Low AMH level: Is it still possible to use my own eggs in an IVF cycle?

Anti-Müllerian Hormone (AMH) is produced by the small follicles in a woman’s ovaries and is one of the most reliable markers of ovarian reserve, which represents the number of eggs that remain in the ovaries. Unlike other reproductive hormones, AMH is secreted locally by the granulosa cells of pre-antral and small antral follicles. Its production does not depend on the brain or the hormonal feedback loops that govern the menstrual cycle. Because of this, AMH provides a direct reflection of the pool of developing follicles at any given time and remains relatively stable across the cycle, unaffected by the day of testing or temporary hormonal fluctuations.

This contrasts with other fertility hormones such as FSH, LH, and estradiol, which are part of the hypothalamic-pituitary-ovarian (HPO) axis. These hormones are influenced by a complex system of feedback. For example, when ovarian activity declines and fewer follicles produce estrogen and inhibin B, FSH levels rise to compensate. However, FSH and estradiol levels can vary widely depending on cycle phase, stress, or even short-term medication use, and sometimes appear deceptively normal despite a reduced ovarian reserve.

Because AMH reflects ovarian activity directly rather than through feedback mechanisms, it offers a clearer and more objective measure of ovarian reserve. Higher AMH values usually suggest a larger cohort of follicles and a stronger response to ovarian stimulation. Conversely, very low or undetectable AMH points to diminished ovarian reserve. Still, it is important to remember that AMH reflects the quantity of eggs, not their quality. It cannot predict natural conception with certainty, but it does play a central role in planning fertility treatment. It helps determine whether a woman is likely to respond to stimulation with her own eggs in IVF, whether ovarian rejuvenation therapies such as PRP might be viable, or whether donor eggs may be the most realistic option.

While age remains the most important factor for fertility potential, advances in reproductive medicine are opening new doors for women who wish to preserve or restore their reproductive capacity. At North Cyprus IVF Center, Dr. Savas Ozyigit has introduced ovarian rejuvenation strategies designed to improve ovarian function and enhance IVF outcomes, offering new hope to women who previously had very limited options.

Here’s how innovative strategies are helping redefine what’s possible.

1. Ovarian PRP Treatment: Awakening Dormant Eggs

Ovarian platelet-rich plasma (PRP) therapy is an emerging technique in reproductive medicine that involves injecting a patient’s own plasma, enriched with growth factors, directly into the ovaries. The aim is to stimulate dormant primordial follicles and potentially reinitiate the process of egg development. The biological rationale comes from the regenerative potential of platelets, which release a variety of cytokines and growth factors known to promote tissue repair, angiogenesis, and cellular proliferation (Sills and Wood, 2019; Pantos et al., 2019).

In some protocols, PRP is combined with exosomes, which are small extracellular vesicles derived from stem cells that play a role in intercellular communication. Exosomes carry proteins, lipids, and nucleic acids that can enhance the ovarian microenvironment, reduce oxidative stress, and improve conditions for folliculogenesis (Mojadadi et al., 2021). This combined approach seeks not just to awaken dormant follicles, but also to create a more supportive niche for oocyte maturation.

However, the potential success of ovarian PRP therapy depends on whether residual follicles are still present. A detectable Anti-Müllerian Hormone (AMH) level is generally considered essential, since undetectable AMH typically reflects the absence of viable follicles and therefore a lack of biological substrate for PRP to act upon (Polyzos and Devroey, 2011). For women with low but measurable ovarian activity, PRP may help enhance natural follicular recruitment and improve the chances of retrieving eggs in subsequent IVF cycles. In contrast, for women with undetectable AMH and no visible antral follicles, ovarian PRP is unlikely to provide benefit.

2. Egg Banking

Egg banking is not a new idea in assisted reproduction, but it is often overlooked as a highly effective way to improve IVF outcomes. When a woman undergoes controlled ovarian stimulation, the number of mature eggs retrieved may be limited, particularly in women over 35 or those with reduced ovarian reserve. With only a small number of eggs, the chance of developing a healthy blastocyst is low. This is not only because of quantity, but because egg quality declines with age. Problems such as spindle defects, mitochondrial dysfunction, and higher rates of chromosomal abnormalities become increasingly common as women get older (Franasiak et al., 2014; Fragouli and Wells, 2012).

