Low AMH, Donor Eggs and IVF: How Fear Sells Treatments You May Not Need

Low AMH Isn’t the End of Your Story

If you’ve ever been told you have “low AMH,” and felt like your whole future got reduced to one scary number, this is for you.

Maybe you were told you have poor ovarian reserve, or your ovaries look like the ovaries of a 45 year old…or maybe you’re in unexpected early menopause. Maybe IVF was suggested immediately. Maybe donor eggs came up before anyone even talked to you about natural conception.

And maybe what hurt the most was the feeling that your story had already been written for you.

It hasn’t.

Low AMH can mean you have fewer eggs left, but it does not automatically mean you cannot conceive naturally. ASRM has said that poor ovarian reserve testing does not necessarily imply inability to conceive or even subfertility. NeoFertility makes the same point clearly: AMH is most useful in IVF settings and cannot reliably predict whether a couple can conceive naturally.

That matters, because it changes the whole conversation.

One healthy egg in one healthy, balanced cycle is all you need.

What ASRM Actually Says

Here’s the plain-English version: low AMH may help predict how someone will respond to IVF stimulation, but it does not prove that natural conception is off the table. Read that again. If harvesting 20 eggs is the goal then low AMH is an issue for IVF clinics because they have to push your body to release those eggs…but as they say themselves it’s NOT always a barrier to natural conception…

That’s a huge distinction.

In IVF, clinics want the ovaries to produce a large batch of eggs in one cycle so they can retrieve, fertilize, and select from multiple embryos. Low AMH becomes a problem there because IVF is not looking for one healthy egg - it is trying to get a lot of eggs at once.

But for natural conception, or restorative reproductive medicine, the goal is different: one healthy ovulation, one well-timed cycle, one chance for conception.

That’s why this matters so much: if low AMH is not a barrier to natural conception, then it makes no sense to act as though the only next step is an intervention designed around producing 10, 15, or 20 eggs in a single cycle.

One Egg, Not Twenty

This is the heart of it.

You do not need 20 eggs to have a baby. You need one egg in one cycle, ovulated at the right time, with the right hormone support, in a body that is ready to receive and sustain a pregnancy.

That’s what NeoFertility focuses on. Instead of asking, “How many eggs can we force out this month?” they ask better questions:

·       Is the follicle actually maturing?

·       Is it rupturing completely?

·       Are progesterone and estradiol strong enough after ovulation?

·       Is there endometriosis, inflammation, immune dysfunction, thyroid trouble, low DHEA, poor mucus, or another hidden issue we can actually treat?

That’s a completely different mindset.

And yes, with low reserve, that difference matters. Dr Jerome Check argued that chronically high FSH exposure can make follicles less responsive by causing FSH receptors to be down-regulated, meaning the ovary may stop responding properly to the signal.

NeoFertility Success Stories

NeoFertility has reported many case studies of women being told donor eggs were their best or only option, only to go on to conceive naturally with their own eggs after cycle optimization and targeted support.

One patient had an AMH of just 0.01 ng/mL (0.07 pmol/L), was told she was not suitable for IVF or ICSI, and was advised to consider donor eggs. NeoFertility used cycle charting, letrozole, HCG, supplements, and luteal hormone support, and she conceived on her first medicated cycle and later delivered a full-term baby boy.

Another woman had an AMH 0.45 ng/mL (3.2 pmol/L) had already gone through four failed IVF cycles including a donor-egg cycle, and then conceived after NeoFertility identified poor follicle rupture, mucus issues, and weak luteal hormone levels.

A third woman with AMH of 0.39 ng/mL (2.8 pmol/L) had a cancelled IVF, then a failed IVF with poor embryo quality, was advised to use donor eggs, and later conceived after treatment for low post-ovulation hormones, incomplete follicle rupture, and mild endometriosis.

NeoFertility’s clinic data on 26 couples with AMH at or below 0.5 ng/mL showed that 54% conceived, with 35 live births, no twins, and no premature deliveries reported in that group.

