Why IVF cannot positively impact the underlying factors that determine AMH

24 Jan

IVF is a reproductive technology, not a restorative therapy. It helps retrieve and fertilise eggs that are already present, but it does not address the biological systems that determine ovarian reserve or AMH production.

AMH Reflects Follicle Biology Established Months–Years Earlier

AMH is produced by small growing follicles that:

Were recruited from the primordial pool months to years ago
Developed under the influence of long-term metabolic, inflammatory, immune and hormonal conditions

IVF stimulation occurs over days to weeks. IVF cannot reverse:

Oxidative damage to follicles
Inflammatory suppression of granulosa cells
Prior follicle loss or atresia

IVF Stimulates Existing Follicles — It Does Not Create New Ones

IVF medications:

Increase FSH to push already-recruited follicles to grow
Do not increase the number of primordial follicles
Do not regenerate ovarian tissue

So while IVF can recruit more follicles in a given cycle and retrieve more eggs than a natural cycle, it CANNOT increase AMH, restore ovarian reserve or improve follicle health retroactively.

IVF Does Not Resolve Inflammation, Immune Dysregulation, or Oxidative Stress

Underlying drivers of low AMH often include:

Chronic inflammation (e.g. endometriosis, autoimmune activity)
Metabolic dysfunction and insulin resistance
Mitochondrial stress
Environmental toxic exposure
Chronic stress / HPA axis dysregulation

IVF protocols do not treat these processes. In fact, high-dose gonadotropins can temporarily increase oxidative stress in the ovary, particularly in inflammatory conditions.

IVF Does Not Improve Egg Quality at the Cellular Level

Egg quality depends on:

Mitochondrial energy production
DNA integrity
Antioxidant capacity
Nutrient sufficiency

These factors are influenced over weeks to months, not during stimulation.

IVF can select embryos, bypass tubal or male factor issues but it cannot repair mitochondrial dysfunction or DNA damage in the egg.

AMH Is Not the Target of IVF

Clinically, IVF uses AMH to:

Predict ovarian response
Adjust medication dosing
Counsel on expected egg numbers

But AMH is not a modifiable outcome of IVF treatment.

This is why:

AMH may continue to decline with time
IVF success depends more on egg quality than AMH alone
Supporting ovarian health outside IVF remains critical

IVF helps work with the eggs you already have, but it doesn’t change the health environment the ovaries have been functioning in. AMH reflects long-term ovarian health, inflammation, and metabolic support. IVF can improve the chances of pregnancy by helping us access eggs, but it doesn’t restore ovarian reserve or address why AMH is low in the first place.

IVF is best understood as a mechanical solution to access eggs and not a therapy that heals ovarian biology, This is why pre-conception optimisation—especially reducing inflammation, improving metabolic health, and supporting mitochondrial function—can meaningfully complement IVF outcomes, even if AMH itself doesn’t dramatically rise.

references

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La Marca, A. and Volpe, A., 2006. Anti-Müllerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool? Clinical Endocrinology, 64(6), pp. 603–610.

La Marca, A., Broekmans, F.J.M., Volpe, A., Fauser, B.C.J.M. and Macklon, N.S., 2009. Anti-Müllerian hormone (AMH): what do we still need to know? Human Reproduction, 24(9), pp. 2264–2275.

Broekmans, F.J.M., Soules, M.R. and Fauser, B.C.J.M., 2009. Ovarian aging: mechanisms and clinical consequences. Endocrine Reviews, 30(5), pp. 465–493.

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Sanchez, A.M., Vanni, V.S., Bartiromo, L., Papaleo, E., Zilberberg, E., Candiani, M. and Viganò, P., 2017. Is the oocyte quality affected by endometriosis? A review of the literature. Oxidative Medicine and Cellular Longevity, 2017, Article ID 5624376.

Bentov, Y. and Casper, R.F., 2013. The aging oocyte—can mitochondrial function be improved? Fertility and Sterility, 99(1), pp. 18–22.

Raffi, F., Metwally, M. and Amer, S., 2012. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. Human Reproduction, 27(11), pp. 3146–3154.

Practice Committee of the American Society for Reproductive Medicine, 2020. Testing and interpreting measures of ovarian reserve. Fertility and Sterility, 114(6), pp. 1151–1157.