Unlocking Success: Navigate Low AMH/High FSH In Pregnancy

Sarah Clark

Now this is for me. I was diagnosed with premature ovarian insufficiency 25 years ago, and I didn’t get a second opinion. They told me the only thing I could do was donor eggs. 25 years later, I speak to women all the time, and they have low AMH. Your AMH is below one. They tell you that your quantity is too low for IVF. You’re not being able to do it, or they say they need to rush to an IVF, and so they’re not measuring the quality, and FSH can vary with each cycle, and we see it come down all the time. People, for IVF, want it below ten, and we see people with it in the eighties and more. Typically, when they’re at that stage, they’re going to, like, I got women telling me they’re receiving a call from their fertility clinic when they’re shopping at Target, saying, donor eggs are your only option, or they’re driving their car, and they get a call from the clinic. We’ve looked at your results. Your AMH is too low. You’re FSH is too high. It’s donor eggs, and it’s devastating. I know what it’s like firsthand and 25 years later, when we look at the other healing opportunities and all the other health issues going on in our body, there’s something we can do to address them.  

A study that came out in 2022 by Harris talked about the fact that lower AMH means that AMH and FSH were poor predictors of live birth outcomes. We’re looking at the wrong thing, and our thesis here is that is it you, is it menopause, or is it your adrenals because of all the stress that you’ve been under, both from a biochemical standpoint and also from the mental and emotional side of that? When I speak to women, they can recite that AMH number by heart. They don’t need to look at any kind of lab work. Nothing is like that in there. It’s embedded in there. In there, in their soul, they feel that there’s nothing else they can do. Meanwhile, in functional nutrition and functional medicine, 25 years later, people are still being told the same thing. But with functional medicine and functional nutrition, there’s a lot we can do. To me, that’s very empowering. I still think conventional medicine is missing the boat. We’re not anti-IVF. We’re pro-health.

Aumatma Simmons, ND, FABNE, MS

There are a couple of terms that you threw out there that I just want to use like ground us and early menopause. That idea is essentially based on what?

Sarah Clark

A lot of times, when they say you don’t have a cycle for more than a year, you’re in menopause. We’ve had people who haven’t had a cycle in ten years get their cycle back naturally. The people would like it if there’s no cycle for three years in their forties, and it comes back. Is it menopause? We don’t know. They’re going to let conventional medicine be labeled that way. But what’s driving it? Do we have thyroid dysfunction, which can impact your AMH, you’re FSH, and your follicle count?  We see a lot of people with either known thyroid issues such as Hashimoto’s, or hypothyroidism, maybe they’re on some medication, or they have a subclinical thyroid issue. It’s not the actual thyroid; it’s the liver and the gut. So medication can be part of that solution. But medication alone is abandoned. We need to dig deeper. We see many people who have come to us, and they’ve gone through multiple failed retrievals. Everything is labeled that poor quality, or that, or the cycle was canceled, or they’re labeled a poor responder, and then they go to work and make these changes. 

We look at either food sensitivities or I just did a whole one-hour podcast before here on my podcast all about the exciting still tests and looking at the health of the gut, which is the foundation of all this piece, the health of your gut and your ovaries are highly correlated. If you’ve got an infection going on in your gut, then that can impact your AMH and your FSH. You’ve got a parasite. You see people with low emissions, high disease, and multiple parasites. They have H. Pylori, so it’s lowering their stomach acid. They have a non-celiac gluten sensitivity. We can see on the stool test that they’re still exposed to gluten. All of those things,  the whole biochemical side of this, and then also the mental and emotional side of it is key. With a premature ovarian insufficiency or a diminished ovarian reserve diagnosis, it can be it’s devastating. A well-meaning RTI is telling you that donor eggs are your only option. If you kind of just like stick with it, and you can even if you feel there’s no option to go forward. But for sure, like, we help people all the time, get pregnant naturally, or improve their chances of pregnancy access, at the clinic, and like yesterday, speaking to people going through multiple miscarriages and like something that you see all the time to people before they come to see you. It’s devastating when we haven’t worked on our health and are working on those foundational pillars to help improve it. 

