5 Things AMH Testing Can (and can’t) Tell You About Your Fertility

Anti-Müllerian Hormone (AMH) is a really important hormone for your fertility and overall health. 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.

There are some myths out there about exactly what AMH testing can and can’t tell you, so in this blog post we’re going to explore exactly that and give you some insights into how you can test your AMH levels with at-home hormone testing.

1. What is AMH?
2. What can AMH testing tell me?
3. What can’t AMH testing tell me?
4. AMH tests with Hertility
5. Can I get a test on the NHS?
6. Can I test if I’m using hormonal contraception?

What is AMH and why is it so important?

Anti-Müllerian Hormone (AMH)  is a super important hormone for fertility and overall reproductive health. AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs. 

Since AMH is made by the follicles, your AMH levels can therefore give you an insight into your ovarian reserve, or how many eggs you have at the time of testing. 

We were all born with all of the eggs we’ll ever have, and as we age, both our egg quality and quantity declines. Generally our AMH levels will decline with age as our egg count diminishes, unless we have an underlying condition or lifestyle factor which is affecting our AMH levels (like PCOS). 

What can AMH testing tell me?

Whether your ovarian reserve is a normal for your age

You were born with all the eggs you’ll ever have. As you age, both your egg quality and quantity declines. This is due to both the natural ageing process and eggs being lost with each menstrual cycle.
As your ovarian reserve declines, so do your AMH levels. 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 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 (there’s a difference!)

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 means 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. 

Although AMH testing may be a useful step towards getting a PCOS diagnosis, it can’t give a definitive diagnosis on its own based on current guidelines,  so we tend to recommend a scan of your ovaries.

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, meaning lower implantation and pregnancy rates. 

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. This lack of eggs is what causes your periods to stop. 

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 (15).

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 (15).

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 yours 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 (3) (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 may be more consistent over repetitive testing than AFC (2), 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.

Like 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 (2).  

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 ovulating or if you have any structural abnormalities within your reproductive organs. You would need a pelvic ultrasound scan to definitely 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. In fact, no correlation between AMH levels and pregnancy rates have 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 never test AMH by itself—we always include it in a panel of up to 10 hormones. 

In order 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. 

Your panel will be personalised to you, your health history, symptoms and specific situation. 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 of:

• 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 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% (7). 

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 (1). 

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.

Key takeaways:

• Anti-Müllerian Hormone (AMH) is an important hormone for fertility and reproductive health.
• AMH testing can help you to determine roughly the number of eggs you have (your ovarian reserve) at the time of testing. 
• 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.

References:

1. Amer SAKS, James C, Al-Hussaini TK, Mohamed AA. Assessment of Circulating Anti-Müllerian Hormone in Women Using Hormonal Contraception: A Systematic Review. J Womens Health (Larchmt). 2020 Jan;29(1):100-110. doi: 10.1089/jwh.2019.7733. Epub 2019 Jul 16. PMID: 31314652.
2. Arvis, P., Rongières, C., Pirrello, O. et al. Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet 39, 1045–1053 (2022). https://doi.org/10.1007/s10815-022-02449-5
3. Busnelli A, Somigliana E, Cirillo F, Levi-Setti PE. Is diminished ovarian reserve a risk factor for miscarriage? Results of a systematic review and meta-analysis. Hum Reprod Update. 2021 Oct 18;27(6):973-988. doi: 10.1093/humupd/dmab018. PMID: 34254138.
4. Bunnewell SJ, Honess ER, Karia AM, Keay SD, Al Wattar BH, Quenby S. Diminished ovarian reserve in recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2020 Apr;113(4):818-827.e3. doi: 10.1016/j.fertnstert.2019.11.014. Epub 2020 Mar 4. PMID: 32145928.
5. Depmann M, Broer SL, van der Schouw YT, Tehrani FR, Eijkemans MJ, Mol BW, Broekmans FJ. Can we predict age at natural menopause using ovarian reserve tests or mother’s age at menopause? A systematic literature review. Menopause. 2016 Feb;23(2):224-32. doi: 10.1097/GME.0000000000000509. PMID: 26372034.
6. Korsholm AS, Petersen KB, Bentzen JG, Hilsted LM, Andersen AN, Hvidman HW. Investigation of anti-Müllerian hormone concentrations in relation to natural conception rate and time to pregnancy. Reprod Biomed Online. 2018 May;36(5):568-575. doi: 10.1016/j.rbmo.2018.01.013. Epub 2018 Feb 9. PMID: 29478840.
7. Landersoe SK, Forman JL, Birch Petersen K, Larsen EC, Nøhr B, Hvidman HW, Nielsen HS, Nyboe Andersen A. Ovarian reserve markers in women using various hormonal contraceptives. Eur J Contracept Reprod Health Care. 2020 Feb;25(1):65-71. doi: 10.1080/13625187.2019.1702158. Epub 2019 Dec 19. PMID: 31852271.
8. Oh, S. R., Choe, S. Y., & Cho, Y. J. (2019). Clinical application of serum anti-Müllerian hormone in women. Clinical and experimental reproductive medicine, 46(2), 50–59. https://doi.org/10.5653/cerm.2019.46.2.50 
9. Kruszyńska, A., & Słowińska-Srzednicka, J. (2017). Anti-Müllerian hormone (AMH) as a good predictor of time of menopause. Przeglad menopauzalny = Menopause review, 16(2), 47–50. https://doi.org/10.5114/pm.2017.68591 
10. Advances in Nutrition, 2017. Current Evidence on Associations of Nutritional Factors with Ovarian Reserve and Timing of Menopause: A Systematic Review. 
11. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/the-use-of-antimullerian-hormone-in-women-not-seeking-fertility-care 
12. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline?utm_source=redirect&utm_medium=web&utm_campaign=otn#1  
13. https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/anti-mullerian-hormone-amh 
14. https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/testing_and_interpreting_measures_of_ovarian_reserve.pd
15. Nelson SM, Davis SR, Kalantaridou S, Lumsden MA, Panay N, Anderson RA. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Hum Reprod Update. 2023 May 2;29(3):327-346. doi: 10.1093/humupd/dmac045. PMID: 36651193; PMCID: PMC10152172.