Egg banking addresses this issue by allowing patients to undergo more than one stimulation and egg collection before attempting fertilization and transfer. By pooling eggs from multiple cycles, the total number available for fertilization is increased, which raises the chances of creating one or more healthy embryos. This approach is particularly helpful for women in their forties, where a greater number of eggs may be required to achieve at least one chromosomally normal embryo (Goldman et al., 2017). Clinical studies have shown that cumulative live birth rates are significantly higher when multiple cycles are undertaken and eggs are banked, rather than relying solely on the results of a single cycle (Smith et al., 2015; Drakopoulos et al., 2016).

In practice, this strategy can be the difference between repeated disappointment and a successful pregnancy. By accepting that a single cycle may not be enough, and by investing in more than one round of stimulation, patients give themselves the best chance of producing embryos that are suitable for transfer. Egg banking, therefore, is not simply a technical option but it can be a crucial step in maximizing reproductive potential and helping couples achieve their goal of having a child.

3. Mitochondrial Replacement Therapy: Revitalizing Egg Quality

For many women of advanced reproductive age, the main challenge is not the number of eggs available but the quality of those eggs. Embryos may fail to develop normally or may carry chromosomal abnormalities (aneuploidy), which are strongly linked to age-related mitochondrial dysfunction. Mitochondria are the energy-producing organelles within the cell, and their decline with age can impair the ability of eggs to support normal fertilization and embryo development (Wilding et al., 2009; Fragouli et al., 2011).

Mitochondrial Replacement Therapy (MRT) seeks to overcome this problem by introducing healthy mitochondria from a donor oocyte into the patient’s own egg, while preserving the patient’s nuclear DNA. This approach effectively rejuvenates the egg’s energy supply and can restore its developmental competence. Pioneering research by Dr. Shoukhrat Mitalipov and colleagues has demonstrated that transferring nuclear genetic material into donor cytoplasm containing healthy mitochondria can lead to normal fertilization and embryo development, and has the potential to reduce transmission of mitochondrial disease as well (Tachibana et al., 2009; Tachibana et al., 2013; Kang et al., 2016).

At North Cyprus IVF Center, this advanced technology is being applied in carefully selected cases where women produce eggs but experience repeated IVF failure due to poor embryo development or recurrent aneuploidy. By restoring mitochondrial function, MRT provides a new opportunity for patients to achieve viable embryos and improve their chances of a successful pregnancy.

4. Tandem IVF: A Personalized Backup Plan

A tandem IVF cycle allows the use of a patient’s own eggs alongside donor eggs within the same treatment cycle. The purpose is not to replace the patient’s reproductive potential but to safeguard it. By combining both sources of oocytes, the treatment provides a built-in safety net: if the patient’s own eggs fail to fertilize or develop into viable embryos, donor eggs are already available in that same cycle.

This approach can be especially cost-effective and emotionally reassuring, since it avoids the need for multiple IVF cycles should the patient’s oocytes not produce embryos suitable for transfer. Instead of facing the disappointment of a canceled transfer or the delay of an entirely new cycle, patients have the option of proceeding immediately with donor-derived embryos. Moreover, any embryos not transferred can be cryopreserved for future use, whether as a backup plan if the current cycle is unsuccessful or for family-building at a later stage.

Tandem cycles are particularly relevant for women with diminished ovarian reserve or borderline egg quality who still wish to attempt treatment with their own oocytes but do not want to risk an empty cycle. While women of advanced reproductive age or poor responders often face low success rates with their own eggs, the use of donor oocytes significantly increases the likelihood of live birth (Sunkara et al., 2011; Kushnir et al., 2015). A tandem cycle bridges these options, empowering women to pursue treatment with their own gametes while simultaneously optimizing the probability of achieving pregnancy within a single cycle.

Fertility treatment is no longer one-size-fits-all. At North Cyprus IVF Center, Dr. Savas Ozyigit and his team tailor rejuvenation approaches based on your biology and goals. Whether it’s reactivating your ovaries with PRP, optimizing egg quality with mitochondrial therapy, or adding a safety layer with a tandem IVF cycle, these innovative treatments are redefining reproductive possibilities.

Science meets hope, and hope gets results!

Dr. Ahmet Ozyigit