Anti-Müllerian Hormone (AMH) is a really important hormone for your fertility because of how closely it is linked to your eggs, AMH testing can help you understand your fertility and give you insights into your overall reproductive health. Here’s what testing can and can’t tell you.

Quick facts:

• Anti-müllerian hormone (AMH) is an important hormone for fertility.
• AMH testing can help you determine roughly the number of eggs you have (your ovarian reserve).
• But it can’t tell you definitively whether or not you are fertile as it only gives insight into potential egg quantity, not quality. 
• AMH testing also can’t give insight into the health of the Fallopian tubes or uterus, which are also important for female fertility and conception. 
• AMH levels naturally decline with age, but there are also certain medical conditions, lifestyle and dietary habits that may impact its levels.

What is AMH and why is it so important?

Anti-müllerian hormone (AMH) is a super important hormone for fertility. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs. 

Because of its close relationship to your eggs, testing your AMH levels can help indicate how many eggs you have left at the time of testing. 

There are a few myths out there about what exactly AMH testing can tell us. So in this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it…

What can AMH testing tell me?

Whether your ovarian reserve is a normal for your age

AMH testing will give you insights into whether your ovarian reserve is in line with other healthy people in your age group. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a full picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol.

Whether you have polycystic ovaries or polycystic ovary syndrome

AMH testing can also indicate whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms. 

People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood. 

Some people with PCO also have the syndrome that can be associated with it—polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods and high testosterone levels. 

According to updated guidelines, AMH testing can be used as a marker for polycystic ovaries, which is one of the criteria for a  PCOS diagnosis. However, we would always recommend getting a scan of your ovaries) to confirm the diagnosis.

Whether IVF or egg freezing could be right for you

AMH testing and understanding your ovarian reserve can also help to determine if certain fertility treatments like IVF or egg freezing could be suitable for you.

During these fertility treatments, AMH levels are often tested to help determine the doses of medication needed and used to predict the outcomes of the egg collection process.

People with lower AMH levels are known to have less successful IVF treatment cycles, whereas someone with high AMH might be at increased risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome). 

Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing.

Whether you may be perimenopausal or menopausal or have POI

Menopause refers to the period of your life, usually post 45-50, where you no longer have menstrual cycles and are therefore no longer able to conceive naturally. Menopause is associated with having an extremely low, or completely diminished, ovarian reserve. 

It is usually diagnosed retrospectively—when women are over 45 years old and have not had a period in 12 months (and are not using hormonal contraception). 

For people who are younger, FSH levels are useful for diagnosing menopause, as FSH levels are known to increase for people with low egg reserves.

Although AMH levels are not recommended to help diagnose menopause, it is known that AMH levels reduce to very low levels at the time of menopause. There is also evidence that people with very low AMH levels (who are not going through menopause) will undergo menopause much sooner than those with AMH levels that are within range.

When the ovaries stop working before the age of 40, this is known as premature ovarian insufficiency (POI), which AMH levels have also been shown to provide a good indicator of.

If you have a higher risk of miscarriage or recurrent pregnancy loss

It is estimated that approximately 1 in 5 pregnancies end in miscarriage. Miscarriages occur most frequently in the first 12 weeks of pregnancy and can be associated with lots of different risk factors. Some of the most common are your and your partner or sperm donors’ age, pre-existing conditions and ethnicity.

Recent evidence has shown that people with diminished ovarian reserve, and therefore very low AMH levels, are more likely to have a miscarriage or recurrent miscarriage (two or three consecutive pregnancy losses). 

However, more research needs to be done to understand the links between AMH levels and miscarriage, including its risk factors.

What can’t AMH testing tell me?

Unfortunately, AMH testing and ovarian reserve forms only one part of the fertility picture and there are some things that AMH testing may not be able to tell you. Let’s take a look…

It can’t determine your egg quality

Although AMH levels can give insight into your egg quantity, it does not provide any insight into the quality of those eggs. Despite poor egg quality being one of the most common causes of female infertility, there is currently no test that can definitely determine egg quality (unless testing embryos in IVF treatment).

It can’t determine your exact egg quantity

Your AMH result can give an indication of the size of your ovarian reserve.  This is because it is released by the follicles which contain our eggs, meaning that the more follicles we have, the higher the AMH that will be produced. However, it can’t tell you your exact number of eggs because each follicle may produce a different amount of AMH depending on its size. 

In order to estimate the number of immature eggs in your ovaries, you need a pelvic ultrasound scan to get your Antral Follicle Count (AFC). However, this only provides an estimate as your total egg reserve will not be visible on a scan. 

