Dr Maggie Ju
Acupuncture London

Low AMH to get pregnant, acupuncture can help. Research update

Acupuncture has been used to treat infertility by improving blood circulation to help follicles develop and increasing the chances of good quality eggs for conception. It can also improve the endometrium, promote ovulation, and reduce pain during egg retrieval. In combination with In Vitro Fertilization (IVF), acupuncture has been shown to improve fertilization rates and reduce uterine artery blood flow impedance in infertile women.

Poor ovarian response (POR) is a predictor of the outcome of IVF. An abnormal ovarian reserve test, such as an AFC of less than 5-7 follicles or AMH of less than 0.5-1.1 ng/ml, indicates poor ovarian response. However, acupuncture can increase clinical pregnancy rates, AMH levels, and the number of retrieved oocytes compared to control groups.

Infertility affects approximately one in six couples worldwide, and IVF is a commonly used treatment method. The success rate of IVF increases with a good response to controlled ovarian stimulation (COS), which can be affected by acupuncture. Acupuncture can improve ovarian function, which can lead to a better response to COS and increase the chances of success with IVF.

In conclusion, acupuncture can help improve the chances of conception by increasing AMH levels and improving ovarian function. While low AMH levels may indicate a reduced ovarian reserve, acupuncture can increase the Antral Follicle Count and improve the quality of eggs, leading to a higher chance of successful conception. Acupuncture can also improve the success rate of IVF by improving ovarian function and response to controlled ovarian stimulation.

Case report: Low AMH, conceived naturally with the help of acupuncture
When you receive the news that your AMH levels are low and that it may not be possible to conceive with your own eggs, it can be disheartening. However, having a low AMH value does not necessarily mean that natural conception is out of the question. It may require more effort on your part than for others. There is a story of a woman who was able to conceive naturally despite having low AMH levels. Although the story is simple, it highlights the determination and hard work she put in under the pressure of uncertainty and limited time.

The 39 years old woman had been trying to conceive for a year without success. After undergoing fertility tests, it was discovered that her AMH levels were extremely low and almost immeasurable. Despite this, she was determined to conceive naturally. She paid close attention to her diet, ensuring that she ate healthily and exercised moderately to maintain good health. By chance, she discovered that acupuncture could aid in fertility and so she began weekly treatments. Through her dedication and belief in herself, she was able to conceive naturally after just six months of acupuncture treatments.

 

References

Kallio S et al Fertil Steril (2013) 99:1305-10

Bentzen JG et al Reprod Biomed Online (2012) 25: 612-9

Dolleman M et al J Clin Endocrinol Metab (2013) 98:1946-53

Yang Fu et al Evid Based Complement Alternat Med. 2022; 2022: 9053930.

Soobin Jang et al  Integr Med Res. 2020 Jun; 9(2): 100395.

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Can I Have Good Egg Quality with Low AMH?

Low AMH levels can be concerning for women who are trying to conceive, especially when they are planning a pregnancy or undergoing fertility treatment. One of the most common questions is: Can I have good egg quality with low AMH?

The reassuring answer is yes. Women with low anti-Müllerian hormone (AMH) levels can still have good-quality eggs and achieve pregnancy naturally or with fertility treatment. Although AMH provides useful information about ovarian reserve, it does not directly measure egg quality or determine whether a woman can become pregnant.

Understanding the difference between egg quantity and egg quality can help you make informed decisions about your fertility and next steps.

What Is AMH, and What Does It Tell You About Fertility?

Anti-Müllerian hormone (AMH) is produced by the granulosa cells of small developing follicles in the ovaries. These follicles contain immature eggs that may develop during the menstrual cycle.

An AMH blood test helps estimate your remaining ovarian reserve, which refers to the number of eggs available for potential development. It is commonly used as part of a fertility assessment and to predict how the ovaries may respond to fertility medications during in vitro fertilisation (IVF).

However, AMH has important limitations.

• AMH primarily reflects egg quantity: It provides an estimate of the number of eggs remaining in the ovaries, not their individual quality.

