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Female Fertility
You got a blood test. The number came back low. Your family doctor mentioned "diminished ovarian reserve" or "low AMH" and may or may not have explained what that actually means for your ability to have a child. Now you're on Google at midnight, and everything you're reading is either terrifyingly vague or aggressively optimistic.
This article gives you a straight answer. What AMH is, what a low result means, what it doesn't mean, how it affects your options, and what to do next; specifically in Ontario, where your first steps look different than what most US-focused content describes.
AMH, or Anti-Müllerian Hormone, is a hormone produced by the small follicles in your ovaries. It's the most widely used blood marker for ovarian reserve, which is a measure of how many eggs you have remaining.
AMH is not a measure of egg quality. It is a measure of quantity. This distinction is critical, and it's the one most patients miss when they first see a low result.
Your AMH level gives your doctor a snapshot of where your ovarian reserve sits relative to the expected range for your age. It helps inform treatment decisions; particularly what type of stimulation protocol might be appropriate, and how your ovaries are likely to respond to IVF medications.
AMH is drawn as a simple blood test. It can be taken at any point in your menstrual cycle and doesn't require fasting.
AMH levels are measured in ng/mL (nanograms per millilitre) or pmol/L, depending on the laboratory and country. The ranges below use pmol/L, the more common unit in Canadian fertility clinics.
Important context: These ranges are general population-level references. AMH naturally declines with age. An AMH of 7.1 pmol/L at age 28 has different clinical significance than the same level at age 40. Your doctor interprets your AMH alongside your age, antral follicle count (AFC), and other factors.
Women with low AMH conceive naturally and with treatment. AMH measures how many eggs remain; not whether those eggs are capable of producing a healthy pregnancy. A patient with low AMH and good egg quality may have excellent outcomes with fewer eggs.
Egg quality is primarily determined by age, not AMH. A 32-year-old with a low AMH typically has better egg quality than a 42-year-old with a normal AMH; because quality is age-dependent while quantity (what AMH measures) is more individually variable.
It means your response to stimulation may be lower; fewer follicles, fewer eggs retrieved. But IVF can be effective with a smaller number of eggs. Your doctor will design a protocol appropriate for your reserve level.
Very low AMH (under 3.6 pmol/L) may suggest you're approaching the end of your reproductive window, but diminished reserve is not the same as menopause. You may still be ovulating regularly with a low AMH.
It means you need information, and potentially a timeline. Low AMH is a signal that your window may be narrower than average, which makes earlier planning more valuable. That's a reason to act, not a reason to despair.
Patients with low AMH typically produce fewer follicles in response to stimulation medication. This doesn't mean IVF fails; it means expectations and protocols are adjusted accordingly. Some clinics use modified or mini-IVF protocols for patients with diminished reserve, using lower doses or natural cycle approaches.
If your goal is to bank embryos (for example, for genetic testing or to give yourself more options), it may take more than one stimulation cycle to achieve the desired number. Your doctor will discuss this with you based on your specific numbers.
When ovarian reserve is already low, the natural decline that comes with each passing year is more consequential. This doesn't mean you need to start treatment tomorrow, but it does mean that delaying a consultation by six months has a different clinical weight than it would for someone with a high reserve.
If you're not ready to try for pregnancy now but want to preserve the option, low AMH shifts the egg freezing conversation from "something to think about" to "something to evaluate soon."
AMH is the most commonly referenced ovarian reserve marker, but it's not the only one, and your doctor will never make treatment decisions based on AMH alone.
An ultrasound-based count of the small follicles visible in both ovaries at the beginning of your cycle. AFC and AMH together give a more reliable estimate of reserve than either test alone. A patient with a low AMH but a reasonable AFC may respond better to stimulation than the AMH alone would suggest.
Measured on Day 2 or 3 of your menstrual cycle. Elevated FSH (above 10–12 IU/L) can indicate that your body is working harder to stimulate follicle development, another marker of reduced reserve. FSH varies from cycle to cycle more than AMH, which is why AMH is generally considered more stable.