Aumatma Simmons, ND, FABNE, MS

There are so many things that can be happening under the surface that we need to dig into to get to that place of, like, we’ve gotten to optimize your health, your fertility, and all of the different factors that could be connected to why either you’re having lower AMH and higher FSH. You have recurrent pregnancies. Whatever the situation, it’s what’s underneath, what’s going on underneath. So many things could be happening. You name the field and you talked about gut health and gut infections of thyroid imbalances, I’m going to call it. It’s not necessarily a disease in some way; it’s just the thyroid is not functioning well. What are some of the other things that you commonly see happening in the Low AMH and high FSH people?

Sarah Clark

We see a theme of non-celiac gluten sensitivity, gluten off the charts, and some of the cross-reactants with gluten, which are dairy, corn, and oats. As I’m not taking these foods out forever. We essentially do an elimination diet, take them off for ten days, then we’ll systematically reintroduce foods over 30 days, tweaking that with food sensitivity testing, and then typically taking foods up for 60 to 90 days. then you can calm the inflammation because if there’s inflammation going on, your body wants to survive and not procreate. Looking at that food piece, a lot of times people are doing all these generalized things: following the fertility diet, being carnivore or vegan, being more plant-based, or maybe they’re doing keto or paleo, and all those things may have worked for someone, but are they right for you? Is taking this very personalized approach, and it fast tracks this, and then we see the adrenal insufficiency. Typically probably people that you work with as well too, like a type-A busy person. We work with a lot of people in health care, like teachers, nurses, doctors, and busy professionals who are like I was yesterday, all last week working 80 to 100 hours a week.

When the baby comes, how are you even going to take care of it? Who’s leaving work to pick the baby up? To mother and father yourself now before the child comes. If you’re more than 50 hours like all that piece that the hours a week, all that peace can be impacting your adrenals.  The stress from work, the stress from a toxic workplace—maybe you’re dealing with a death in the family or there’s been an estrangement in the family. I can’t tell you how many people have a low AMH or high FSH  they’re also working full-time, 40 to 50 hours a week. Plus, they’re doing a graduate program we’re working on. We’re going to school as well to do that. There’s just one question: how many people are doing master’s and PhDs, and how is that impacting their stress? Maybe they’ve had losses. pregnancy losses, maybe they’ve gone through. Typically, what we see with the people I work with is that they’ve gone through repeat either miscarriage or chemical pregnancy; they’ve been told they were poor responders; they’ve had canceled cycles.

They’ve gone through multiple IVF cycles, and it hasn’t worked, but no one’s looked at their health. Looking at that, that adrenal piece is key. Then we also see that there’s a toxic burden. We can see if there’s personal care that you’re exposing, your care with all the chemicals you’re exposed to, the water that we drink, the air that we breathe—all that, not to go crazy on all of it, but like if you got the Glade plug-ins and you have those candles lit all over your house, you’re inhaling all these toxic fragrances. Maybe shift those out sooner rather than later. Then as each product in your, cleaning chemicals and product and personal care products, as each one of those expires, you can replace it. Then also, like, we talk about gut infections. If you have a parasite, a bacterial infection, or a fungal infection going on, you need to address that. The mental-emotional piece on this too. like we talk about the adrenals of the thyroid and how that impacts the thyroid, which impacts the ovaries. the mental-emotional side of things, to be able to get honest about that stops. Sometimes people get very excited about the biochemicals, but the mental and emotional ones, like if there’s been trauma that you’ve experienced, we will refer you to therapy, EMDR therapy, or EFT. Emotional Freedom Technique to be able to deal with that, that trauma piece because you can’t outrun it. 

Speaking of running, we do see a lot of people who are over-exercising. I can’t tell you how many people who are doing that with low AMH and high FSH are joggers. Even though that’s how you cope, using exercise is that right for your body? Maybe the next day you’re kind of dragging your body, and you’re not doing that well. Another interesting theme as we’re seeing them breast implant people with breast implants. Nothing’s going on. I’m like, I don’t want to offend you. I just want to ask a question. When I’m speaking to people on Zoom, do you have breast implants? Yes, I do. Maybe some of those toxins that are circulating in your body—everything else is fine—have impacted your reproductive health. Also, we see blood sugar issues. We see a lot of people who have poor or dysregulated sleep. Maybe they’re feeling hungry or have sugar cravings. then, that can impact your menstrual cycle and your ovulation, and the blood sugar piece is there, too. The good news is that there are lots of things we can do in a very targeted manner like that, that mind, body, and spirit approach and be able to use conventional medicine 25 years later like it is still missing. I speak probably the same as you women all the time, where they’ve been told you got a rash over here to IVF and then no one’s looked at their health.