• AMH does not directly measure egg health: A low result cannot tell you whether your eggs have normal chromosomes or can develop into healthy embryos.

• AMH does not independently predict natural conception: It is only one part of a broader fertility assessment.

• AMH can help guide fertility treatment: Lower levels may indicate that fewer eggs will be collected during an IVF stimulation cycle.

In simple terms, AMH tells you more about the number of eggs that may be available than about their potential to produce a healthy pregnancy.

Can You Have Good Egg Quality with Low AMH?

Yes. It is possible to have good egg quality despite having low AMH.

Egg quantity and egg quality are two different aspects of fertility. Ovarian reserve describes how many eggs are likely to remain, while egg quality relates to an egg's ability to mature, fertilise, develop into an embryo and ultimately contribute to a healthy pregnancy.

A woman with low AMH may still produce mature eggs that fertilise normally and develop into viable embryos. However, she may have fewer eggs available in a given menstrual cycle or during IVF treatment.

For example, two women may have different AMH levels but produce eggs of comparable quality. The woman with lower AMH might produce fewer eggs during an IVF cycle, but some of those eggs may still have the potential to result in a healthy pregnancy.

It is important to remember that good egg quality cannot be confirmed by AMH alone. A fertility specialist considers several factors, including age, menstrual history, ovarian ultrasound findings, previous fertility results and, when available, the outcomes of fertilisation and embryo development.

How Does Age Affect Egg Quality When AMH Is Low?

Age is one of the strongest indicators of egg quality.

As women age, the proportion of eggs with chromosomal abnormalities generally increases. This can affect fertilisation, embryo development, implantation and the risk of miscarriage.

AMH and age provide different information about fertility.

• Younger women with low AMH: They may have a reduced ovarian reserve but still have a relatively high proportion of chromosomally normal eggs for their age.

• Women in their mid-to-late 30s: Egg quality may be declining with age, even if AMH levels remain within the laboratory's reference range.

• Women aged 40 and above: The likelihood of chromosomal abnormalities in eggs generally increases, making age particularly important when assessing fertility prospects.

These are general patterns rather than guarantees. Individual outcomes vary, and low AMH does not automatically mean poor egg quality at any age.

A younger woman with low AMH may have a different fertility outlook from an older woman with the same AMH result. This is why age and AMH should be interpreted together rather than in isolation.

What Does a Low AMH Level Mean?

AMH levels are usually reported in nanograms per millilitre (ng/mL) or picomoles per litre (pmol/L). The interpretation depends on the laboratory, the assay used and the clinical context.

A low AMH result may suggest diminished ovarian reserve, meaning fewer eggs are likely to be available than expected. However, there is no single AMH threshold that can reliably determine egg quality or establish whether natural pregnancy is possible.

Low AMH can be associated with:

• A lower number of eggs retrieved during IVF.

• A reduced response to ovarian stimulation medications.

• A potentially shorter reproductive window in some women.

• The need to discuss fertility planning sooner, depending on age and pregnancy goals.

Importantly, low AMH does not necessarily mean that you are infertile, that you cannot ovulate or that you will experience early menopause. AMH alone cannot reliably predict the exact timing of menopause.

Can You Get Pregnant Naturally with Low AMH?

Yes. Natural conception is possible with low AMH, provided that other important factors support conception.

Pregnancy depends on several elements, including ovulation, egg competence, sperm quality, open fallopian tubes, uterine health and the timing of intercourse.

A woman with low AMH may continue to ovulate regularly and release an egg during each menstrual cycle. Although she may have fewer eggs remaining overall, this does not mean that every egg released is poor quality.

However, the likelihood of pregnancy also depends strongly on age and the presence of other fertility issues. Research suggests that AMH has limited ability to predict short-term natural conception in women without known infertility, particularly when considered on its own.

If you are trying to conceive and have low AMH, a fertility assessment can help determine whether it is reasonable to continue trying naturally or whether further evaluation or treatment would be beneficial.

Can Low AMH Affect IVF Success?

