▶ Watch the full video on YouTube
Quick answer
According to Dr. Marc Sklar, The Fertility Expert, a low AMH result at 40 or over does not mean you cannot get pregnant naturally. Here is what matters most:
- AMH reflects egg quantity, not egg quality, and you only need one healthy egg each month to conceive.
- Five root causes often sit underneath a low AMH: blood sugar and insulin resistance, chronic stress, gut health and inflammation, environmental toxins, and egg quality or mitochondrial health.
- Many women over 40 with low AMH do conceive naturally when these root causes are supported together rather than treated in isolation.
- Egg quality can be supported over a roughly 90 day window through nutrition, targeted supplements, and lifestyle.
The takeaway: a low number is a reason to look deeper, not a reason to give up.
If you have been told that low AMH at 40 or over makes natural pregnancy impossible, I want you to know that is not the whole story. Low AMH does not mean you have no eggs, and it does not mean your fertility is over. Over more than two decades helping thousands of women conceive naturally through the HOPE Program, I have seen again and again that a low number is usually a sign the body needs deeper support, not a dead end. Below is what AMH really means, the five root causes I look for, and exactly what you can do about each one.
What does low AMH actually mean over 40?
AMH, or Anti Mullerian Hormone, is produced by cells in the small follicles in your ovaries, and doctors use it as a marker of ovarian reserve, which is roughly how many eggs remain. When AMH is low, conventional care often jumps straight to donor eggs or IVF. The piece that gets missed is that AMH is a measure of quantity, not quality. To conceive naturally you need one good, healthy egg in a given month, so the more useful focus is supporting the quality of the eggs you do have, and supporting the conditions that influence AMH in the first place.
Can blood sugar and insulin resistance lower your AMH?
Blood sugar swings and insulin resistance are closely linked with ovarian aging and lower AMH, and you do not need a PCOS diagnosis to have them. When blood sugar spikes and crashes through the day, it drives inflammation and can disrupt the hormones that support ovulation and conception. Steadying blood sugar is one of the most foundational changes you can make, because when this is off, the rest of the system struggles.
What you can do now
- Build balanced meals with protein, healthy fat, and fiber, and avoid eating carbohydrates on their own.
- Do not skip meals, which can trigger blood sugar crashes.
- Reduce processed sugar and refined carbohydrates.
- Ask a functional medicine provider to test fasting insulin and HOMA IR, not only fasting glucose.
- Some women find a month of continuous glucose monitoring very revealing.
How does chronic stress affect AMH and egg quality?
Chronic stress is something I see in almost every woman I work with. When you live in a constant state of fight or flight, whether from work, finances, or the emotional weight of infertility itself, your body produces high levels of cortisol. Your body cannot tell the difference between real danger and worry, so it responds the same way, and it can shift resources away from reproduction. Over time this can suppress ovulation, disrupt your cycle, and affect egg quality. Supporting your stress response is not a luxury, it is part of the foundation.
What you can do now
- Protect 7 to 9 hours of quality sleep each night.
- Practice daily nervous system regulation, including calming breathing or gentle somatic practices, not only meditation.
- Set boundaries around work, draining relationships, and overwhelming information.
- Ask your provider about adaptogenic herbs and about testing your cortisol pattern across the day.
Get the free egg-quality roadmap
Download The Proven 6 Ways to Improve Egg Quality in 90 Days, the exact framework we use with HOPE Program clients.
Can gut health and inflammation affect your fertility?
This is a root cause that almost no conventional doctor talks about, yet I see gut issues in roughly half of the women in my program. Your gut influences hormone balance, immune function, and inflammation, all of which affect fertility and AMH. Issues like leaky gut, SIBO, yeast overgrowth, or long standing digestive symptoms keep the body in a low grade inflammatory state, and that inflammation can disrupt hormones, egg quality, and implantation. Bloating, constipation, and other digestive symptoms are not something you simply have to live with, they are signals worth investigating.
What you can do now
- Take digestive symptoms seriously and mention them to a provider, even if you have had them for years.
- Add fiber and probiotic rich foods, and reduce ultra processed foods.
- Ask about comprehensive stool testing to look for bacterial imbalance, yeast, and inflammation markers.
- Address food sensitivities that may be driving inflammation.
Do environmental toxins harm egg quality?