Aumatma Simmons, ND, FABNE, MS

Do you find that women with low AMH, and high FSH who are maybe under 40 to 43 are maybe in a different category than those who are in their late forties?

Sarah Clark

Because in the later forties, when we speak to women who are like them, they get this when they’re in their early thirties, and also because we want to look at the genetic piece, we have a doctor on our team who was trained in functional medicine, she’s an OB-GYN. So, is there a premature ovarian insufficiency piece? Is there Fragile X or Turner syndrome? Is there a genetic piece that we need to look at? The people that we work with to see if that’s not the case. It’s just that all of a sudden, the ovaries have shut down. A lot of times we find there’s a lot of stress before that. So it can be like this is not a miracle cure here. This is not what people are saying, Sarah, can you guarantee me a baby? I’m not guaranteeing you anything. All I can tell is that conventional medicine is not going to serve you here, and they kind of kick you to the curb from that piece. But it’s like, let’s take a very targeted approach. Looking at all those different pieces from the blood sugar to the thyroid to the infections to the food sensitivities. What can we do to improve your chances here?  For someone who’s got it early in their thirties, it can be easier. We get people pregnant within four to five months.

Other times, like, it can take a while, and some of those times, it doesn’t work. It’s not that everyone magically deals with diminished ovary reserve and premature ovary ovarian insufficiency, we’ll get pregnant. But with conventional medicine, they’re giving you a 5% chance. We have a 50% higher chance. It’s an average success of around 12 to 18 months. Our program is six months old, and that’s just the beginning. then you still need to keep making these changes, and a lot of times, however old you are, these things have been brewing in your body for years and years. Some people will beat the odds there and get pregnant faster. Other times, it takes people longer. There’s like I’m doing a Q&A tonight on my platform. They’re just all about that. The partner and having a partner make these changes, even though we’re dealing with female factors such as fertility, low emissions, and high age. We will coach the partner to make sure his semen and his blood chemistry are in good shape.

Then sometimes, the female is kind of like reminding, slash nagging, the partner to take his supplements, don’t drink, and get out of the hot tub, and like all these things, it can impact your relationship. Then, you’re kind of stuck as a couple, and everyone kind of around you, or you’re getting pregnant, and you’re feeling kind of stuck in a stuck spot. including your partner to be able to if you are struggling as a part of a team or as a couple, be able to improve that and be able to talk about it. Or if you are doing well, just deepen that relationship. You set a strong foundation because you have a partner with you, and we do work with people who are single by choice, either manifesting their man and working on their health until the man comes along or they’re too busy using sperm donors.

Aumatma Simmons, ND, FABNE, MS

Are there things that conventional medicine is missing when they are talking to or trying to work with women who have this low AMH, and high FSH scenario?

Sarah Clark

A lot of times, women will say, I asked my RNI, and he said, I asked him about diet and lifestyle, and he was like, It’s okay but it’s not essential. It’s just you’re asking the wrong person, and they’re highly trained in what they’re doing. We are not anti-IVF. We’re pro-health. But you need to have that team around you. First of all, you’re in the center of someone’s, like, you’re saying, there’s something wrong with my thyroid. My hair’s falling out. My hands are cold. My skin’s as dry as a lizard, and I’ve got low AMH, and they’re like, I’m only going to look at the FSH. I’m not going to look at the full panel, and then get a second. You’ll get another provider. We can help with that as well. But sometimes it’s like that medical gaslighting where you go and you’re like, 

There’s something up with my blood sugar, and they’re like, you’re not prediabetic. You’re right, but it may be normal, but not optimal. Instead, it’s so conventional medicine will mess up things that are trending the wrong way. In this case, it’s not typically a sick population. People aren’t lying in bed all day long, clinging to life, although some people can be quite unwell. But most people are functioning. They’re going to work. They’re out in their community. They’re doing their thing. But their reproductive health is struggling. They’ve been struggling and trying for two, three, four, five years or more. It’s not working. This will just take over their lives. I had one couple tell me they’ve done like seven IVFs, and he’s like, I’m just the caboose on her train, and 