Low AMH can influence IVF treatment, mainly because it helps predict how many eggs the ovaries may produce in response to stimulation.

Women with low AMH may develop fewer follicles and have fewer eggs collected during an IVF cycle. This can reduce the number of opportunities to obtain a mature egg, fertilised embryo or embryo suitable for transfer.

Nevertheless, low AMH does not automatically mean IVF will fail.

Even when only a small number of eggs are retrieved, a successful outcome may still be possible if one of those eggs fertilises and develops into a suitable embryo.

IVF outcomes depend on multiple factors, including:

• The woman's age and the chromosomal competence of her eggs.

• The number of mature eggs retrieved.

• Sperm quality and fertilisation.

• Embryo development and quality.

• Uterine factors and the clinic's treatment approach.

A fertility specialist can use AMH, an antral follicle count (AFC) from an ultrasound and other clinical information to help estimate ovarian response and develop an individualised treatment plan.

How Can You Support Egg Health If Your AMH Is Low?

There is currently no proven way to reliably increase the number of eggs remaining in the ovaries or reverse age-related egg decline. However, taking care of your general health can support reproductive health and may help optimise your chances of conception.

1. Eat a balanced, nutrient-rich diet

Focus on a varied diet containing vegetables, fruits, whole grains, legumes, healthy fats and adequate protein. A Mediterranean-style eating pattern is one reasonable option for overall health, although no specific diet has been proven to restore ovarian reserve or guarantee improved egg quality.

2. Avoid smoking

Smoking is associated with poorer reproductive outcomes and earlier ovarian ageing. Avoiding cigarettes and other tobacco products is an important step when planning a pregnancy.

3. Limit alcohol and avoid recreational drugs

Avoiding alcohol while trying to conceive is the safest approach, and recreational drugs should be avoided. Discuss any substance use with your healthcare professional if you need support.

4. Maintain a healthy lifestyle

Regular physical activity, adequate sleep and a healthy weight can support general and reproductive health. Extreme exercise, restrictive diets and significant undernutrition may disrupt menstrual function and should be avoided.

5. Take appropriate preconception supplements

Folic acid is recommended for people planning pregnancy to reduce the risk of neural tube defects. In the UK, the usual recommendation is 400 micrograms daily before conception and during the first 12 weeks of pregnancy, unless a healthcare professional advises a higher dose.

Other supplements, including CoQ10 and DHEA, are sometimes discussed in fertility care. However, evidence that they improve live birth rates in women with low AMH is limited, and DHEA can cause adverse effects and hormonal changes. Speak with a fertility specialist before starting fertility supplements.

6. Seek timely fertility advice

If your AMH is low, understanding your reproductive goals and age is particularly important. Rather than focusing only on improving a laboratory result, discuss what the result means for your individual chances of pregnancy and whether any time-sensitive options should be considered.

7.Regular acupuncture treatment

Can Egg Quality Be Tested?

There is no routine blood test that directly measures the overall quality of a woman's eggs.

AMH and antral follicle count estimate ovarian reserve, while other assessments help provide a broader picture of fertility.

Depending on your circumstances, a fertility specialist may recommend:

• Antral follicle count: An ultrasound measurement of small follicles in the ovaries that helps estimate ovarian reserve.

• Follicle-stimulating hormone (FSH) and estradiol: Blood tests that may provide additional information about ovarian function, often measured early in the menstrual cycle.

• Ovulation assessment: Evaluation of whether ovulation is occurring when clinically indicated.

• Semen analysis: Assessment of sperm quantity, movement and shape when evaluating a couple's fertility.

• Embryo assessment during IVF: Fertilisation and embryo development provide additional information, although embryo appearance cannot guarantee chromosomal normality or a live birth.

Chromosome testing of embryos through preimplantation genetic testing for aneuploidy (PGT-A) may be considered in selected IVF circumstances. It does not directly test all aspects of egg quality, and its benefits are not established for every patient.

The most useful assessment depends on your age, medical history, how long you have been trying to conceive and any previous fertility treatment.