That doesn’t mean every low-AMH story ends that way. It means hope is still medically reasonable.

Dr Jerome Check’s Simpler Story

Dr. Jerome Check’s work matters most for women told they are basically in menopause because their FSH is very high and their estrogen is very low. His idea was simple: if FSH stays high for too long, the ovary may stop responding well to it, almost like the follicles have become numb to the signal.

So instead of pushing harder, he tried the opposite.

He would first use estrogen to bring FSH down for a few weeks. In his early reports, this often meant about 3 to 4 weeks of treatment until FSH dropped from very high levels back toward the normal range. In later protocols, he often used a tiny dose of ethinyl estradiol so the body’s own estradiol could still be tracked on bloodwork.

Only after FSH came down would he try gentle stimulation. The idea was that lowering FSH gave the ovary’s FSH receptors a chance to “reset” so a follicle might respond again.

Some of his cases are inspiring:

·       A 27-year-old woman with no periods for 6 months, very low estrogen, and FSH rising from 39.2 to 52 mIU/mL did not respond to fertility drugs alone. After estrogen treatment lowered her FSH to about 10 mIU/mL, she responded, ovulated, and conceived on the next properly stimulated cycle.

·       A woman diagnosed with premature ovarian failure had FSH around 65.4 mIU/mL, failed prior stimulation, then had her FSH lowered to 12 mIU/mL after a month of higher-dose estrogen. She began ovulating and conceived on her fifth treatment cycle.

·       Another woman with FSH averaging about 120 mIU/mL had severe estrogen deficiency and no withdrawal bleeding. After estrogen lowered her FSH to 12 mIU/mL, she ovulated in two cycles, showing that even very shut-down ovaries may still respond once the signal is reset.

·       In later work, Check also described women with apparent ovarian failure, including one with FSH measured at 143 mIU/mL in his clinic and reportedly as high as 185 mIU/mL elsewhere, who ovulated using ethinyl-estradiol-based receptor up-regulation and went on to conceive with progesterone support.

You do not need to understand every hormone pathway to understand the message: sometimes the ovary doesn’t need to be pushed harder. Sometimes it needs the signal turned down first so it can hear again. Has your clinic offered you this simple restorative approach before diving into IVF?

Red Light Therapy and AMH

There is also early research on red light therapy, also called photobiomodulation, that may be relevant here, but this part needs careful framing.

The strongest evidence so far is in animal studies, especially aging mice, not mainstream human fertility guidelines.

A 2024 study on ovarian aging found that photobiomodulation improved ovarian function in aging mice, with reports of higher AMH-related markers, lower FSH patterns, and healthier follicle development after treatment.

A 2019 study found that low-level laser therapy increased AMH-positive follicles, reduced follicle cell death, and improved oocyte quality in mature mice without reducing primordial follicle numbers.

So the honest way to say it is this: red light therapy has shown promise in animal studies for supporting ovarian function, improving AMH-related markers, and reducing high FSH patterns, but it is still an emerging area and not standard fertility care.

That makes it worth watching - and worth a separate conversation.

The Bigger Truth

If you’ve been told low AMH means the end, that message is too simple and often just wrong. ASRM says poor ovarian reserve testing does not automatically mean you cannot conceive. NeoFertility shows real natural pregnancies can happen even with very low AMH. Dr Jerome Check’s work shows even very high FSH does not always mean the ovaries are done forever.

What low AMH may really mean is that you need a different strategy.

Not a panic plan.
Not a factory model.
Not an intervention built around getting 20 eggs when your body may only need one.

A better plan asks how to support the eggs you still have, the ovulation you still can make happen, and the body that still knows how to carry life.

Low AMH isn’t the end of your story.

Can you get pregnant naturally with low AMH?

Yes, natural conception is still possible with low AMH, especially if you are ovulating and there are no major additional fertility factors. ASRM themselves say ovarian reserve testing does not necessarily mean inability to conceive naturally.

