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The story of a patient with critically low AMH, where the first failure was not the end — but the point from which a different treatment strategy began.
In my practice, there are stories that stay with me for a long time. Not because they are “complex” — but because they change the way of thinking for both the doctor and the patient.
This is the story of a 36-year-old woman who came to us at Reprolife after three years of unsuccessful attempts to conceive. She had no history of previous pregnancies. But she had a very clear desire — not just to become a mother, but to have two children. For me, this is always an important moment: when a patient comes not just with a problem, but with a vision for their future.
When is it important to tell the truth?
Her cycle was already atypical then — short, 22–23 days, and over time it became irregular. We performed an examination, and it became clear from the ultrasound that the situation was not simple: only one antral follicle.
Tests confirmed this:
AMH — 0.04 ng/ml, FSH — 16.9 mIU/ml.
This is a level we regard as a severe decrease and ovarian reserve depletion. And it is at this precise moment that the most important thing begins — communication. I always believe that the patient should know the truth. Not a “soft version,” but the reality.
We discussed it: there is a chance. But it doesn’t lie in a single cycle. And if we want a result, we need to think differently.
Why the standard approach doesn’t work here
In most IVF programs, the expectation is simple: one stimulation — one result (“one and done”). But for patients with this level of AMH, that doesn’t work. The key here is the cumulative effect. Not “will we get something now,” but “what can we accumulate over several stages.”
This changes everything: the tactics, the expectations, and the psychology.
The first stage — and the first failure
We started stimulation after estrogen priming (aimed at lowering the high FSH level), focusing exclusively on what we could see — one follicle.
We performed the puncture.
And we did not obtain an egg.
This is the moment when many people stop and give up.
And I perfectly understand why.
But in such cases, this is not a “failure.” It is part of the process.
Why it’s important not to pause
We made the decision not to stop.
We performed ovarian PRP therapy and immediately continued stimulation using the DuoStim principle — meaning without waiting for a new cycle. And this is exactly where the situation began to change. On the ultrasound, we saw new follicles. Small, but active. This is always a very delicate moment — you need to be able to see this potential and not lose it.
In this stage, we obtained: 4 mature eggs and 2 top-quality blastocysts (5AA) on day 5.
When the result forms gradually
not one “big chance,” but several steps that together yield a result.
An important point — genetics
When the story becomes a happy one
What these stories mean
Low AMH is not a verdict.
A failed first stimulation is not the end.
But time is a resource that cannot be returned.
And most importantly: a result in reproductive medicine is not a coincidence. It is always a combination of strategy, experience, readiness to act, and the couple’s faith in the outcome.
At Reprolife, we work precisely with such complex cases. And we know: even where it seems “too late,” often a different approach is simply needed.