocytes, potentially improving egg quality. 200–600 mg daily for 2–3 months before IVF is often recommended for women over 35 with low reserve.
• Growth Hormone co-treatment: In selected poor responders, Growth Hormone (GH) is added to the IVF stimulation protocol. Evidence suggests it can improve ovarian response and egg yield in women who have previously had a poor response to standard stimulation.
• Antral Follicle Count (AFC) correlation: AMH is always interpreted alongside AFC on ultrasound. Sometimes AMH is disproportionately low relative to the visible follicle count — in such cases, the ovarian response may be better than the AMH level suggests.
• Natural Cycle IVF: For women with very low AMH (below 0.3 ng/mL) who produce very few follicles even with stimulation, Natural Cycle IVF — collecting the single naturally selected dominant egg each month — may offer a gentle, cost-effective way to accumulate embryos without the side effects of high-dose stimulation.

For the overwhelming majority of women with low AMH, the strategies above provide a genuine and often successful path to pregnancy with their own eggs. However, we believe in honest, transparent counselling — and there are situations where, after an exhaustive and genuine attempt with own eggs, the likelihood of success becomes very low.

In such circumstances, Dr. Shah will have a full, unhurried conversation about the remaining pathways. At Wellspring IVF, this conversation is always factual, never pressured, and always led by what is in your best interest — not by commercial considerations.

Donor Egg IVF — Important Information Under the ART (Regulation) Act, 2022

In India, the use of donor eggs in assisted reproduction is strictly regulated by the Assisted Reproductive Technology (Regulation) Act, 2022, and the rules framed thereunder. At Wellspring IVF, we follow these regulations completely and without exception.

Under the ART Act 2022, oocyte (egg) donation is permitted only through a registered ART Bank. Key provisions that patients must understand:

• Donor source: Eggs can only be obtained from registered, voluntary oocyte donors through an ART Bank registered under the ART Act 2022. Direct or known donation between individuals is not permitted under the Act.
• Voluntary donation: All donors are voluntary — they have provided informed consent to donate oocytes through the registered ART Bank system. Donors are never coerced or commercially exploited.
• Donor anonymity: Donor identity is maintained as per the provisions of the ART Act. The child born has the right to access non-identifying medical information about the donor.
• Medical screening: All donors registered with the ART Bank undergo comprehensive medical, genetic, and psychological screening as mandated by the Act.
• Matching: Matching between donor and recipient is performed considering physical characteristics as permitted under the Act and its guidelines.

We understand that reaching this conversation is emotionally significant. Dr. Shah and our counselling team will guide you through every aspect of this process — the medical procedure, the legal framework, the emotional considerations, and the realistic success rates — with complete transparency and compassion.

Low AMH sometimes occurs alongside other fertility conditions. A complete evaluation at Wellspring IVF ensures nothing is overlooked: