Low AMH, One Blocked Tube, Still Not Pregnant? Dr. Jay Mehta Explains

UPDATED ON 05 Jan. 2026

Low AMH, One Blocked Tube & Late Ovulation—What’s Really Going On?

Query Asked

My egg ruptured at 24 mm. My AMH is 0.97. One fallopian tube is blocked. I am still not pregnant. What could be the issues? I am totally depressed and don’t know what to do next.

My Take: Why Isn’t Pregnancy Happening Despite Ovulation?

When you are dealing with low AMH (0.97), one blocked fallopian tube, and a follicle that ruptures at a larger size like 24 mm, the reason for not conceiving is rarely a single problem.

In my clinical practice, I see this as a combination of three factors working against natural conception—not a failure on your part.

First, an AMH below 1.0 ng/mL indicates a reduced ovarian reserve. This means the number of eggs available is lower, and time becomes an important factor.

Second, having only one open fallopian tube reduces your chances of natural pregnancy by nearly 50% in every cycle, depending on which ovary releases the egg.

Third, although ovulation at 24 mm confirms that the egg is being released, such large follicles can sometimes reflect a suboptimal hormonal environment and may be associated with egg quality issues, even when cycles appear regular.

When these three issues come together, relying on natural conception becomes uncertain, emotionally exhausting, and often frustrating.

What Should You Do Next?

At this stage, the focus should shift from hoping for a chance pregnancy to creating a structured, evidence-based treatment plan that bypasses these biological hurdles.

In most women with this combination, IVF offers the highest and most time-efficient chance of pregnancy, as it bypasses the blocked tube, maximizes egg usage despite low AMH, and allows careful embryo selection.

AUTHOR

TREATMENT

IVF

CONDITION

Low AMH

Blocked Fallopian Tubes

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Quick Summary: Understanding Your Fertility Challenges

• Low AMH (0.97): This indicates a Diminished Ovarian Reserve (DOR). While it doesn’t mean you have no eggs left, it signifies that the quantity is reduced, and time is of the essence.

• One Blocked Tube: This functionally makes you a “one-sided” player. You can only conceive in the months when the egg is released from the ovary on the side of the open tube, effectively halving your chances.

• Large Follicle Rupture (24 mm): While ovulation is happening, a follicle growing this large before rupture might suggest hormonal imbalances or that the egg within could be “post-mature” and of lower quality.

• The Male Factor: Has your sperm been thoroughly checked beyond a basic count? Sperm DNA fragmentation is a critical, often-missed factor in these cases.

Why Hasn’t It Happened for Us Yet?

As a fertility specialist at the Shree IVF Clinic in Ghatkopar, Mumbai, I often sit with couples who are overwhelmed and disheartened.

 They come with a file full of reports, each pointing to a different piece of a complex puzzle.

As seen in this situation—a low AMH, a blocked tube, and questions about ovulation—this is a classic scenario I’ve addressed 1000 times in my 13 years of practice.

It’s completely understandable to feel depressed, but I want to assure you that having these answers, even if they are difficult, is the first step towards a successful strategy.

Let’s break down each component, not as a roadblock, but as a piece of information we can use to build a plan that works.

What Does an AMH of 0.97 Truly Mean for Your Wife?

AMH, or Anti-Müllerian Hormone, is a blood test that gives us an estimate of a woman’s ovarian reserve—the number of eggs remaining in her ovaries.

Think of it like this:

A woman is born with all the eggs she will ever have. An AMH test is like a fuel gauge for that reserve.

• A normal AMH for a woman under 35 is typically > 1.5 ng/mL.

• An AMH of 0.97 ng/mL falls into the category of Diminished Ovarian Reserve (DOR).

What Is AMH? (Anti-Müllerian Hormone)

What it tells us: AMH is a marker of egg quantity, not egg health. A low AMH signals that the number of available eggs is lower than expected for a woman’s age.

It tells us we need to be proactive because time becomes an important factor in fertility planning.

What it does not mean: AMH does not measure egg quality, and it does not mean pregnancy is impossible. I have personally seen women with an AMH as low as 0.5 ng/mL conceive successfully using their own eggs.

However, a low AMH means we cannot afford to waste months on treatments with low success rates. The ‘wait and see’ approach is not for you.

Dr. Jay Mehta is a fertility specialist and reproductive medicine expert at Shree IVF Clinic, Mumbai, with extensive experience in managing complex fertility cases involving low AMH, tubal factors, recurrent implantation failure, and advanced reproductive immunology.

Case from My OPD: When “Just Keep Trying” Wasn’t the Answer

AMH 0.8 and Two Years of Waiting: A Fertility Case

How Does One Blocked Fallopian Tube Affect Pregnancy Chances?

As you can observe, in this case, wife’s fallopian tubes is blocked. The fallopian tube is the pathway where the egg meets the sperm. It is the site of fertilisation.
Imagine you have two highways leading to a destination. If one is permanently closed, all traffic must divert to the single open highway.

• Halved Opportunity: Females ovulates from either the left or right ovary each month. If she ovulates from the ovary on the side with the blocked tube, there is virtually a 0% chance of natural conception in that cycle.

• The Hydrosalpinx Risk: It is crucial to know why the tube is blocked. If it is blocked at the far end and filled with fluid (a condition called hydrosalpinx), this is a major problem.

The fluid is toxic and can leak back into the uterus, preventing even a perfect embryo from implanting.

