Between school, social media, news articles, bloggers, and anecdotes from family and friends, there is a lot of mixed information out there about fertility, and it can be pretty overwhelming.
We all know that a woman's fertility starts to decline at some point and that some people have more challenges than others in this area, but how do you actually find out about your own situation?
One way to find out a little bit more about your fertility is through AMH testing.
But what exactly is AMH, what does the test involve, and how much can it tell you about your fertility? Let's find out.
What is an AMH test?
An anti-mullerian hormone (AMH) test measures your body's level of the AMH hormone. This can give indicators of your ovarian reserve, meaning the quantity of eggs and the number of fertile years you might have left [1].
An AMH test is a factor in fertility assessment and is not a comprehensive test [2].
It cannot give any guarantees about your fertility, it doesn't predict your likelihood of being able to get pregnant, and it doesn't give further explanation or evaluation of your egg quality, which is important in order to conceive and carry a healthy pregnancy.
It is possible to have low ovarian reserve and healthy eggs, and it is possible to have normal AMH levels and still have difficulty conceiving or carrying a pregnancy.
However, AMH test results can be a useful starting point for finding out about your fertility, or a helpful test if you are trying to conceive and have not yet been successful.
You can get your levels checked via a simple blood test, and you will typically need a referral from a GP.
The AMH blood test generally takes a few minutes, and depending on your clinic, you may get your results results within a few days.
What is the anti-mullerian hormone (AMH)?
We know there are a lot of hormones that play a role in fertility and reproduction, and the anti-mullerian hormone is one of these.
In unborn babies, AMH helps form male and female reproductive organs and post-puberty, the hormone is secreted by granulosa cells during the process of developing egg sacs (follicles) [3].
AMH concentration is related to egg reserve [4]. Females are born with their lifetime supply of eggs, meaning as we get older, our egg count — or ovarian reserve — decreases [5].
AMH tests can give insight into how many eggs you have remaining, with low AMH indicating low ovarian reserve.
In short, AMH tests are used to find out about egg quantity.
However, as we mentioned before, it is important to understand that this test doesn't tell us anything about the quality of those eggs, which is also important when trying to get a full picture of your fertility.
What happens during an AMH test?
Organising and getting an AMH test done is a relatively simple process.
Typically, your referring doctor (this can be a GP or specialist) will provide you with a referral to a clinic to get the test done. You can then contact the clinic and organise your test.
On the day, the test is done via a blood sample, and should only take a few minutes to complete. When the results come back, your doctor can help you review and interpret the results.
The test can be done at any time of the month [6].
Some research has suggested hormonal contraception can impact your AMH level, so it is best to check this with your doctor to make sure you are doing the test under appropriate conditions.
Who may need an AMH test?
Anybody can have an AMH done if they would like to know more about their AMH levels, but it may be more useful (and important) for some people than others [7].
If you have been trying to conceive for 6 months or more, or are considering in-vitro fertilization (IVF) or other fertility treatments, checking your ovarian reserve is a good place to start.
An AMH test is also useful if you have had ovarian surgery, chemotherapy, or other treatments that may have impacted your fertility.
As we mentioned earlier, your egg number declines as you age, along with fertility. For women, fertility generally starts to decline in the early 30s, and this decline speeds up after 35.
With that in mind, if you are in your 30s and would like to conceive at some stage but are not quite ready yet, an AMH test could be a helpful starting point and assist with your planning and reproductive options.
In addition to age, factors such as smoking, physical activity level, obesity, ethnicity and whether you have a family history of early menopause can all impact your AMH levels [8].
What is a normal AMH level?
A 'normal' AMH level depends on your age and can be impacted by numerous other factors.
Depending on your clinic, your AMH test results may be recorded in either pmol/L (picomole per litre) or ng/ml (nanograms per millilitre).
Using the pmol/L measurement, AMH levels of below 11 pmol/L are indicative of a poor egg reserve or ovarian reserve, while high levels (over 24pmol/L) could be a symptom of PCOS [9].
Using the ng/ml measurement, normal AMH levels are around 3ng/ml for 25-year-olds, 2.5 for 30-year-olds, 1.5 for 35-year-olds, and 1 for those aged 40 [10].
What happens if you have low AMH?
As we've mentioned, low AMH levels — indicating poor egg reserve — can be a sign to start considering your reproductive options sooner (if you are not already doing so).
If you are trying to conceive, or if you know you want to in the future, you might want to speak to a specialist about fertility treatments.
Low AMH can also be a biomarker for how your body may respond to IVF, and whether you are likely to get fewer eggs during an IVF cycle.
How much does an AMH test cost?
The cost will depend on several factors including your location, which medical clinic or company you go with, and whether you are getting other types of testing done as well.
An AMH test only, for example, will have a lower cost than a test that involves a wider analysis of other hormones involved with fertility.
The importance of getting your fertility tested
Understanding your fertility, menstrual cycle, and reproductive hormones is important, whether you are trying to get pregnant or not. Your hormones can impact many areas of your health, and knowing more about what is going on in your body can be a powerful tool.
If you are considering undergoing fertility testing, it is also important to remember there are many other things you can find out in addition to your AMH level and egg number.
A fertility test can test your follicle-stimulating hormone, estradiol, luteinizing hormone, prolactin, thyroid-stimulating hormone, free thyroxine and free testosterone.
These hormones can't tell you everything about your fertility, but they are a starting point and can tell you a lot.
The test results can indicate how you might respond to IVF or egg freezing, whether you are likely to hit menopause earlier or later than average, and whether other conditions such as PCOS or thyroid issues may be impacting you.
The comprehensive test is designed to help you be proactive about your fertility — whether you are thinking of having kids soon or not, understanding your options now can help you take control of your future.
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