How to Improve and Manage Ovarian Reserve
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
A diagnosis of diminished ovarian reserve — often delivered via a low AMH result or a poor response to IVF stimulation — is one of the most emotionally difficult things a woman can hear. It implies that time is short and that options may be limited. In my experience treating hundreds of women with low AMH, the picture is more nuanced than the numbers suggest. While we cannot increase the number of eggs remaining, we can meaningfully improve the quality of those that are there — and quality, not quantity, is the primary determinant of IVF success.
Understanding Ovarian Reserve
Ovarian reserve refers to the remaining pool of eggs (primordial follicles) in the ovaries. AMH (anti-Müllerian hormone), produced by small antral follicles, is the most useful blood marker — it reflects the size of the remaining pool. AFC (antral follicle count) on transvaginal ultrasound provides a direct visual assessment. FSH, when elevated, indicates the pituitary working harder to stimulate a declining ovarian reserve. None of these markers tells us about egg quality — only about quantity.
TCM Understanding
In traditional Chinese medicine, ovarian reserve is an expression of kidney jing — the fundamental reproductive essence that is finite, declines with age, and governs egg quality and quantity. The goal of TCM treatment is not to create new eggs (this is not possible) but to nourish kidney jing, kidney yin, and blood so that the remaining follicles develop in the richest possible environment — maximising the proportion of chromosomally normal eggs in each cycle.
Acupuncture
Research has shown that acupuncture improves ovarian blood flow — which is the rate-limiting factor for follicular development. Better perfusion means better oxygen delivery, better nutrient supply, and better removal of waste products from the developing follicle. Several studies have demonstrated improvements in FSH levels and ovarian response following acupuncture in women with diminished ovarian reserve. I treat patients weekly for a minimum of twelve weeks before an IVF cycle, with treatment focused on the follicular phase.
Chinese Herbal Medicine
The foundational formulas for kidney jing and kidney yin deficiency are Zuo Gui Wan and Liu Wei Di Huang Wan. Key individual herbs include Shu Di Huang, Tu Si Zi, Nu Zhen Zi, Gou Qi Zi, and Sang Ji Sheng. I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, tailored to each patient's full pattern and adjusted across the cycle phases.
Key Supplements
CoQ10 (ubiquinol, 600mg daily) is the most important supplement — it directly supports mitochondrial energy production in the oocyte, which declines as kidney jing depletes with age. DHEA (25–75mg daily) improves ovarian response in diminished reserve — discuss with your IVF clinic. Vitamin D, melatonin (3mg at night as an antioxidant in follicular fluid), and omega-3 fatty acids complete the evidence-based foundation. All supplements should be started at least three months before an IVF cycle.
Lifestyle
Adequate sleep, stress management, a Mediterranean-pattern diet, stopping smoking (smoking accelerates ovarian ageing), and moderate rather than excessive exercise all support ovarian health. Avoiding environmental toxins — BPA from plastics, pesticide residues, phthalates in cosmetics — reduces the oestrogenic and oxidative burden on follicular development.
For a personalised low AMH treatment plan, contact me or book a consultation in Wokingham.