If a hydrosalpinx is present (>2cm in diameter), studies show that IVF success rates are cut in half unless the tube is clipped or removed before the embryo transfer.

So, having one open tube doesn’t mean you have a 50% chance of pregnancy. It means you have a 50% chance of even having a chance in any given month.

When combined with a low AMH, this makes natural conception a statistical long shot.

Is an egg rupturing at 24 mm a good or bad sign for pregnancy?

This is a very insightful question.

A follicle is the fluid-filled sac that contains the egg.

It grows under the influence of hormones, and when it reaches a mature size, it ruptures to release the egg (ovulation).

Typically, ovulation occurs when a follicle reaches 18-22 mm.

A follicle reaching 24 mm before rupture is on the larger side.

While it means ovulation is happening, it can sometimes be a subtle sign of a problem:

• Hormonal Imbalance: The follicle might be growing larger because the LH surge (the hormonal trigger for ovulation) is delayed or not strong enough. This can affect the final maturation of the egg.

• Post-Mature Egg: An egg that stays in an oversized follicle for too long can become “post-mature.” Think of it like a fruit that becomes overripe on the vine.

It’s still a fruit, but its quality is compromised. This can lead to fertilization failure or poor embryo development.

• Luteinized Unruptured Follicle (LUF) Syndrome: In some cases, a large follicle may not rupture at all, despite hormonal changes. It just turns into a cyst.

A follow-up scan post-ovulation is needed to confirm rupture.

So, while you see a rupture, the large size is a yellow flag that points towards potential issues with egg quality.

Have We Overlooked the Male Factor? A Question for You, the Husband

In 50% of infertility cases, a male factor is involved.

You and your wife are a team, and the “infertility” diagnosis belongs to you as a couple.

I see you are here seeking answers, which is the most important step a man can take.

Has your fertility evaluation been as thorough as your wife’s?

• Standard Semen Analysis vs. DNA Fragmentation: A standard test checks count and motility. But as I’ve mentioned, the DNA inside the sperm is what truly matters.

We need to know the Sperm DNA Fragmentation Index (DFI). If your DFI is high (>30%), it could be the primary reason for not conceiving, regardless of your wife’s issues.

• Lifestyle and Oxidative Stress: Your job, diet, sleep, and stress levels all directly contribute to the quality of your sperm.

In a city like Mumbai, the high-stress environment is a major contributor to high DFI.

The “It’s Not Me” Fallacy

A couple came to me for a second opinion after two failed IUIs.

The husband, a successful banker, was adamant that the problem was with his wife’s “older eggs” (she was 36). His semen report was “normal.”

I calmly insisted we run a DFI test.

It came back at 42%. He was shocked.

We put him on a 3-month antioxidant and lifestyle modification plan. For their IVF cycle, we used microfluidics to select the best sperm.

They are now pregnant.

The emotional relief for his wife was immense. It’s crucial to remember this is a team journey.

What Is the Next Logical Step in Your Fertility Journey?

You feel depressed and unsure of what to do next. Let me give you a clear, logical roadmap. Based on the evidence—low AMH, a partially blocked pathway, and potential egg quality issues—the path forward is to bypass these problems altogether.

The solution is in vitro fertilization (IVF) treatment

Here’s why IVF is the most logical and efficient next step:

• It Overcomes the Blocked Tube: IVF completely bypasses the fallopian tubes. We retrieve the eggs directly from the ovaries, fertilize them in the lab, and place the resulting embryo directly into the uterus. The blocked tube becomes irrelevant.

• It Maximizes Your Low Ovarian Reserve: With IVF, we use injections to stimulate the ovaries to produce multiple eggs in one cycle, instead of the single egg you get in a natural cycle.

For a woman with a low AMH, this allows us to “harvest” several eggs at once, making the most of her remaining reserve.

• It allows for embryo selection: We can monitor the embryos as they develop in the lab. This allows us to choose the healthiest-looking embryo for transfer.

For couples with recurrent failures, we can even perform Preimplantation Genetic Testing (PGT-A) to ensure the embryo is chromosomally normal before transferring it.

• It Addresses the Male Factor: If high DFI is an issue, we can use advanced techniques like ICSI (Intracytoplasmic Sperm Injection), MACS, or microfluidics to select the single best sperm and inject it directly into the egg, overcoming any issues with motility or DNA damage.

Wasting more time on natural cycles or IUI would be an emotional and financial drain with a very low probability of success.

Stop Worrying, Start Acting: Your Fertility Plan Starts Today

Feeling depressed in this situation is normal, but feeling powerless is a choice. You can take back control by moving forward with a clear plan.

Book a Consultation with a Specialist: You need an expert who can look at all the pieces of your puzzle at once and create a holistic plan.

Complete the Male Diagnosis: Insist on a sperm DNA fragmentation test. This is non-negotiable.

Discuss Advanced IVF: When you consult a specialist, talk about a personalized stimulation protocol for your wife’s low AMH and advanced sperm selection techniques for you.

At Shree IVF Clinic, we specialize in complex cases like yours. Our expertise lies not just in performing IVF but in customizing it to solve the specific problems that have prevented you from conceiving.

We understand the science, but we also understand the emotional journey.
You have the information. The next step is to use it. Do not let another month of uncertainty and heartbreak pass you by.

AUTHOR

TREATMENT

IVF (In Vitro Fertilization)

CONDITION

Low AMH

Blocked Fallopian Tubes

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