I’m just going to keep going. I don’t know when she’ll stop, and I’m just going to keep going with her. But like it was ripping apart their marriage, and there’s a biological thing and a woman that you can’t even begin to describe it. Biology is that we want to have our baby, and so do men equally. But it’s different; it’s different, depending on how they handle it. In conventional medicine, they’re going to miss the thyroid piece. They’re going to maybe do a conventional stool test. They’re going to say everything’s fine. They’re going to have you do a celiac test. In the current celiac test, the conventional ones are only going to test for four proteins and gluten; there are over 60. there are some false negatives. You’re like, I don’t have celiac, but do you have non-celiac, gluten sensitivity?  Blood sugar? Maybe you don’t have diabetes, but are you like all-day-long hangry? You got the mood swings; is your blood sugar up and all? Is this optimal? 

The same with gut infections. I went and had a stool test; I didn’t have H. Pylori, which lowers your stomach acid and predisposes you to those, so you can eat that beautiful, healthy diet, but you’re not absorbing any nutrients. Maybe you found out you have low vitamin D, but the conventional reference range for that is anything. The functional reference range is 60 to 80 for vitamin D, and the conventional one will say it’s normal at 30. While that’s a hormone that is important for sperm health, if that’s low, then you might be told to supplement. But why is it low? Is there a gut infection under there with it? With a low vitamin D level, are there immune issues? Why is it low to begin with? We’re not opposed to conventional or IVF. But there’s just one thing: functional medicine and functional nutritionists are just 20 years in the future. 

We’re still not there, and our health care system is like that pill for the ill, where you’re like, Here you go. In this case, let’s pump your body full of hormones. If you’re wondering, I have a couple doing 16 IVFs. What is that doing to your health? We don’t know. I had both my kids as donor eggs, and, years later, my health took a nosedive. We don’t know all those things that are being pumped into our bodies and what they’re doing to our health, and one can only assume doing that many is not going to be good. First of all, why is it not working? Let’s work on your health now. To me, you’re in a very powerful position to make changes.

Aumatma Simmons, ND, FABNE, MS

What a lot of people forget is that if you’ve done one, two, or three IVF cycles, by that point, you should know that if you don’t change anything, your next three cycles are not going to be that different. When we say don’t change anything, I’m not talking about, like, did you change the medication dose? Did you change the type of medication? At that point you’re looking at: is there something else going on here that is causing the IVF to not have the outcome that it should have? A lot of people forget that. Then a lot of doctors don’t necessarily advocate or like other types of things that you could be doing to support your IVF to work better. You’ve said this a couple of times, like we’re not anti-IVF. I don’t feel like I’m an anti-IVF either. I just think that when we’re going into it blind and we don’t use the data that we collect from an IVF cycle, it’s data; it’s how many eggs were created, how many were collected, how many were retrieved, how many survived, and how many made it to day five embryos. 

All of that is information. Every single step of that process is telling us what’s happening in your body, where is this breaking down? If you’re going to go through IVF, you can use that data. That’s a very expensive test for you to be getting. But for the women, I met someone who had been through 12 IVF cycles or 11 when I talked to her, and this very weird clinic—I don’t remember the name of it—said to her that they would refund her if the 12th cycle doesn’t work. I’m like, if she’s only 11 and fails, there’s not going to be a different outcome here. She’s like, I’m just going to go through it so I can get my money back. Now I’m like, at that point, it’s not even going to be a positive outcome. She’s hoping for a negative because she just wants her money back, but she’s putting her body through that degree of hormones. and we don’t know the impact that it has. I’m curious if you’ve seen it. I feel like this is specific to maybe women who already had some high or low AMH. They go through IVF cycles, and then their AMH is even lower.

