Endometriosis and AMH: Does It Affect Ovarian Reserve?

UPDATED ON 08 SEPT. 2026

AUTHOR

CONDITION

Endometriosis

GET IN TOUCH ON

AMH, or anti-Müllerian hormone, is produced by cells in small developing ovarian follicles. An AMH blood test is used as a marker of ovarian reserve, or the size of the egg supply, but it does not directly count all the eggs in the ovaries.

When assessing fertility in women with endometriosis, Dr Jay Mehta,  Endometriosis Specialist at Shree IVF Clinic, Mumbai, considers the AMH result along with the woman's age, ovarian findings, endometriomas, previous ovarian surgery, and fertility plans.

This gives a more complete picture than looking at AMH alone.

Can Endometriosis Lower AMH Levels?

Yes, endometriosis can be linked to lower AMH levels, especially when the disease affects the ovaries.

However, not every woman with endometriosis will have low AMH.
Endometriosis causes inflammation and changes in the tissues around the reproductive organs.

When the ovaries are involved, these changes may affect ovarian reserve. The association appears to be stronger with ovarian endometriomas and moderate to severe endometriosis.

This is why an individual assessment is important when planning endometriosis treatment, particularly if future fertility is a concern.

Does an Endometrioma Lower AMH?

Yes, an ovarian endometrioma can be associated with a lower AMH level. An endometrioma is a cyst in the ovary caused by endometriosis and is sometimes called a “chocolate cyst".

Ovarian endometriomas have been associated with reduced ovarian reserve, and studies have reported lower AMH levels in women with endometriomas compared with women without them.

A lower AMH does not automatically mean that pregnancy is impossible. It mainly provides information about ovarian reserve and the expected response to ovarian stimulation.

Why Can an Endometrioma Affect Ovarian Reserve?

An endometrioma may affect ovarian tissue through inflammation, changes in the normal ovarian environment, and damage to healthy ovarian tissue around the cyst.

The endometrioma itself is not the only factor to consider. Previous surgery to remove an endometrioma can also affect ovarian reserve, particularly when healthy ovarian tissue is affected during the procedure.

For this reason, treatment decisions should consider both the symptoms caused by the endometrioma and the woman's fertility goals.

Can Endometriosis Surgery Lower AMH?

Yes. Surgery involving an ovary, especially surgery to remove an endometrioma, can reduce AMH levels because ovarian tissue containing developing follicles may be affected during the procedure.

The degree of change can vary depending on the type of surgery, the size and location of the endometrioma, whether one or both ovaries are involved, and the amount of ovarian tissue affected.

This does not mean that surgery should always be avoided. In some women, surgery may be considered to manage pain or other problems or to improve access to follicles during fertility treatment.

Does Endometriosis Surgery Always Reduce AMH?

No. The effect of surgery on AMH is not the same for every woman.

Ovarian surgery carries a greater concern for ovarian reserve than surgery that does not directly involve ovarian tissue.

This is why the potential benefits and risks should be discussed before choosing laparoscopic surgery for an ovarian endometrioma.

The decision should take into account symptoms, ovarian reserve, the appearance of the endometrioma, previous treatment and plans for pregnancy.

Should an Endometrioma Be Removed Before IVF?

Not necessarily. An endometrioma does not routinely need to be removed simply to improve IVF success.

Surgery may be considered in selected situations, such as significant pain, suspicion of another ovarian condition, or when the endometrioma makes it difficult to access the follicles during egg retrieval.

Because ovarian surgery can reduce ovarian reserve, the decision needs to be individualised. If IVF is being considered, your fertility specialist can assess whether treating the endometrioma first is likely to provide more benefit than risk.

Your IVF treatment plan should therefore be based on your ovarian reserve, age, symptoms, previous treatment and overall fertility assessment.

Can You Have IVF With Endometriosis and Low AMH?

Yes. Low AMH does not automatically rule out IVF.

AMH helps doctors estimate how the ovaries may respond to stimulation and approximately how many eggs may be retrieved.

It does not directly measure egg quality or guarantee whether pregnancy will or will not occur.

When AMH is low, your fertility specialist may consider your age, antral follicle count, previous response to stimulation, and other fertility factors before recommending a treatment approach.