Does low AMH mean infertility?

No. Low AMH suggests reduced ovarian reserve, but it does not automatically mean infertility or inability to conceive naturally.

Why is low AMH a bigger problem for IVF than for natural conception?

Because IVF usually aims to retrieve multiple eggs in one stimulated cycle, while natural conception only needs one healthy egg released at the right time. AMH is especially useful for predicting ovarian response to IVF drugs.

What treatment did NeoFertility actually use for low AMH?

NeoFertility’s low-AMH cases used a combination of:

·       cycle charting for a few months

·       day 3 bloodwork,

·       ultrasound follicle tracking,

·       letrozole or clomiphene to stimulate follicle growth,

·       HCG trigger shots to time ovulation,

·       day-7-post-ovulation progesterone and estradiol labs,

·       luteal support with progesterone, sometimes plus estradiol,

·       supplements such as vitamin D3, omega-3, folic acid, and sometimes DHEA or naltrexone,

·       and treatment of specific problems like incomplete follicle rupture, poor mucus, inflammation, or endometriosis.

Why does NeoFertility care so much about “complete follicle rupture”?

Because growing a follicle is not the same as releasing an egg. NeoFertility’s case reports repeatedly tracked whether the follicle actually ruptured fully, since partial or incomplete rupture may look like ovulation is happening when conception is still being blocked.

Why do they check progesterone and estradiol seven days after ovulation?

They use that blood test to assess the quality of ovulation and the strength of the luteal phase. In the low-AMH material, NeoFertility aims for target Peak+7 levels around progesterone 19 - 31 ng/mL - 109–245 pg/mL estradiol). Europe (60 - 100 nmol/L and estradiol 400 - 900 pmol/ as markers of better cycle quality.

What did Dr Check do differently for women with high FSH?

He first tried to lower FSH for several weeks using estrogen, then used gentle stimulation only after the ovary seemed more responsive. His theory was that high FSH over time can make the ovary less able to hear the signal, so lowering it first may help “reset” the response.

How long did it take to “reset” FSH receptors in Jerome Check’s reports?

In his early reports, FSH often dropped into a more normal range after about 3 to 4 weeks of estrogen treatment, and only then did stimulation begin.

Has red light therapy been shown to improve AMH?

Animal studies suggest photobiomodulation may improve ovarian function, including AMH-related markers and high-FSH patterns in aging mouse ovaries, but this is still preclinical research and not proven standard care for humans yet.

Should low AMH automatically mean donor eggs?

No. Donor eggs may be the right choice for some women, but low AMH alone should not automatically end the conversation about natural conception, cycle optimization, or using your own eggs.

What is the best next step after a low AMH result?

The best next step is a full fertility evaluation that looks at ovulation, partner factors, tubal issues, uterine anatomy, cycle quality, hormone support, and any treatable underlying problems rather than relying on AMH alone (read my other blogs on ‘unexplained' infertility and why the IVF industry isn’t being transparent with couples).

Resources:

Fertility evaluation of infertile women
Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertility and Sterility. 2021;116(5):1255‑1265. doi:10.1016/j.fertnstert.2021.09.011.
PubMed: https://pubmed.ncbi.nlm.nih.gov/34607703/
Full text: https://www.fertstert.org/article/S0015-0282(21)01984-1/fulltext

Testing and interpreting measures of ovarian reserve
Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertility and Sterility. 2020;114(6):1151‑1157. doi:10.1016/j.fertnstert.2020.09.134.
PubMed: https://pubmed.ncbi.nlm.nih.gov/33280722/

NeoFertility / Dr Phil Boyle – low AMH and natural conception

Low AMH case series (3 couples, natural conception with stimulation)
Boyle P. Case series – three couples with low AMH levels who conceived with natural conception and ovarian stimulation. IIRRM Conference Proceedings. 2015.
PDF (IIRRM): https://iirrm.org/wp-content/uploads/2025/11/AMHBoyle.pdf[5]