Sarah Clark

It’s that interesting to me because of all the stress that they’ve experienced through IVF. Even though it means your insurance covers it, we have a lot of people going cycle after cycle, and nothing’s changed. How is that impacting your mental and emotional? Then if you had a chemical pregnancy or maybe there’s a miscarriage or you’ve gone in and you’re I was talking to him the other day. He’s like, I’m already like, I already had my solution. When we did the three IVFs, I had my hopes up every time. Now they’ve had miscarriage after miscarriage, and the hopes have been dashed. He’s like, I don’t even know. I feel jaded. That’s why, as we say with functional medicine and nutrition, you’re going to have the data ahead of time. You’re going to know, so we got to, so adrenal issues is being; we need to work on that. There’s thyroid dysfunction. 

You’ve got a gut infection, or you’ve got fluid sensitivity. You’re going to have data in front of you to decide when to do the next IVF, because right now you’re just going, and I’m going next month. That’s what they told me to do. There’s no data, except that they’re saying that the AMH is low. We’re saying that before I went, we were chatting a little bit here. 25 years ago, when I was diagnosed with premature ovarian insufficiency, no one was measuring AMH. Now, I feel to use it as a scare tactic, you have to go right to IVF because your AMH is low. Now, the FSH has meant they’ve been measuring that for a while, but just because that AMH is a low piece, it does scare women and people in their thirties going, and then we just go there. We haven’t worked on our health, and we’re in a panic, an absolute panic. 

Aumatma Simmons, ND, FABNE, MS

I feel like AMH is also misunderstood a lot. The way that it was discovered is through IVF cycles. What they found was that women with an AMH below 1.06, which is generally the cutoff, had poorer IVF outcomes. They said women below 1.06 are too low, or their reserves are too low. But I feel that range from 1.06 down to point three they get the worst end of the stick because the IVF doctors are like, “You need to do IVF faster.” You’re asking more aggressively, more instantly. and that’s the worst thing that they could be doing because we already know that the data says that below 1.06, their chance of IVF being successful is already lower. Why would we put your body through something that has lower chances than even the average of your age population? Why is it a good thing to do faster? It just doesn’t make any sense. Then we’re like, by the way, we’re going to push your body even harder. You’re going to get a higher number of hormones and higher doses, and all of that is just going to deplete the egg quality. When you come out of this, None of this logically makes sense. Why would we do the thing that is shown to be the worst thing for us to do? We should do it faster. Harder. 

Sarah Clark

The exact opposite of what it is like to receive your body is your baby. You’re in a state where your body feels safe. You’re not in this, like putting on your hat, and you’re just like rushing towards something in a panic of impatience and worry, and you’re too old, your eggs are too old, and the whole thing’s about to fall apart. That just doesn’t serve anyone. That’s why a lot of times I’ll say donor eggs. So if it is low, let’s not do that because, like they’re saying, AMH they’re pretty developed to see how well you’ll do with IVF. To me, it’s because they’ve looked and we’ve missed the whole other side of things, like just all those different health issues I’ve gone through, and they also didn’t even talk about autoimmune disease. many people with low AMH and high FSH. Another thing we see is that autoimmune disease is typically either celiac rashes, lupus, or rheumatoid arthritis, graves like there’s potentially an autoimmune disease and there you are rushing off to IVF and then, that’ll mean, an autoimmune disease in that, that doesn’t matter. 

Functional medicine and functional nutrition are the only ways to reverse that. We’ve seen people be able to reverse it and get antibodies in the nine hundreds down to below ten. It’s and you’ve got antibodies, to begin with in the thyroid, like it’s something you’ve got to address, and conventional medicine misses the mark on that, too. Thyroid medication can be part of it, but that alone is a band-aid, and you need to dig deep into the diet and lifestyle piece and have someone guide you to fast-track it because otherwise you’re just going to be DIYing this, and generalized recommendations that have worked for someone, and they’re just going to say, it doesn’t work. That’s because you followed generalized guidelines.

Aumatma Simmons, ND, FABNE, MS

You mentioned earlier that panic that these women experience when they’re told that they’re in this, like, low ovarian reserve or whatever we want to call it. But this picture of low AMH high FSH, and it’s like an instant stressor, as it puts you into survival, like, “I’ll never have this baby that I want. I will do anything to get this.” What are some of the mindset strategies or mind-body things that people could incorporate in those moments of panic and stress that, if we stay in that mode, that’s not going to serve at all? It doesn’t matter what you do. If we don’t look at the mental, emotional, and spiritual aspects, it becomes challenging to be successful.

