Anti-müllerian hormone (AMH) testing is often portrayed as the crystal ball of understanding your fertility. Whilst this test certainly has its benefits, the truth is that on its own, it does not provide the full picture of a woman’s ovarian reserve.
You may already know that women are born with their lifetime compliment of eggs – about 2 million. Over time, and through each menstrual cycle, eggs will continue to be lost unless they are fertilised and lead to a pregnancy. These eggs sit inside follicles within the ovaries, until they are stimulated to mature, ready for ovulation.
The follicles that contain the eggs are responsible for producing AMH, so the more follicles you have, the more AMH is produced. This is why AMH can be an indicator of the number of follicles, and therefore eggs, that remain.
It’s important to point out here that natural fertility is about more than just the number of eggs you have remaining. An AMH test cannot tell you anything about the quality of those eggs, and so an AMH test should never be taken without expert personalised fertility advice to help you to understand exactly what it means for you. Therefore, AMH testing can be a good indicator of your ovarian reserve and helps to paint the bigger picture, but is not a good predictor of your natural fertility. A more accurate way to understand the number of follicles remaining is by counting them, and this is done using ultrasound to obtain something called an antral follicle count. We explain more about what this is below.
Normal AMH Levels
AMH test results will be presented in terms of pico moles per litre (pmol/L). Beyond this, it’s not a good idea to be asking ‘Dr Google’ what a ‘normal’ result is, or comparing your result to what someone else has received. This can cause so much unnecessary stress and anxiety. AMH levels are individual to each person, and a fertility doctor or nurse will interpret this and tell you what this means for you.
AMH and IVF
AMH testing is commonly used before starting IVF treatment as it gives a good indication of how well the ovaries will respond to stimulation treatments. Low levels of AMH suggest the ovaries may respond poorly to stimulation. However, higher levels of AMH can produce poor quality eggs. High levels can also highlight a risk of hyper-stimulation, meaning your ovaries develop too many eggs, which may have further complications.
As previously mentioned, AMH testing doesn’t reveal anything about the quality of the eggs that are produced, so again it is important for results to be discussed in the wider context of fertility health with a fertility expert.
Alternatives to AMH testing
The NHS normally prioritises AMH testing for IVF procedures and it is therefore generally not made available as part of initial blood tests to investigate fertility. At Dr Fertility, we do provide AMH testing as part of our routine ‘baseline’ blood tests that we offer in our Personalised Female Fertility Home Test & Nurse Video Consultation package.
This personalised set of blood tests is always supported with a full 60-minute medical consultation with a fertility nurse to help you to better understand what the test results mean for you. If your AMH levels are low for your age, you’ll be given further support and impartial expert advice moving forward.
If it becomes important to understand your ovarian reserve to an accurate level, the next option may be to arrange an ultrasound scan to obtain an antral follicle count. This is a pelvic examination carried out by a trained sonographer, where an internal scan of your ovaries can reveal the number of follicles that you have remaining. This visual check therefore provides a more accurate assessment of your ovarian reserve.
This ultrasound scan should again be followed up with a consultation with a fertility doctor or nurse to help you to understand your results and your options for your fertility journey.
Natural fertility and conception
Natural conception describes being able to become pregnant through sexual intercourse without any type of medical intervention. We know that 84% of couples will fall pregnant naturally (with regular unprotected sex every 2-3 days) within 12 months of trying, increasing to 92% after 2 years of trying. For many, trying for this long to conceive naturally may lead to anxiety, with some questioning if they have “left it too long”. It is often this that prompts women to seek out an AMH test much earlier in their fertility journey.
As we have already stated, AMH is not a good predictor of your natural fertility because there are other important factors to consider, and without this context your results may cause you unnecessary stress and anxiety. This is why we include AMH testing as part of our wider set of baseline fertility blood tests, supported by a follow up consultation with a fertility nurse to help you to understand what the results mean for you.
- Can Anti-Müllerian Hormone (AMH) Predict Future Fertility? Big Fertility Project [online] https://bigfertilityproject.com/anti-mullerian-hormone-amh/ Accessed 10/03/22
- NHS Conditions – IVF Risks [online] https://www.nhs.uk/conditions/ivf/risks/ Accessed 29/03/22
- Infertility – Clinical Knowledge Summaries [online] https://cks.nice.org.uk/topics/infertility/ Accessed 17/03/22
Written on: 01.04.22 Review by: 01.04.25