We are exposed to many chemicals every day that our grandmothers never encountered, and some act as endocrine disruptors. Toxins like BPA, phthalates, pesticides, and flame retardants can mimic estrogen, throw off hormone balance, and affect eggs at the cellular level. For women with low AMH this matters even more, because the goal is to protect the eggs you do have. This is not about extreme cleanses, it is about steadily lowering your everyday exposure.
What you can do now
- Swap plastic food storage for glass or stainless steel, and never microwave in plastic.
- Filter your drinking water.
- Choose organic where it counts most, especially the Dirty Dozen produce.
- Move toward cleaner personal care and cleaning products (the Environmental Working Group databases help).
Should you focus on egg quality or egg quantity?
Egg quality and mitochondrial health matter, and they are often where women put all of their attention, taking CoQ10 and other supplements while still not getting pregnant. Here is the key point: egg quality is not more important than the other four root causes, it works alongside them. Your eggs need energy to mature and fertilize, and that energy comes from healthy mitochondria, which is why blood sugar balance, lower inflammation, good sleep, and stress management all feed into egg quality. Supplements are one piece, not the whole plan.
What you can do now
- Talk with your provider about CoQ10 (often as ubiquinol) and other antioxidants for egg quality.
- Eat antioxidant rich, colorful foods.
- Support mitochondria through the lifestyle basics above: stable blood sugar, lower inflammation, quality sleep, and stress care.
- If you want a formulated option, Dr. Sklar helped create Rejoova to support egg quality and ovarian health.
Can women over 40 with low AMH really get pregnant naturally?
In my experience, yes, it happens more often than most women are told, especially when the whole picture is addressed rather than a single number. I have worked with women who were told it was too late, who then went on to conceive naturally once we supported blood sugar, stress, gut health, toxic load, and egg quality together. Results and timelines vary from person to person, and this is not a promise, but a low AMH result on its own is not a reason to lose hope. It is a reason to get a fuller evaluation and the right support.
Frequently asked questions
Does low AMH mean I cannot get pregnant naturally?
No. AMH reflects how many eggs remain, not their quality, and natural conception needs one healthy egg. Many women with low AMH conceive naturally, particularly when underlying root causes are addressed.
Can AMH improve?
AMH can fluctuate, and some women see it improve when factors like blood sugar, inflammation, stress, and nutrient status are supported. The more reliable goal is improving the environment for your eggs, which supports quality even when the number moves slowly.
How long does it take to improve egg quality over 40?
Eggs mature over roughly 90 days, so most practitioners suggest giving natural changes at least three months of consistency, though some women notice improvements in their cycle sooner.
What tests are useful with low AMH?
Beyond AMH, it can help to look at a full hormone picture, comprehensive thyroid markers, fasting insulin and HOMA IR, inflammatory markers, nutrient status, and gut health. Ask your provider which are right for you.
Do I still need to focus on egg quality if I take supplements?
Supplements are one piece. Egg quality also depends on stable blood sugar, low inflammation, good sleep, and managed stress, so lifestyle and supplements work best together.
When should I get personalized help?
If you are over 40 with low AMH, sooner is generally better, because you can begin supporting egg quality right away. A fuller evaluation can identify what standard testing has missed.
Ready for a personalized plan?
Book a fertility assessment with Dr. Sklar and his team. We review your full picture, your cycle, symptoms, history, and labs, and build a roadmap tailored to you.
About Dr. Marc Sklar, The Fertility Expert
Dr. Marc Sklar is a doctor of acupuncture and Chinese medicine and a nationally recognized natural fertility specialist with more than 20 years of clinical experience. Known as The Fertility Expert, he is the founder of the HOPE Program and host of Fertility TV, and he has helped thousands of women conceive naturally, many told they had little chance without IVF. Learn about the HOPE Program →
References
- American Society for Reproductive Medicine (ASRM). Patient guidance on ovarian reserve testing, AMH, and preconception health. reproductivefacts.org
- American College of Obstetricians and Gynecologists (ACOG). Guidance on fertility evaluation and age related fertility. acog.org
- Peer reviewed literature on CoQ10, antioxidants, and oocyte quality. pubmed.ncbi.nlm.nih.gov
- Environmental Working Group. Shopper’s Guide to Pesticides in Produce and Skin Deep database. ewg.org
This article is for general educational purposes and is not a substitute for individualized medical advice. Individual results vary. Talk with your own healthcare provider about your specific situation.