Sarah Clark

That’s why we believe in the mind, body, and spirit. Either it’s your faith, lean in on your faith piece. As part of our program, we include a session to look at scripture from the Bible and be able to see if that’s kind of giving you some peace of mind. You lean heavily on that because sometimes we just have this deep knowing. We have a knowing it’s going to work. Other times we could have, negatively hypnotized ourselves from the REI who says it’s not going to work. It’s his voice stuck in our heads, not our deep knowing that everything’s going to work out fine. I’m going to be okay. I’ve seen from a spiritual standpoint we have an energetic passion where it’s being able to pull cards and spirit, and all of that peace to be able to again dig into your intuition. you just have that solid knowing that, you’re okay and then will be fine. Also, our coaches are trained in HeartMath. It’s been used for over 25 years; for longer-term studies, it’s been used in organizations, hospital settings, and schools so it can help you look at your HRV. If that’s popping all around, maybe you’re meditating all day long, but you’re still like, We’re willing to do that list and all these things, and you got the back of your mind. You’re worrying. 

Maybe that’s impacting you. If you look up HeartMath, there’s like a little two-minute video that will take you through it. It’s a simple technique. You need to breathe into the heart space and focus on someone that you love. Then just like bringing love into the heart space. There’s a whole methodology that our coaches are trained in. But to me, that spiritual piece of your intuition, your faith, whatever it is lean in on that. that’s what’s going to stop the panic, the overwhelm, and the impatience. Typically, this is a Type A woman. She is like an ambitious woman who has gone up the corporate ladder, typically doing everything. She probably is a highly educated, smart woman, and everything. now they’re thrown at the fertility journey after researching day and night. Instead of researching, like hanging out with your partner and having some intimacy, not all about baby-making like lovemaking, hang out with your friends. You need to protect yourself from that sort of thing. If they’ve got babies all around them, and maybe you don’t need to be the one who plans the baby shower, and you can arrive late and don’t go early. But do not put joy on hold until we have our baby, or we’ll be happy then like it’s right now to mother yourself, put yourself first, and be able to, and that is, mother yourself now and father yourself now. 

Aumatma Simmons, ND, FABNE, MS

What do you wish everyone knew about low AMH and high FSH?

Sarah Clark

That there was something that we could do about it and that we could take action right now with functional medicine and functional nutrition, there are things we can do as a recovering planner and, that type-A like let’s get things done, that whole approach appeals to me and people that we work with too. You’ll have the data, and you’ll have the information. Was there an infection? Is there an imbalance? Is there anything going on in there? Then being able to, in a targeted manner, make these changes, your body is always whispering to you if you ignore the signals, is going to shower you with disease. Right now, the reproductive system is under attack. Sometimes we can say, that person down there doesn’t have to go gluten-free. Or she over there’s eating a whole bunch of stuff and drinking and still getting pregnant. But we don’t know what’s going on with her health. Comparison of the for joy and being able to run your race for people like myself who are diagnosed with POI. people listening with low AMH, and high FSH that has impacted our fertility. That’s what it is so now we need to take action and have a plan to be able to make some changes in a targeted manner to improve the chances of this working.

Aumatma Simmons, ND, FABNE, MS

Thank you so much for being here and sharing your story, and I hope that the low AMH, and high FSH pattern is something that can have a different outcome than that after a negative outcome that you have been told is likely for you. Where is the best place for people to connect with you?

Sarah Clark

They can check out or check out my podcast. I Get Pregnant Naturally. I’ve got a free guide called The Ultimate Guide to Getting Pregnant this year with a low AMH, and high FSH. They go to gpthisyear.com. Get that guide, it talks about the themes we see. some of the things we’re talking about today, like the diet that’s right for that. There’s some blood chemistry in there. If you have a blood count, you can compare that, and you can see if you’ve been told things are normal, but are they optimal? gpthisyear.com.

Aumatma Simmons, ND, FABNE, MS

Beautiful. Thank you so much for being with us today. Thank you for being here.

Sarah Clark

Thanks so much for having me. Dr. Aumatma. I appreciate it.