Low AMH and reduced ovarian reserve (video presentation)
Boyle P. Low AMH and reduced ovarian reserve. NeoFertility Clinic; lecture published 2019.
Video: https://www.youtube.com/watch?v=3YnfK-1O2bs

Multifactorial infertility / DHEA and estradiol in pregnancy (broader RRM context)
Boyle P, et al. Restoration of serum estradiol and reduced incidence of miscarriage in patients with low serum estradiol during pregnancy: a retrospective cohort study using a multifactorial protocol including DHEA. Frontiers in Reproductive Health. 2024; (ahead of print 2023).
(Link via Dr Boyle’s LinkedIn publications listing.)

Dr Jerome Check - high FSH, diminished reserve, receptor “reset”

FSH receptor up‑regulation in DOR (key 2022 review)
Check JH, Choe JK. Maximizing correction of infertility with moderate to marked diminished egg reserve in natural cycles by up‑regulating follicle stimulating hormone receptors. Gynecology and Reproductive Health. 2022;6(4):1‑7.
https://www.factsaboutfertility.org/boosting-fsh-receptors-to-restore-fertility-in-diminished-ovarian-reserve/

Early estrogen + hMG work (hypergonadotropic amenorrhea / POF)

Pilot estrogen + hMG study (5 women)
Check JH, Chase JS. Ovulation induction in hypergonadotropic amenorrhea with estrogen and human menopausal gonadotropin therapy. Fertility and Sterility. 1984;42(6):919‑922. doi:10.1016/S0015-0282(16)48273-0.
PubMed: https://pubmed.ncbi.nlm.nih.gov/6517594/[13]

Larger series – 100 women with hypergonadotropic amenorrhea
Check JH, Nowroozi K, Chase JS, et al. Ovulation induction and pregnancies in 100 consecutive women with hypergonadotropic amenorrhea. Fertility and Sterility. 1990;53(5):811‑816. doi:10.1016/S0015-0282(16)53441-9.
(Indexed and cited in later summaries of his work.)

Case reports at older ages / very high FSH

Three pregnancies despite elevated FSH and advanced age
Check JH, Check ML, Katsoff D. Three pregnancies despite elevated serum FSH and advanced age: case report. Human Reproduction. 2000;15(8):1709‑1712. doi:10.1093/humrep/15.8.1709.

Imminent ovarian failure with extremely high gonadotropins
Check ML, Check JH, Kaplan H. Pregnancy despite imminent ovarian failure and extremely high endogenous gonadotropins and therapeutic strategies: case report and review. Clinical and Experimental Obstetrics & Gynecology. 2004;31(4):299‑301.

Live delivery in overt menopause at 46.5 years
Check JH, Check DL, Richardson K. Live delivery in a 46.5‑year‑old woman in overt menopause by restoring follicular sensitivity to follicle stimulating hormone. Gynecology and Reproductive Health. 2022;6(1):1‑3.

POF with high FSH who conceived after FSH up‑regulation (after failed donor egg cycles)
Check JH, Katsoff B. Successful pregnancy with spontaneous ovulation in a woman with apparent premature ovarian failure who failed to conceive despite four transfers of embryos derived from donated oocytes. Clinical and Experimental Obstetrics & Gynecology. 2006;33(1):13‑15.

Check JH. Pharmacological options in resistant ovary syndrome and premature ovarian failure. Clinical and Experimental Obstetrics & Gynecology. 2006;33(2):71‑77.[12]

Check JH, Wilson C. The younger the patients the less adverse effect of diminished oocyte reserve on outcome following in vitro fertilization‑embryo transfer as long as the proper ovarian stimulation protocol is used. Journal of Reproduction & Contraception. 2013;24(4):221‑227.[12]

Check JH. The multiple uses of ethinyl estradiol for treating infertility. Clinical and Experimental Obstetrics & Gynecology. 2010;37(4):249‑251.[12]