This is a controversial question. Anti-müllerian hormone (AMH) is linked to female fertility, so AMH testing has its uses, but it’s not a crystal ball (if only!).
Whether you’ve come across AMH before or you’ve never heard of it, you’ll want the facts. That’s why we’re back with part two of our fertility awareness series.
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Should You Track Your AMH Levels?
Despite the media hype around ovarian reserve and AMH, the answer isn’t simple. Let’s dive into the context to help you make an informed decision.
What Is AMH?
It's a hormone that's made in the reproductive tissues of all humans, playing a vital role in reproduction. For women and birthing parents, AMH levels indicate ovarian reserve (the number of eggs you have left in your ovaries). This can be a helpful indicator of fertility.
Where Does AMH Testing Happen?
Most often, in the fertility clinic. Timings for an IVF treatment cycle are scheduled according to AMH levels. These levels influence which medication you’re given and how much. So doctor-led AMH testing is central to the IVF treatment process.
The key there is doctor-led.
In recent years, self-testing for AMH (i.e. patient-led) has become common. This is a whole other ball game. Self-testing kits for AMH are often advertised as giving women an idea of future fertility – this simply is not the case and these results can become a source of immense stress.
Why Is AMH Self-Testing Controversial?
1. It ignores the bigger picture with a transvaginal ultrasound for a detailed look at the uterus, ovaries and fallopian tubes, as well as medical history, family history and lifestyle information. The thing is, AMH is just one of many indicators of fertility. Test results should only be considered in along
2. No test is 100% accurate No individual test can tell you definitively how fertile you are. If your results show low ovarian reserve, it doesn’t mean you won’t become pregnant. Likewise, if you have a high reserve, this doesn’t guarantee you will become pregnant.
3. It's based on benchmarking Self-testing for AMH has the same problem as most forms of home health testing: your results aren’t fully personalised to you. Your AMH result may come back as low, but this is compared to the benchmark. It may be that for your own unique hormone profiles, your AMH levels are fine. The test will not tell you that.
4. You're mapped against a "reference range" of ages Levels of AMH vary by age. As an individual, you’re mapped against the averages for a “reference range” population of females. How your levels compare for that age range has some predictive value (it might be accurate for some people), but it’s not a perfect predictive value (there’s no guarantee that it’s accurate for you). In one study, AMH also varied throughout the menstrual cycle.
5. Averages can't predict *your* future Your test results are based on averages, and it is impossible to make concrete predictions for individuals based on averages. If your test result says you have low AMH levels, this doesn’t necessarily translate into reduced fertility. (Some studies even found AMH to be a poor predictor of natural pregnancy.)
6. Your results could be skewed by the pill, implant, injection, IUD... Your AMH test result will also be impacted by any hormonal contraception you're using, or how long ago you stopped using hormonal contraception. A lot of women who self-test their AMH levels and are still using birth control end up getting results that are incorrect as well as distressing.
The Dilemma
Nobody should feel compelled to make a decision about starting a family based on a single data point. Especially one that's as hard to interpret as AMH. Yes, even for doctors.
On the one hand, AMH results from self-testing can offer false reassurance. They can also trigger anxiety in people with no history of infertility, driving them to reshape their lives for no medical reason (we are not fans of the nickname “the egg timer test”).
On the other hand, many people feel that if they’re trying to plan ahead, and the results could help them clarify their timelines – wouldn’t they rather know? Even with the lack of accuracy, it seems worth the trade-off.
So, Should You or Shouldn’t You?
Ultimately, It’s Your Decision
The medical world still has a lot to learn about the role of AMH in fertility. You can choose to use it as an imperfect guide, or keep the box closed.
Do Your Own Research
Academic studies have contradicted one another, so watch out for bold marketing claims, and always check the source of those claims (e.g. is it a company with an agenda?).
Think Twice Before You Start Testing
Tracking your AMH levels is a major decision. The results could make you want to change the course of your life, and once you know them, you can’t un-know them. Ask yourself: if you discover that your AMH levels are low or high, what would you do differently?
Planning to Start Trying to Get Pregnant Soon?
Consider carefully whether there’s any benefit at all in testing. If you learn that your AMH levels are low, but you’re already pressing ahead as fast as you can, how does that serve you?
Remember, It’s Just One Data Point
We understand how easy it is to get caught up in the buzz!
Got more questions? Reply to this email and we’ll do our best to help.
Next Week: Does the Biological Clock Only Tick for Women?
In part three of this series, we’ll be setting the record straight about male fertility.
We hope you have a wonderful weekend and we’ll see you next Friday!
