Diminished ovarian reserve
Low AMH treatment in Ireland
Medically reviewed by Dr. Phil Boyle, MICGP, MRCGP · Last reviewed June 2026
Low AMH (anti-Mullerian hormone) is a blood marker of reduced ovarian reserve. At NeoFertility, we treat the woman and the cycle, not just the number. For natural conception you need one good egg per cycle, and in many couples with low AMH that remains possible.
A low AMH result does not mean natural conception is impossible.
If your AMH came back low, you may have been told your eggs are too old, or too few. You may have been told the only realistic path left is IVF with donor eggs.
We see couples in this position every week. What we do first is look at what the ovary is actually doing each cycle, not just at the number on the blood test. The number of follicles matters for IVF.
It is not the whole story for natural conception.
What low AMH actually measures
AMH is produced by the small antral follicles in your ovaries.
A low AMH result means a smaller follicle pool than is typical for a woman's age. It is the most common laboratory marker of diminished ovarian reserve. What it does not measure is follicle quality, egg quality, or ovulation function. These are separate questions entirely.
A woman with low AMH can still produce a dominant follicle each cycle. Whether that follicle ovulates well, and whether the luteal phase that follows supports a healthy pregnancy, is a different matter. A single AMH test tells us nothing about that.
AMH levels typically fall with age. They can also be suppressed by hormonal contraception or vary between assay methods. AMH is relatively stable across a single cycle, per ASRM guidance on ovarian reserve testing.
So a reading that looks critically low at one point may not be the fixed endpoint it appears to be. If you want to know your AMH, the test costs EUR 80 at NeoFertility.
You can see AMH blood test pricing and the full range of investigations on the clinic pricing page.
Why low AMH matters more for IVF response than for predicting natural conception
IVF works by stimulating the ovaries to produce multiple follicles at once.
It needs to retrieve many eggs because at each step of the process some are lost. Not all fertilise, not all reach blastocyst stage, not all survive the transfer. A larger starting number gives better cumulative odds per cycle.
When AMH is low, there are fewer follicles to stimulate. Fewer eggs are retrieved, and the odds per IVF cycle fall. At a certain threshold, most IVF clinics will decline to proceed or will recommend donor eggs.
If that is the conversation you have just had, that recommendation follows from what the IVF process requires. It is the reasoning of a treatment built around retrieving many eggs at once.
The NeoFertility approach is different. We build the highest-quality single ovulation possible each cycle. Natural conception needs one good egg per cycle. Women with low AMH often cannot produce the many eggs IVF needs. They can still produce one good one each month.
We are not trying to extract nine eggs from an ovary that has one. We are asking a different question: is the follicle this ovary is producing right now ovulating as well as it possibly can?
In plain terms, a follicle is the small fluid-filled sac that grows each month and releases an egg. If your ovary is still producing one each cycle, you are still in the conversation.
If your ovary is still producing one follicle each cycle, you are still in the conversation, whatever your AMH number says. NeoFertility approach
How NeoFertility investigates low AMH
The investigation follows our three-phase treatment plan structure, applied specifically to ovarian function.
So what we look at is:
- Fertility charting: Is the cycle ovulatory? Can we pinpoint when ovulation occurs? What does the mucus pattern tell us about follicle development and oestrogen activity?
- 7 DPO blood tests: These are drawn at 7 DPO (7 days post ovulation), the point in your cycle when the body is preparing to support a pregnancy. We target progesterone above 60 nmol/L and oestradiol above 400 pmol/L. Day-21 testing, standard in most clinics, frequently misses the timing of ovulation and routinely under-reports luteal phase problems.
- Day 3 blood profile: FSH, LH, and oestradiol at the start of the cycle give a baseline picture of what the ovaries are doing before the follicle develops.
- DHEA-S and androgen panel: Low androgen levels are common in women with diminished ovarian reserve and are treatable. We assess this from the start.
- Male factor assessment: Both partners are evaluated from the first consultation. Male factor is a significant contributor to impaired fertility in many couples, and we investigate it from day one, not as an afterthought. You are not carrying this investigation alone.
ChartNeo, NeoFertility's fertility charting app, is used to track whether a low-AMH cycle is producing a dominant follicle and whether that follicle is ovulating well. Charting starts at or before the first consultation.
Surgical referral is discussed whenever the investigation points toward something physical, such as endometriosis or uterine factors, that could be contributing. For some women that conversation happens early. For others it comes later.
Low AMH treatment at NeoFertility
Treatment targets what the investigation finds, not a standard protocol for every woman with a low number.
For women with low AMH, the main aim is to improve the quality of each cycle's single ovulation. Your ovary is still producing a follicle each cycle. The aim is to make sure that follicle ovulates as well as it possibly can.
Where blood work confirms low DHEA-S, we add DHEA as part of the protocol. DHEA is a hormone, not a shop-shelf supplement, and that gives many women pause. It is the right instinct.
