IUI with Low AMH: Is It the Right Treatment for You?

You’ve just received the results of your Anti-Müllerian Hormone (AMH) test, which show that your levels are low. You may be wondering what this means for your fertility and whether treatments like intrauterine insemination (IUI) could help.

The good news is that, while low AMH levels can make conception more challenging, they don’t prevent pregnancy. With the right approach, IUI can be a viable option for achieving pregnancy.

What is IUI?

Intrauterine insemination (IUI)is a fertility treatment that increases the chance of pregnancy by placing sperm directly into the uterus (womb). Before the procedure, your doctor will collect and prepare a sperm sample to select the healthiest and most active sperm.

During ovulation, the prepared sperm is injected into the uterus using a thin, flexible tube (catheter). This shortens the distance sperm must travel to reach the egg resting in the fallopian tube, improving its chances of fertilisation.

IUI is less invasive and more affordable compared to in vitro fertilisation (IVF). It's often recommended for couples with unexplained infertility, mild male factor infertility, low sperm count, or cervical issues affecting conception.

What is AMH?

Anti-Müllerian hormone (AMH) is a protein produced by cells in developing ovarian follicles. It plays an important role in regulating which follicles mature and are released during ovulation.

AMH levels help indicate your ovarian reserve, which refers to the number of eggs remaining in your ovaries. Doctors often measure AMH levels during fertility testing to assess your reproductive potential.

Unlike other reproductive hormones that fluctuate during your cycle, AMH levels stay relatively stable, making it a reliable marker for assessing ovarian function. Higher AMH levels suggest a healthy ovarian reserve, while lower levels indicate fewer remaining eggs. AMH naturally declines with age as your egg supply decreases.

Why consider IUI if you have low AMH levels?

Even with low AMH, IUI can still be an option if you’re trying to conceive. Low AMH often indicates a smaller ovarian reserve, but as long as ovulation occurs, pregnancy is still possible. The IUI process includes:

• Ovulation monitoring:

  • The process involves tracking hormone levels and using fertility medication to encourage egg development.

• Sperm preparation:

  • This step involves treating the sperm from a donor or your partner to select the healthiest and most active cells for insemination.

• Insemination:

  • Your doctor injects the prepared sperm into your uterus using a catheter during ovulation.

This process helps place the best sperm closer to the egg, increasing the chances of fertilisation.

If you’re unsure how IUI with low AMH would work for you, schedule an appointment with Thomson Medical. Our specialists can explain the process and help identify the most appropriate approach for your fertility condition.

When is IUI recommended for women with low AMH?

IUI may be recommended for women under 35 with low AMH, as research shows similar success rates to IVF in younger women with reduced egg reserves. It's also less invasive and more cost-effective.

For women over 35 with low AMH, doctors often recommend moving to IVF. However, it's important to know that if your AMH is very low (≤1.2 ng/mL), IVF may not always be more successful than IUI. This is because very low AMH can mean your ovaries don't produce enough eggs for transfer, even with IVF stimulation.

The decision also depends on other fertility factors, including ovarian reserve testing results, sperm quality, and whether your fallopian tubes are open and functioning properly. Your fertility specialist usually recommends 3-4 IUI cycles before considering other options, though this depends on how your ovaries respond to stimulation.

What are the challenges of IUI with low AMH?

IUI with low AMH can be more challenging due to a smaller ovarian reserve and potential egg quality issues. 

Low AMH means fewer eggs remain in the ovaries than typically expected for a given age, which can limit the number of follicles that develop during ovarian stimulation. Fewer eggs reduce the chances of successful fertilisation and pregnancy.

In addition, low AMH may reflect lower egg quality, even when eggs reach maturity. Women with low AMH may have embryos (fertilised eggs before they implant in the uterus) that are more likely to have chromosomal abnormalities (genetic errors), which can increase the risk of miscarriage or implantation failure.

If these challenges feel overwhelming or you’re unsure how low AMH may affect your fertility, schedule an appointment with Thomson Medical. Our specialists can help by explaining your options and recommending the most suitable approach for your fertility conditions.

How to improve IUI success when AMH is low

While AMH levels cannot be increased, certain lifestyle and medical approaches can help support IUI success. Even small changes can make a meaningful difference, here are some approaches you can try:

• Eat a balanced diet rich in protein, antioxidants, omega-3 fats, and vitamins.

• Drink 2-3 litres of water daily to stay hydrated.

• Maintain a healthy body weight and BMI.

• Engage in regular moderate exercise, such as brisk walking or swimming.

• Get 7-9 hours of sleep each night.

• Avoid smoking and limit alcohol intake.

• Reduce consumption of foods that can cause inflammation, such as high amounts of  caffeine, sugar, and processed meat.

Optimising the IUI procedure can also help improve outcomes:

• Monitor ovulation carefully to time insemination accurately.

• Use fertility medications such as letrozole or clomiphene citrate to stimulate egg development.

• Prepare sperm samples to select the most active and healthy sperm for insemination.

What can you expect with IUI and low AMH?

While women with low AMH have fewer eggs than expected for their age, IUI success is still possible – especially with fertility medication and proper timing.

You may need several IUI cycles before achieving pregnancy. Your doctor may recommend fertility drugs to stimulate egg growth and release, improving the chances of fertilisation.

Each woman’s situation is different, so it’s best to discuss your options with a doctor who can guide you based on your AMH level, age, and overall reproductive health.

FAQ

How much AMH is required for IUI?

Is IUI worth trying before IVF if I have low AMH?

Is it possible to conceive with low AMH?

Yes. Low AMH means fewer eggs, but conception is still possible if you ovulate and your eggs are healthy.

Can IUI be successful with low AMH?

Yes, success is possible, particularly for women under 35 or those who respond well to fertility medication. The key factor is developing at least one or two mature, healthy follicles during your treatment cycle, which can still occur even with reduced ovarian reserve.

Is low AMH considered infertility?

No. Low AMH indicates a reduced egg supply, not infertility. Many women conceive naturally or with fertility treatment despite low AMH.

How many IUI cycles should I try with low AMH?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situations, please consult a specialist at Thomson Medical. Schedule an appointment with Thomson Medical today.