This is arguably the most important variable. AMH tells your doctor about quantity; your age is the strongest predictor of quality. Treatment planning integrates both.
Prior ovarian surgery, chemotherapy, endometriosis, autoimmune conditions, and smoking can all impact ovarian reserve beyond what AMH captures.
If your family doctor flagged a low AMH, the next step is a consultation with a Reproductive Endocrinologist and Infertility (REI) specialist. In Ontario, you need a physician referral, but some fertility clinics arrange a referral for you through a partner clinic if you don't already have one. It takes minutes. The initial consultation is OHIP-covered.
If you have a GP:
You can send your doctor the referral link on our website:
At Pollin, If you do not have a family doctor and require a referral to be facilitated for you, we will set you up with a virtual, OHIP-covered referral appointment with our partner GP after you have booked your consultation.
AMH alone doesn't tell the whole story. Your specialist will order an antral follicle count, additional bloodwork, and review your history to build a complete picture.
Are you trying to conceive now? Next year? In several years? Your goals shape the recommendation. A patient with low AMH who wants to conceive now has a different conversation than one who wants to preserve her options through egg freezing.
Depending on your full evaluation, your specialist may recommend:
This isn't meant to create urgency for the sake of it. But if your AMH is low, the most common regret patients express is not coming in sooner. Information gives you options. Waiting removes them.
What is considered a low AMH level?
Generally, an AMH between 3.6 - 7.1 pmol/L is considered below average, and below 3.6 pmol/L is considered low. However, AMH is interpreted in the context of your age; the same level has different implications at different ages. Your fertility specialist will explain what your specific number means for your situation.
Can you still get pregnant with low AMH?
Yes. Low AMH indicates fewer eggs remaining, not that pregnancy is impossible. Women with low AMH conceive both naturally and with fertility treatment. Egg quality, which is more closely related to age than AMH, plays a significant role in outcomes.
Does low AMH mean IVF won't work?
No. Low AMH may mean fewer eggs are retrieved during an IVF cycle, but IVF can be effective with a smaller number of eggs. Your doctor will use a stimulation protocol designed for your reserve level. Some patients with low AMH require more than one cycle to accumulate enough embryos, depending on their goals.
Should I freeze my eggs if my AMH is low?
If you're not ready to try for pregnancy now and your AMH is low, egg freezing is worth discussing with a specialist. Low AMH means your ovarian reserve is declining, and the eggs available today may not be available in a year or two. A consultation will help you evaluate whether egg freezing is the right step for your situation.
What causes low AMH?
The most common cause is natural age-related decline; ovarian reserve decreases over time for all women. Other contributing factors can include prior ovarian surgery, endometriosis, autoimmune conditions, chemotherapy or radiation exposure, and smoking. In some cases, low AMH has no identifiable cause beyond individual variation.
Is AMH the only test that matters for fertility?
No. AMH is one part of a broader evaluation that includes antral follicle count (ultrasound), FSH, age, and medical history. AMH measures egg quantity, not quality. Your specialist will use all of these factors together to assess your fertility and recommend a path forward.
Book a consultation at Pollin Fertility to understand what your numbers mean. Your initial visit is OHIP-covered, there's no waitlist, and we handle your referral.
Pollin Fertility was founded in 2023 with a mission to develop the most advanced clinical, digital and IVF, egg freezing and andrology lab technology to improve the fertility patient experience and treatment outcomes.
Pollin has 2 flagship, full-service clinics:
Pollin Toronto: located at 2360 Yonge St.
Pollin Ottawa: located at 303 Moodie Dr. in Bells Corner
To provide greater access to patients who need high-quality fertility care, Pollin has satellite monitoring clinics in Markham and Sudbury Ontario, with more on the way.
To learn more about the fertility treatments and services offered at Pollin visit www.pollinfertility.com
To book an OHIP-covered consultation with one of fertility specialists or click the link below.
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