Low AMH Protocols

Egg Development Protocols in Low AMH – A Comprehensive Guide

What is Low AMH?

AMH (Anti-Müllerian Hormone) is an important parameter indicating ovarian reserve. Low AMH indicates a reduced number of eggs, but it does not mean that the chance of pregnancy is completely absent.

The Main Goal of Treatment

In patients with low AMH, the aim is to obtain maximum quality from the existing small number of eggs.

1. Antagonist (Short) Protocol

It is the most frequently preferred protocol. It starts on day 2–3 of menstruation and provides more flexible management.

Why is it Preferred?

It is faster, has less ovarian suppression, and the remaining reserve can be utilized better.

2. Microdose Flare Protocol

It starts with a low-dose GnRH agonist, increasing FSH secretion from the pituitary gland. It is especially used in poor responder patients.

Advantage

Egg response can be increased with the contribution of endogenous hormones.

3. Dual Stimulation (DuoStim)

Egg development is performed twice within the same cycle, in both the follicular and luteal phases.

Who is it Used For?

It is preferred for collecting more eggs in a short time in patients with very low reserve.

4. Minimal Stimulation

The aim is to obtain few but high-quality eggs with low-dose medication.

Advantage

Medication cost and side effects are lower.

5. Natural Cycle IVF

Naturally developing eggs are collected with no or very little medication.

Who is it Suitable For?

It can be an alternative for patients with very low reserve and poor response to medication.

Additional Supports

Supports such as DHEA, CoQ10, and growth hormone can be used in some patients (evidence is limited).

Factors Affecting Treatment Success

Age, previous response, FSH level, and antral follicle count are the most important determinants.

Conclusion

There is no single standard protocol for patients with low AMH. A personalized approach and the selection of an experienced center determine success.