Fu Yiman, Huang Baoyi, Ma Lin
Laboratory for Assisted Reproduction and Reproductive Genetics, the Reproductive Medical Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No. 628, Zhenyuan Road, Xinhu Street, Guangming District, Shenzhen, Guangdong, China.
J Ovarian Res. 2025 Mar 18;18(1):57. doi: 10.1186/s13048-025-01640-3.
Anti-Müllerian hormone (AMH) is a useful marker of ovarian reserve in reproductive-aged women. However, the predictive value of AMH for the occurrence of a spontaneous ongoing pregnancy has limits. We reported a patient with extreme low AMH achieved spontaneous conception three times.
A 35-year-old woman, gravida 1, para 0, with a history of one miscarriage, presented with a one-year history of secondary infertility seeking reproductive assistance. Laboratory evaluation showed negligible (0.072 ng/mL or 0.514 pmol/L) AMH levels and ultrasound revealed reduced bilateral antral follicle count (AFC). She was diagnosed with diminished ovarian reserve (DOR) and counseled about her limited fertility prognosis. Despite recommendations for assisted reproductive techniques (ART), the patient pursued spontaneous conception. Two natural cycles and two ovulation induction cycles were conducted, utilizing recombinant follicle-stimulating hormone (FSH) with ovulation triggered by 8,000 IU of human chorionic gonadotropin (HCG). Remarkably, the patient successfully conceived three pregnancies and delivered four healthy children. In April 2022, she gave birth to a healthy boy weighing 3.17 kg via spontaneous vaginal delivery. In August 2023, she delivered another healthy boy weighing 3.80 kg via spontaneous vaginal delivery. Subsequently, in November 2024, she delivered healthy twins-one boy and one girl-via spontaneous vaginal delivery.
This case underscores the clinical significance of specialized reproductive medicine intervention in achieving successful pregnancy outcomes in patients with rapidly declining and persistently low AMH levels. It highlights that even in cases of severely diminished ovarian reserve, natural conception is possible with expert guidance. Clinicians should exercise prudence when providing prognostic guidance regarding fertility among patients presenting with markedly diminished or undetectable AMH concentrations. The application of AMH measurement for fertility assessment in the general population still need to be clarified in well-designed prospective studies.
Not applicable.
抗苗勒管激素（AMH）是育龄期女性卵巢储备的一个有用标志物。然而，AMH对自然持续妊娠发生的预测价值有限。我们报告了一名AMH极低的患者三次自然受孕成功。
一名35岁女性，孕1产0，有一次流产史，因继发性不孕一年前来寻求生殖辅助。实验室检查显示AMH水平极低（0.072 ng/mL或0.514 pmol/L），超声检查显示双侧窦卵泡计数（AFC）减少。她被诊断为卵巢储备功能减退（DOR），并被告知其生育预后有限。尽管建议采用辅助生殖技术（ART），但该患者仍追求自然受孕。进行了两个自然周期和两个促排卵周期，使用重组促卵泡生成素（FSH），并使用8000 IU人绒毛膜促性腺激素（HCG）触发排卵。值得注意的是，该患者成功受孕三次并分娩了四个健康的孩子。2022年4月，她经自然阴道分娩产下一名体重3.17千克的健康男婴。2023年8月，她经自然阴道分娩产下另一名体重3.80千克的健康男婴。随后，在2024年11月，她经自然阴道分娩产下健康双胞胎——一个男孩和一个女孩。
本病例强调了专业生殖医学干预对于AMH水平迅速下降且持续较低的患者实现成功妊娠结局的临床意义。它突出表明，即使在卵巢储备严重减退的情况下，在专家指导下自然受孕也是可能的。对于AMH浓度明显降低或检测不到的患者，临床医生在提供生育预后指导时应谨慎。AMH检测在一般人群生育评估中的应用仍需在精心设计的前瞻性研究中加以明确。
不适用。