Does Low AMH Mean You Cannot Get Pregnant?

No. A low AMH level does not mean that you cannot become pregnant.

AMH is mainly a marker of ovarian reserve. It does not directly measure egg quality, and it is not a standalone test of your ability to conceive naturally.

For this reason, a low AMH result should be interpreted along with your age, menstrual history, ovarian ultrasound, and other relevant fertility factors.

What AMH Level Is Considered Low?

There is no single AMH value that can accurately define fertility for every woman.

AMH levels can vary between laboratories and testing methods, and the result also needs to be interpreted in the context of age and other clinical findings.

A low result may suggest reduced ovarian reserve, but it should not be interpreted on its own.

If your AMH result is lower than expected, a doctor may recommend an antral follicle count and other fertility assessments before deciding what it means for your treatment.

Can AMH Increase After Endometriosis Treatment?

AMH can vary over time, but treatment should not be expected to reliably restore ovarian reserve.

If AMH falls after ovarian endometrioma surgery, the change may reflect an effect on ovarian tissue. The amount of change and any later variation can differ between women.

It is therefore better to look at AMH as one part of ongoing fertility assessment rather than expecting a particular percentage or timeframe for recovery.

Does the Stage of Endometriosis Affect AMH?

The stage and location of endometriosis may influence its effect on ovarian reserve.

Research suggests that moderate to severe endometriosis, particularly when the ovaries are involved, can be associated with lower AMH.

Ovarian endometriomas appear to have a stronger relationship with reduced ovarian reserve than some forms of superficial endometriosis.

However, the stage of endometriosis alone cannot predict an individual woman's AMH or fertility outcome.

How Is Ovarian Reserve Checked With Endometriosis?

Ovarian reserve is usually assessed using AMH, antral follicle count, and other clinical information.

AMH is measured through a blood test. Antral follicle count, or AFC, is assessed using an ultrasound scan to count the small follicles visible in the ovaries.

These tests provide different pieces of information and are best interpreted together with age, medical history, previous ovarian surgery, and fertility goals.

What Is an Antral Follicle Count?

Antral follicle count is an ultrasound assessment that counts small developing follicles in the ovaries.

AFC can help estimate ovarian response during fertility treatment and is commonly considered alongside AMH when assessing ovarian reserve.

When Should You Check AMH If You Have Endometriosis?

AMH may be useful when you are planning pregnancy, undergoing fertility evaluation, or considering treatment for an ovarian endometrioma.

It can also be helpful to assess ovarian reserve before and after certain ovarian treatments when clinically appropriate. However, the timing and need for testing should depend on your individual situation.

If you have endometriosis and are concerned about fertility, a complete fertility evaluation is more useful than relying on an AMH result alone.

What Should You Do If You Have Endometriosis and Low AMH?

If you have both endometriosis and low AMH, discuss your fertility plans with a fertility specialist rather than interpreting the AMH result on its own.

Your assessment may include:

• AMH blood test
• Antral follicle count
• Pelvic ultrasound
• Assessment of endometriosis and endometriomas
• Age and menstrual history
• Previous ovarian surgery
• Previous fertility treatment
• Your plans for natural conception, IUI, or IVF

The right approach depends on your individual fertility goals and how endometriosis is affecting your reproductive health.

Can You Get Pregnant Naturally With Endometriosis and Low AMH?

Yes, natural pregnancy can still occur with endometriosis and low AMH.

AMH does not tell you whether you will or will not become pregnant naturally.

The chances of conception depend on several factors, including age, ovulation, sperm health, fallopian tube function, the severity and location of endometriosis, and ovarian reserve.

If pregnancy is a priority, an early fertility assessment can help identify the factors that may affect your chances and whether treatment should be considered.

What Is the Main Link Between Endometriosis and AMH?

Endometriosis can be associated with reduced AMH, with the strongest effects generally seen when the ovaries are involved or an ovarian endometrioma is present.

Ovarian surgery for endometriosis can also affect AMH. However, a low AMH level does not mean that pregnancy is impossible and should not be used as the only measure of fertility.

The most useful approach is to interpret AMH together with your age, ovarian ultrasound, endometriosis findings, previous treatment and fertility goals.