We only add DHEA with documented low blood levels and review it as part of the ongoing protocol, not as a one-off prescription.
Peer-reviewed evidence supports this approach. A 2022 meta-analysis found DHEA significantly increased serum AMH in women with diminished ovarian reserve. Eight studies, 431 women (Yin et al., BMC Endocrine Disorders, 2022; PMID 35698127). The effect was modest but statistically significant.
In NeoFertility's peer-reviewed retrospective cohort, DHEA also reduced miscarriage rates. Among women with low oestradiol in early pregnancy, the drop was from 45.5% in the untreated group to 17.5%, with a p-value of 0.038 (Boyle et al., Frontiers in Reproductive Health, 2024).
If you are also managing a history of recurrent miscarriage alongside low AMH, you can read more on the recurrent miscarriage page.
Hormonal support for the follicular and luteal phases, follicle stimulation where needed, and HCG trigger are all part of the toolkit when indicated. Treatment is a process over time, and each cycle tells us more about what is working.
For couples where AMH is extremely low and FSH is very high, the question is whether the ovary can still produce any follicular activity. Dr. Phil Boyle has published clinical case presentations on successful conception in women with AMH levels considered untreatable by most IVF clinics.
In one published case presentation (Boyle et al., 2025), a 41-year-old patient presented with FSH 97.7 IU and AMH 0.07 pmol/L. Using transdermal oestradiol and follicle stimulation, she conceived in her fifth cycle, with an estimated due date of June 2025.
This is a single case and we present it as such. But a low number, on its own, is not the end of the conversation.
What the data shows
In a sub-cohort of 26 couples from NeoFertility's 2015 clinic audit, all with AMH below 3.5 pmol/L, the live birth rate was 35%. The miscarriage rate was 19%, and the pregnancy rate was over 50%.
There were zero preterm deliveries and zero multiple pregnancies in this group. These are real numbers from real patients.
The cohort is small (N=26), and this is a clinic audit sub-analysis, not a separately published study. It is not a guarantee for any individual couple. For the full context of these figures, see our published results.
NeoFertility has also published peer-reviewed data for couples presenting after failed IVF. In this cohort (N=403), the average couple had tried 2.1 IVF cycles before starting restorative treatment.
The adjusted live birth rate after restorative treatment was 32.1% (Boyle et al., Frontiers in Medicine, 2018). A significant proportion of those couples will have had impaired ovarian reserve.
The full 2015 clinic cohort included 412 couples, average female age 37, with 21% having prior failed IVF. The adjusted live birth rate at 24 months was 53.6%. That figure comes from a clinic audit, not a peer-reviewed journal.
But it reflects a consistent pattern of outcomes across more than a decade of practice.
The comparison figure from HFEA 2017 for IVF is 26.4% per treatment cycle. Bear in mind the two figures are not directly comparable: ours is cumulative over up to 24 months, theirs is per individual cycle.
What can be said is that those cumulative outcomes compare very favourably, at a fraction of the cost of a single IVF cycle in Ireland.
For couples who have been told donor eggs are the only option
NeoFertility hears this from couples every week.
If you have been sent away from an IVF clinic with a donor-egg recommendation, that follows from what the IVF process requires. IVF is built around retrieving multiple eggs in a single cycle.
When the ovary cannot supply that number, donor eggs become the next step within that model.
The one-follicle approach is a different logic. If your ovary is producing a follicle each cycle, that follicle is worth supporting. This is not possible for every couple, and we are honest about that. But it is worth a serious conversation before considering donation, which is not acceptable to every couple.
There is nothing in the restorative assessment that closes off future options. The investigation itself tells you something no AMH number can: what your cycle is actually doing right now.
If you want to read what a conversation like this can look like from the other side, Niamh and David's story is the one we would point you to first.
Niamh was told after a first failed IVF cycle that she had the ovaries of a 46-year-old and that donor eggs were likely. The couple went through three IVF cycles and a failed donor egg cycle before coming to NeoFertility.
New investigations found low progesterone, low oestradiol, elevated natural killer cells, and low DHEA. They conceived within three months of charting and went on to have two babies. This is only one example. But it shows what a different set of questions can uncover.
Getting started
The first step is a 45-minute consultation with Dr. Phil Boyle or Dr. Agnes Toth.
No GP referral is required. You can book directly. ChartNeo begins at or before the first consultation, so we arrive with cycle data already in hand.
Blood tests can often be arranged locally if you live outside Dublin. The consultation and scans are the only appointments that require you to come to Sandyford in person.
For couples who are also managing age as a factor, those additional considerations are covered on the fertility after 35 page.
The initial fertility consultation costs EUR 300. Our treatment plan cost covers up to 12 balanced cycles of treatment including consultations, follicle tracking scans, and pregnancy support. A single round of IVF in Ireland typically costs EUR 5,000 to EUR 8,000 per cycle.
The NeoFertility treatment plan is a fraction of that.
