Low AMH / diminished ovarian reserve in Peniche, Portugal: diagnosis, treatment and reference centres

Around 10% of women of reproductive age have age-discordant diminished ovarian reserve (POSEIDON Group 1–2). Frequency rises after age 35.

Portugal does not publish population-level epidemiological registries specific to Low AMH / diminished ovarian reserve, but international data applies. Regionally, demand for reproductive medicine consultations in Centro has risen steadily since 2010 per CNPMA annual reports. This reflects both delayed motherhood (mean age at first child in Portugal: 31.2 years, INE 2024) and greater reproductive health literacy.

Early recognition of Low AMH / diminished ovarian reserve preserves treatment options. Women with risk factors — family history, irregular cycles, chronic pelvic pain, or unsuccessful conception attempts ≥6 months at age >35 — should seek specialist evaluation without waiting the conventional 12 months.

Serum AMH (any cycle day) + antral follicle count (AFC) by early-cycle transvaginal ultrasound. ESHRE Bologna criteria require 2 of 3: age ≥40, AMH <0.5–1.1 ng/mL or AFC <5–7, prior poor response (≤3 oocytes).

In Portuguese practice, the pathway is: (1) GP consultation for baseline labs and ultrasound; (2) referral to gynaecology / reproductive medicine via SNS or direct private consultation; (3) full couple work-up even when the symptom seems isolated to one partner. In Peniche, the couple is typically referred to Leiria or another city with a licensed PMA centre, keeping baseline tests and ultrasound local.

Official sources: this protocol follows ESHRE Guideline: Ovarian Stimulation in IVF/ICSI (2019, addendum 2023). The DGS and CNPMA recognise these international guidelines as the basis for clinical care in Portugal.

Individualised protocols: mild/mini-IVF can yield comparable oocyte quality with lower drug cost. DuoStim (two stimulations within one cycle) considered for POSEIDON 3–4. Ovarian PRP and DHEA/CoQ10 supplementation have limited evidence — ESHRE does not recommend as standard.

Treatment choice should always weigh: female age, infertility duration, ovarian reserve (AMH), male factor, comorbidities, and patient preferences. Each option has different efficacy, risk, and cost profiles. Related treatments commonly discussed in consultation: fiv, icsi, preservacao-fertilidade.

Plans often evolve from less to more invasive options based on response. We recommend requesting a written plan that defines the maximum number of cycles before re-evaluation, objective criteria for strategy change, and the expected impact of each decision on cumulative pregnancy probability.

Peniche does not currently host a CNPMA-licensed PMA centre in the municipality. The typical pathway involves: initial consultations and baseline tests (hormones, ultrasound, semen analysis) locally, with referral to the nearest authorised unit — usually Leiria. This logistics model is common in Portugal and aligned with ESHRE recommendations for decentralised access.

For SNS, referral follows the Centro ARS. Privately, clinics in Leiria may offer remote monitoring or partner with local professionals. See the clinic directory in Leiria.

Access to infertility treatment in Portugal is regulated by Law 32/2006 (amended 2016 and 2021). Couple rights: technique-specific written informed consent, access to the medical record, second opinion, and complaint with the Health Regulator (ERS). Embryo cryopreservation is capped at 3 renewable years; gamete donation is anonymous by default (offspring may access non-identifying data at age 18).

The psychological impact of Low AMH / diminished ovarian reserve is frequently underestimated. The Portuguese Society of Reproductive Medicine recommends structured psychological support, particularly after pregnancy loss, cycle failure, or diagnosis that changes the parental project. Many PMA units include in-house psychology; alternatively the Portuguese Order of Psychologists maintains a directory of fertility-specialised professionals.