Negligible serum anti-Müllerian hormone levels and successfully spontaneous pregnancy three times: a case report.

Background: 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.

Case presentation: 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.

Conclusions: 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.

Clinical trial number: Not applicable.