If you are ready to take the next step, book your first consultation. If you are not sure yet, that is fine too. Read more. Talk to people who have been through it. And when the time feels right, we are here.
Frequently asked questions
What does a low AMH level actually mean?
If you are reading this after seeing a low AMH result, one thing is worth knowing right away. A single number is a starting point for investigation, not a verdict.
AMH stands for anti-Mullerian hormone. That is a mouthful, but it simply measures the number of small antral follicles currently active in your ovaries. A low result means fewer follicles than average for your age.
What it does not measure is egg quality, follicle quality, or how well your ovulation is functioning.
For natural conception, you only need one good follicle and one good egg per cycle. A low AMH reading changes the picture for IVF, which is built around retrieving many eggs at once. It does not, on its own, determine whether natural conception is possible.
AMH levels can also vary with hormonal medications, timing of the test within your cycle, and assay differences between labs.
Can AMH levels change over time?
AMH generally declines with age, but values can shift depending on hormonal medications, when in the cycle the test is drawn, and which laboratory assay is used.
Some women are told their AMH is critically low in their early thirties, yet conceive naturally when ovulation is properly supported. At NeoFertility, we look at AMH alongside the fertility chart, the follicle tracking scan, and timed blood tests.
We do not treat it as the whole story.
The relevant question is not just how many follicles remain. It is what the follicle this cycle is actually doing.
I was told to consider donor eggs. Is it worth trying NeoFertility first?
In many cases it is, and it is worth doing before considering donation. A donor-egg recommendation usually follows when an IVF clinic cannot retrieve enough of your own eggs for that process to work.
That reflects what IVF is built around, which is collecting several eggs in a single cycle. It does not settle the separate question of what your own cycle can do with the right support.
Restorative reproductive medicine operates on a different principle: one good follicle, properly supported, each cycle. We have worked with couples who were referred for donor eggs and went on to conceive naturally with their own eggs.
Not every couple in that situation will have the same outcome. But the results from our own low AMH sub-cohort suggest the conversation is worth having before moving to donation. You can read Niamh and David's story for one example of how that conversation went.
How does NeoFertility treat low AMH differently from IVF?
IVF responds to low AMH by stimulating aggressively to collect as many eggs as possible. When ovarian reserve is low, that strategy produces fewer eggs, fewer embryos, and lower odds per cycle.
Our approach asks a different question. We are not asking how many eggs we can retrieve. We are asking: is the follicle your ovary is producing this cycle ovulating well? We track it with a scan.
We time blood tests for progesterone and oestradiol at 7 days post ovulation (7 DPO). We target progesterone above 60 nmol/L and oestradiol above 400 pmol/L.
Where DHEA-S is documented as low, we add DHEA supplementation, which has published evidence for improving ovarian function in women with diminished ovarian reserve. The goal is not nine eggs. The goal is one good egg, each cycle.
What are the chances of success with low AMH at NeoFertility?
In a sub-cohort of 26 couples from our 2015 clinic audit, all with AMH below 3.5 pmol/L, we recorded a live birth rate of 35%, a miscarriage rate of 19%, and a pregnancy rate of over 50%. These are real numbers from real patients.
The cohort is small (N=26), and this is presented as a clinic audit sub-analysis, not a separately published study. It is not a guarantee for any individual couple.
But for couples who have been told there is nothing more medicine can do, these figures suggest the conversation is still worth having. You can read our full results data at our published results page.
Is it too late if my AMH is very low or my FSH is very high?
Not necessarily, and we say that carefully rather than easily. We have helped women conceive at AMH levels where IVF clinics would have declined treatment.
In one published case presentation (Boyle et al., 2025), a 41-year-old patient presented with FSH 97.7 IU and AMH 0.07 pmol/L. Using transdermal oestradiol and follicle stimulation, she conceived in her fifth cycle. Her estimated due date was June 2025.
This is one case, not a general success rate. But it is a reason to have the assessment and have the conversation rather than closing the door. The first step is understanding what your specific cycle is actually doing.
What about DHEA? Does it actually help?
DHEA is a hormone, not a shop-shelf supplement, and we understand that makes women pause before starting it. That pause is the right instinct.
We only use DHEA when blood work documents that your DHEA-S is low, and we monitor you while you are on it.
Once those conditions are met, the evidence is reassuring. A 2022 meta-analysis of 8 studies in 431 women found DHEA significantly increased serum AMH in women with diminished ovarian reserve (Yin et al., BMC Endocrine Disorders, 2022; PMID 35698127).
The effect was modest but statistically significant.
In our clinic, DHEA sits inside a broader protocol with regular review. It is not a default prescription for every low AMH patient.
How long will treatment take if my AMH is low?
There is no low-AMH-specific timeline. The duration depends on what the investigation finds and how the cycle responds to treatment.
Our treatment plan covers up to 12 balanced cycles or until successful birth, whichever comes first. Many couples conceive within six to twelve cycles once the cycle is properly balanced. You can read about the full three-phase structure at our three-phase treatment plan page.
