A young woman in her late twenties came to me after surgery for extensive endometriosis. The procedure had given her relief; her pain was gone. Her follow-up testing looked reassuring: her fallopian tubes were open on hysterosalpingogram (HSG), and her anti-Müllerian hormone (AMH) level was above 4 ng/mL, which is considered normal. Her question was straightforward: “If my AMH is good and my tubes are open, doesn’t that mean everything is fine? If doctors are worried about my fertility, aren’t they just trying to push me into treatment?” This question gets to the heart of one of the most common misunderstandings in fertility care: what AMH really tells us and what it doesn’t.

What AMH actually measures

• AMH is a hormone produced by small ovarian follicles.
• It reflects egg quantity (ovarian reserve), not egg quality.
• An AMH above 4 ng/mL suggests a healthy pool of recruitable follicles compared to age-matched norms.

What AMH does not guarantee

• Egg quality is determined largely by age and cellular health (things like chromosomal integrity and mitochondrial function), not AMH alone.
• A 25-year-old and a 40-year-old can both have an AMH of 4, but their eggs do not have the same reproductive potential.
• Endometriosis adds another layer. Even after successful surgery, the disease can still affect fertility through:
  • Scarring or adhesions that interfere with egg pickup by the tubes
  • Microscopic inflammation that disrupts fertilization, implantation, or embryo growth

Endometriosis and fertility outcomes

Research shows that women with moderate to severe endometriosis often have lower fertility rates compared with women without the disease, even when AMH and tubal patency are normal. Surgical relief of pain does not necessarily equate to restored fertility. Recent studies also suggest:

• Oocytes from women with endometriosis may show structural changes (dark cytoplasm, irregular zona pellucida) that can affect embryo development.
• Endometriosis and adenomyosis together reduce cumulative live birth rates across multiple IVF cycles, though many women still achieve pregnancy with persistence.
• Individualized treatment strategies (tailored stimulation protocols, lifestyle interventions to reduce inflammation, and sometimes surgery) may improve outcomes.

Is caution “fear mongering”?

It’s understandable that patients may feel pressured when doctors raise concerns about fertility treatment. But caution is not necessarily fear mongering; it’s grounded in data. That said, not every woman with endometriosis needs immediate IVF. For a patient in her twenties, with good ovarian reserve and no pain, trying naturally for six to 12 months may be perfectly reasonable. At the same time, awareness of the possible fertility impact of endometriosis ensures she won’t lose valuable time if conception doesn’t occur.

The bottom line for patients

• An AMH >4 is reassuring, but it does not equal excellent egg quality.
• Endometriosis, even after surgery, may still reduce natural fertility chances.
• Advanced treatments like IUI or IVF are not always required immediately, but they are legitimate considerations, not scare tactics.
• The best approach is an individualized plan, balancing age, AMH, disease severity, and personal goals.

Closing thought

Endometriosis is complex, and fertility is never explained by a single lab result. Numbers matter, but so does the broader context. For patients, the key is not to dismiss medical advice as fear mongering, but to seek clarity, ask questions, and work with a physician who can translate the science into a tailored path forward.

Oluyemisi (Yemi) Famuyiwa is a renowned fertility specialist and founder, Montgomery Fertility Center, committed to guiding individuals and couples on their path to parenthood with personalized care. With a background in obstetrics and gynecology from Georgetown University Hospital and reproductive endocrinology and infertility from the National Institutes of Health, she offers cutting-edge treatments like IVF and genetic testing. She can be reached on Linktr.ee, LinkedIn, YouTube, Facebook, Instagram @montgomeryfertility, and X @MontgomeryF_C.