A combination of your AMH results and AFC results are used to estimate your ovarian reserve. Although some studies have shown that AMH levels have actually been shown to be strongly correlated with AFC results and maybe more consistent over repetitive testing than AFC more research is needed to confirm this.

There are some situations where AMH levels may not correlate to AFC, such as for people who have cysts, PCOS or a diminished ovarian reserve.

As we mentioned before, individuals with PCOS accumulate high numbers of immature follicles in their ovaries, resulting in higher levels of AMH in the blood. Many of the immature follicles in those with PCOS, which show up as multiple cysts on a pelvic ultrasound scan, will likely not release eggs. This means that AMH levels in those with PCOS may not be representative of the size of their remaining egg reserve, or what their AFC will be in a pelvic ultrasound scan.   

There is some evidence that also shows AMH levels are less likely to correlate with the AFC if the ovarian reserve is extremely low (or diminished), however, more research needs to be done to understand exactly why this is.

For the most comprehensive analysis of ovarian reserve, both hormone testing and pelvic ultrasound of the ovaries is recommended.

It can’t determine the health of your reproductive organs

For pregnancy to successfully occur, you need to have healthy functional eggs and reproductive organs. These include your Fallopian tube(s), uterus and ovaries. 

AMH testing can’t give you insight into whether your ovaries are functioning properly or if you have any structural abnormalities within your reproductive organs. You would need a pelvic ultrasound scan to diagnose any structural problems.

It can’t tell you if you are infertile

A low AMH level does not necessarily mean you cannot conceive naturally. No correlation between AMH levels and pregnancy rates has been found. However, as mentioned above, very low AMH levels are associated with entering menopause sooner. 

Because your fertility is influenced by so many different factors, no single test by itself can determine infertility.

AMH testing with Hertility

Even if you have normal AMH levels, your fertility can still be affected by other conditions. This is why, at Hertility, we do not test AMH by itself— it is taken into account along with other hormones (we test up to 10) alongside a detailed medical history, including age, symptoms, past or current health conditions, medication and lifestyle behaviours

To assess for as many risk factors for infertility as possible, including screening for up to 18 health conditions, we test AMH alongside FSH, luteinising hormone, oestradiol, testosterone, prolactin and thyroid hormones. 

Each panel of hormones we test is tailored to your specific needs and concerns and will be personalised to you, your health history, symptoms and specific situations. This approach provides a more accurate and meaningful assessment of reproductive health, beyond the narrow scope of a single hormone level.

If you want to take the first step toward understanding your fertility and reproductive health, get started with an at-home Hormone & Fertility Test today. 

Why can’t I get an AMH test on the NHS?

The NHS prioritises AMH testing for those experiencing fertility issues and needing IVF treatment only— and is not usually funded as part of initial blood tests to investigate fertility. NHS-funded AMH testing is only available to those who fulfil the strict criteria:

• Not having conceived after regular unprotected sex after 1 year (or 6 months if you are 35 or older) as long as you don’t have any condition that can impact your reproductive health.
• For single people and same-sex couples who have had 6 cycles of unstimulated artificial insemination with no success. 
• Being known to,  or suspected to have, a reproductive issue in either partner

However, NHS policies can vary based on where you live and some integrated care boards (ICBs) even have AMH cutoffs for NHS-funded treatment. Therefore, if you are interested in finding out your specific ICB policy, we recommend you speak to your GP.

Can I test my AMH if I’m using hormonal contraception?

At Hertility, we encourage AMH testing for people, however, there is some research which shows that some types of hormonal contraception may temporarily reduce AMH levels. This is because hormonal contraception aims to suppress your ovarian function (by stopping ovulation from taking place), therefore suppressing your AMH levels too.  

More research is needed to determine the links between different types of hormonal contraception and AMH levels, however, it is estimated that the most common form of contraception (the combined oral contraceptive pill) could suppress AMH levels by about 30%.

However, this suppression will vary massively depending on the individual, the type of hormonal contraception and how long they have been using it—with AMH levels actually appearing not to be affected within the first 6 months of use or less. 

We still test AMH in those using hormonal contraception because overall there is not enough evidence to suggest that everyone’s AMH level will be suppressed.  Additionally, we can still identify a low egg reserve and polycystic ovaries in people who are using hormonal contraception.

Importantly, all studies have shown that AMH levels return to what was normal for that individual after coming off hormonal contraception.

If you are currently using any hormonal contraception and have been thinking of coming off it, you may prefer to wait at least 3 months after stopping contraception (as clinically recommended) to test your hormones for the most accurate insight.

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