IVF vs. IUI: How to Choose When You Have a Low AMH Level

In my previous blog post, Your AMH Level Is NOT a Fertility Test, I joked that if I were to make a t-shirt, it would say: “Your AMH is not a fertility test!” That phrase captures a core truth I wish more people knew. So many women come to me after being told, or after Googling late into the night (don’t worry, I do it too), that a low AMH level means they’ll never conceive naturally, that they need IVF right now, or that they’re somehow “running out of time.” Let’s set the record straight together.

I’m Dr. Lucky Sekhon, a double board-certified Reproductive Endocrinologist and Infertility (REI) specialist practicing in New York City. Through this blog, my Instagram platform @lucky.sekhon, and my upcoming book The Lucky Egg, I help patients cut through the noise: scary lab values, social media fertility myths, and conflicting advice on treatments like IUI and IVF. My mission is to empower you with clear, compassionate, and science-backed guidance so you can focus your energy, time, and resources where they actually count.

Many others, including myself, have written countless articles that help guide women on the differences between IVF and IUI, but in this post, I want to focus this conversation squarely as it relates to women with low AMH or diminished ovarian reserve DOR). I recently published a video on this topic on my Instagram and YouTube channels, in this blog post, lets dive deeper into some of the topics I cover in the video below:

Understanding What a Low AMH Actually Means

AMH, or anti-Müllerian hormone, is a hormone produced by the small follicles in your ovaries. It serves as a snapshot of your egg quantity, but it says nothing about your egg quality.

Here’s the real truth: if you’re still ovulating, even if your AMH is low, each month your body releases one egg. The quality of that egg, not the number left behind, is what truly dictates your chance of pregnancy.

I love using the gumball machine metaphor: your ovaries are like a gumball machine that dispenses one gumball at a time. Whether there are 10 gumballs left or 100, only one comes out per cycle, and how “good” that gumball is depends on its individual properties, not the total count inside.

For a deeper dive on what your AMH level actually represents, and why you should NOT interpret it as any sort of fertility measure, read my full breakdown: Your AMH Level Is NOT a Fertility Test.

IUI: A Gentle Nudge for the Egg and Sperm

Intrauterine insemination (IUI) is often described as giving nature a friendly little push. During IUI, sperm is placed directly inside the uterus around ovulation, shortening the distance it has to travel to meet the egg.For women with low AMH who are still ovulating, IUI can still be a reasonable option. Why? Because in these cases, you’re not relying on the total number of eggs in your ovaries; you’re relying on the one egg that your body selects each month.If your cycles are regular and your partner’s sperm parameters are good (or you’re using donor sperm), IUI can be a cost-effective, lower-intervention first step.

IVF: More Control, More Eggs, More Options

In vitro fertilization (IVF), on the other hand, is like taking over as the conductor of your reproductive orchestra. We stimulate the ovaries to mature multiple eggs at once, retrieve them, fertilize them in the lab, and then transfer an embryo back into the uterus.

With low AMH, IVF can help us maximize the chances of finding a viable egg by retrieving as many as possible in one cycle. This is especially valuable for those who are older or who want to preserve embryos for future family building.

When someone has low AMH, they may produce fewer eggs even with high doses of stimulation medication. This doesn’t mean IVF won’t work; it simply means that managing expectations is key. You may need more than one retrieval cycle to bank enough embryos.

For more on how these processes compare, check out my earlier post: IUI vs. IVF: Which Fertility Treatment Is Right for You?

How to Decide: Key Factors to Consider When You Have a Low AMH Level

When you have a low AMH level, the biggest questions to ask yourself are:

• How urgently do I want (or need) to get pregnant?
• Do I want more than one child?
• How comfortable am I with the idea of multiple treatment cycles?

Your Age and Egg Quality

In women with low AMH, age becomes the most important piece of the puzzle. That’s because egg quality declines with age, and it’s the quality, not quantity, that determines whether an egg can develop into a healthy baby.

