Many couples delay starting a family for various reasons. Even though they share the common goal of desiring parenthood. While delays suit our busy modern lives, it’s important to keep an eye on your biological clock. This article will answer frequently asked questions about the anti-mullerian hormone test (AMH), often referred to as an “egg timer test”. AMH is the best marker of a woman’s egg reserve, however, it does not predict your chances of a natural conception in the near future.
What is the AMH test?
An AMH test is the best biochemical marker of a woman’s egg or ovarian reserve. The test itself uses a blood sample to measure the hormone produced by the primary follicles (small clusters of cells that surround immature eggs) in a woman’s ovaries. An AMH test can give you an indication of your ovarian reserve compared to other women of a similar age.
Who should have an AMH test?
It can be helpful to know what your ovarian reserve is when considering having a baby or planning to conceive in the future. It can help you understand your current fertility position.
Unlike men who continually produce sperm, women are born with their lifetime supply of eggs. There are large variations in the number of eggs between individual women, as well as the pace at which the egg pool declines. An early indication of fertility status may help in deciding whether to start a family sooner or later or whether to consider other fertility options like egg freezing.
An AMH test gives you some insight into the remaining quantity of eggs and number of fertile years you may have, but it cannot tell you much about the quality of those eggs.
What factors contribute to a low AMH?
Age affects every woman’s AMH level. From birth, you will have all the eggs that you can release in your lifetime. The starting number was genetically determined and can vary greatly between women. Eggs are steadily lost until the age of 30 and then the rate of loss increases rapidly, especially after 35.
Levels of AMH can be further altered by some lifestyle and environmental factors including smoking, obesity, exposure to toxins and air pollution. Some women have a genetic predisposition for diminished ovarian reserve such as Fragile-X or Turner Syndrome. One factor that can artificially lower your AMH level is the use of the oral contraceptive pill.
How are the results of the AMH test measured?
To interpret your results, you should compare your own level with other women of the same age due to the natural decline in AMH over time. AMH is a measure of quantity and it is important to interpret the AMH result in combination with other factors that influence fertility.
An AMH test is not a measure of egg quality – the best estimation of quality and potential of eggs to become a baby is a woman’s age.
What is a healthy range for an AMH test?
AMH levels can vary widely, even amongst fertile women. Interpretation of the AMH level should be considered as part of your holistic assessment and your plans for future fertility. A low AMH should not necessarily be considered as a stand-alone concern, and is not associated with a reduced monthly chance of getting pregnant. This will depend on many other factors including regularity of menstrual cycles, if ovulation is occurring and the quality of your partner’s sperm.
The table (from Genea Australia) below depicts the normal range for AMH at different ages.
What can you do if you have a low AMH?
While you cannot increase the number of eggs in the ovary, as long as you have regular periods, you will ovulate one egg per month. It only takes one egg to be fertilised to produce an embryo. You may produce few, but very good quality eggs. We will support you to take proactive action to improve the quality of your eggs and discuss family planning strategies if you wish to have one or more children in the future.
What does a high AMH level mean?
You will ovulate one egg per month, like anyone else. In some cases, women might experience irregular periods with high AMH. Studies have shown that the level of AMH is 2-3 times higher in women with polycystic ovary syndrome (PCOS). However, women without PCOS who have high AMH levels are commonly very fertile and they are less likely to enter menopause early.
How can I determine the quality of my eggs?
Age is the best indicator of egg quality. Other lifestyle factors such as being overweight, smoking and exposure to environmental toxins might affect a woman’s egg quality. Over time, eggs can become metabolically fatigued which makes them more prone to genetic changes. Preliminary studies show that the quality of the eggs can be influenced by your diet, lifestyle, specific nutritional supplements and herbal medicines.
When to have an AMH test?
The optimal time to have an AMH test is at the beginning of your menstrual cycle (days 2-5) and 2 months after discontinuing oral contraceptive medication (OCP). AMH levels can be temporarily reduced by the long-term use of OCP.
How do I get an AMH test?
If you want to know more about your fertility, talk to us at Northern Beaches Health & Fertility. We can advise and order an AMH test as well as other tests that are relevant to fertility such as routine antenatal screening investigations. The AMH test costs around $80 and is not covered by Medicare.
Our practitioners with a particular interest in supporting couples in their reproductive journey are Karen Latter and Alison Maunder. For an individual assessment and a programme that is specific to your needs, make an appointment with us at Northern Beaches Health & Fertility https://nbhealthandfertility.com.au/