Low AMH treatment in Bangalore

What AMH actually measures

Anti-Mullerian hormone is produced by the small growing follicles in the ovary, so the level tracks how many follicles remain available to be recruited in a cycle. It is a quantity marker. It is a good predictor of how many eggs a stimulation cycle will yield, and a poor predictor of whether any given egg will make a healthy embryo.

Egg quality follows age far more closely than it follows AMH. A woman of 31 with an AMH of 0.6 ng/mL usually has fewer eggs of reasonably good quality; a woman of 43 with an AMH of 2.4 usually has more eggs of poorer quality. This is why two people with the same AMH can be given quite different advice, and why a number alone should never end the conversation.

AMH is also not a reliable test of natural fertility. Studies of women without a history of infertility have found that a low AMH does not, on its own, predict a lower chance of conceiving naturally over a year. Its real use is in planning treatment, not in deciding whether treatment is needed.

AMH tells you roughly how many eggs a cycle will produce. Your age tells you what those eggs are likely to be worth.

What is assessed alongside it

• Antral follicle count on a transvaginal scan, done early in the cycle - the direct anatomical counterpart to AMH.
• Day 2 or 3 FSH, LH and oestradiol, which can unmask a reserve problem that AMH alone underestimates.
• Age, which remains the single strongest predictor of live birth in every published dataset.
• Cycle history - shortening cycles are often the earliest sign of a falling reserve.
• Thyroid function, prolactin and vitamin D, because these are correctable and frequently abnormal.
• Any history of ovarian surgery, endometriosis, chemotherapy or pelvic radiotherapy.
• The male partner, in full - low reserve on one side does not remove the need to look at the other.

How stimulation is planned when the reserve is low

The aim in a low reserve cycle is not a big number of eggs. It is to collect the eggs that are genuinely available, without wasting a month on a protocol the ovary was never going to answer. The POSEIDON classification is a useful frame here because it separates low reserve by age and by previous response, and those two things call for different plans.

• Antagonist protocols, which are shorter, gentler and easier to modify mid-cycle.
• Doses set to the follicle count rather than pushed to the maximum - beyond a certain point more gonadotrophin recruits no more follicles and only adds cost.
• Dual stimulation in the same cycle, follicular and luteal, where time matters and each single collection yields very few eggs.
• Accumulating oocytes or embryos across two or three cycles before a transfer, rather than transferring whatever appears each time.
• Trigger chosen to the cycle - Dr Gupta is running a randomised trial of a 0.2 mg GnRH agonist trigger against a dual trigger in women with poor ovarian reserve.
• Freeze-all where the endometrium or the hormonal picture argues against a fresh transfer.

Adjuvants: what the evidence supports

A great deal is sold to women with low AMH. Being straight about the evidence matters more here than anywhere else in fertility medicine, because the people asking are frightened and the treatments are expensive.

DHEA and growth hormone are the two most commonly offered. Both have some supporting trials and both have trials showing no benefit; the overall evidence remains weak and inconsistent, and neither should be presented as established. Coenzyme Q10 has a plausible mechanism and modest data. Platelet-rich plasma into the ovary and other ovarian rejuvenation techniques remain experimental and should be described that way, not sold as a service. ESHRE has been explicit that add-ons must be offered with an honest account of what the evidence does and does not show, and that principle is applied here.

When donor eggs are discussed

Donor oocytes are raised when repeated cycles have produced no usable embryo, when age and reserve together make a reasonable chance with own eggs unlikely, or when the couple asks. It is a conversation, not a recommendation delivered on a first visit, and it belongs after the picture is clear rather than before.

Where donor gametes are used, they come through an ART bank registered under the Assisted Reproductive Technology (Regulation) Act 2021. The Act prohibits any commercial sale of gametes, requires the bank rather than the clinic to source and screen the donor, and sets the treatment age limits - 21 to 50 for women and 21 to 55 for men. Donors are anonymous to the recipients under the Act.

What a first consultation should give you

You should leave knowing three things: what your reserve actually is on scan as well as on paper, what a realistic yield per cycle looks like for you, and what the plan is if the first cycle behaves the way the numbers suggest. Anything sold as a guarantee, on any of the three, should be treated with suspicion.