If you’re in your early to mid-30s with a low AMH and regular ovulation, you might have time to try less aggressive options like IUI first. But if you’re in your late 30s or early 40s, or if time is not on your side, it often makes more sense to move straight to IVF. IVF allows us to retrieve as many eggs as possible while they’re still of higher quality, which is key when egg supply is already low.

Your Family-Building Goals

Women with low AMH who want more than one child should think strategically. IVF offers the chance to create and freeze embryos now, preserving your reproductive potential while your eggs are still viable. Even if you aren’t ready for a second or third child right away, having embryos stored means you won’t be as affected by further declines in egg supply or quality later.

On the other hand, if your main goal is to have one baby and you’re open to taking a slower, stepwise approach, trying IUI first may still be a good choice — especially if other factors (like age and sperm quality) are favorable.

Response to Ovarian Stimulation

Women with low AMH often have a reduced response to stimulation medications during IVF, meaning they might produce fewer eggs per cycle. This doesn’t mean IVF won’t work, but it does mean you may need to plan for more than one egg retrieval to achieve enough embryos, depending on your family goals.

Emotional and Financial Readiness

IVF with low AMH can be an emotional rollercoaster. Knowing ahead of time that egg numbers may be low can help set realistic expectations and avoid heartbreak from unexpected outcomes.

Financially, while IVF is more expensive upfront, it might ultimately be more cost-effective if IUI cycles repeatedly fail or if your timeline is tight. Conversely, if affordability is a major concern and you’re comfortable with a potentially lower chance per cycle, starting with IUI may help you feel you’ve tried a less invasive approach first.

My Advice in a Nutshell

When I sit with a patient who has low AMH who is debating between IVF or IUI, I generally use the following rubric to help guide them to the right decision

• If you’re young and want one baby, you might have time to try IUI first.
• If you’re older or want multiple children, strongly consider IVF sooner rather than later to preserve future options.

Be prepared for the possibility of needing more than one IVF or IUI cycle to get there, and don’t let that discourage you. Success often takes patience and persistence, regardless of your AMH level!

Here’s a quick comparison to help guide your decision when choosing between IVF or IUI:

	IUI	IVF
Approach	Natural ‘boost’	Controlled, lab-based
Eggs Retrieved	1 egg per cycle	Multiple eggs per cycle
Importance of AMH	Less critical	Important!
Cost (avg. per cycle)	$500 – $2,500	$15,000 – $25,000
Time to Pregnancy	Slower, generally requires multiple cycles to succeed	Faster, more controlled.

Final Thoughts

AMH can help us plan treatments, especially when thinking about IVF protocols and embryo banking. But it should never be used to scare you or push you into decisions that don’t feel right.

While this blog post offers a helpful overview, the reality is that choosing between IUI and IVF when you have a low AMH level is rarely a simple, black-and-white decision. There are so many nuanced factors: from your age and overall health, to your emotional readiness, financial considerations, and long-term family-building dreams.

In my upcoming book, The Lucky Egg, I dive even deeper into these choices, breaking down not only the medical aspects but also the emotional and lifestyle considerations that play such a huge role in this journey. If you’ve ever felt overwhelmed by all the noise: whether it’s conflicting advice online, well-meaning but misguided input from friends, or pressure from your own inner voice, I wrote this book for you. It’s designed to be a compassionate, evidence-based guide to help you make informed decisions that feel right for you.

No matter which path you choose, the most important thing is to remember that you are more than your lab numbers. Your AMH level is not a fertility test!

Now, if only I could find the time to actually get that t-shirt (or mug, or hat) made…maybe that’ll be my next project now that I’ve finally put the finishing touches on my book.

If you are interested in following more of my updates on fertility related topics, I encourage you to follow me on Instagram and subscribe to my monthly newsletter. If you are in the NYC area and would like to book an in person consultation with me at my office, you can submit an appointment request here.

Remember, no matter which path you take: you’ve got this. I’m here cheering you on, every step of the way.