Expert / 29 April, 2019 / Dr Amin Gorgy
A growing number of women are opting to have fertility MOTs, otherwise known as fertility tests. However, there has been much controversy in the media about them being unreliable. Despite the negative press, these fertility tests, which include the Anti-Mullerian Hormone (AMH) test, provide valuable insight and enable a fertility specialist to provide an accurate snapshot of a patient’s fertility potential at the time of the test(s).
Fertility tests are most frequently used to allow fertility consultants to assess a patient’s fertility status and decide upon the best way forward for any fertility treatment. But an increasing number of women are using them to find out about their ovarian reserve to help make informed choices about their fertility. Fertility MOTs should not be used as a scare tactic, but should be a proactive way to plan for the future. If you think you may want a biological child, or children, in the future, then fertility testing can highlight any potential issues, allowing women and their partners to consider whether they need to take certain measures or plan for pregnancy sooner than expected.
We see many patients who have questions about the AMH test, in particular, including its significance and reliability. Below I have answered some of the most commonly asked questions about the AMH test.
AMH is a protein which is produced by the small follicles in the ovaries (which contain the eggs at an early stage which mature and then can go on to be fertilised by the sperm). Women are born with a finite number of eggs in their ovaries and these are known to reduce in both number and quality as they age (particularly after the age of 35). The AMH level in the body is linked to the number of follicles in the ovaries.
The AMH test for egg counting is a simple blood test which looks at the AMH levels in the blood. Once the sample of blood is taken this is sent to the laboratory for testing. The AMH level in the blood can indicate whether a woman has a low, normal or high amount of follicles within the ovaries, allowing experts to estimate the ovarian reserve and their fertility potential.
Although the media implies otherwise, the AMH test is an accurate marker of fertility potential (within set limits) and the results are reliable within a controlled environment. Although there may be small differences in the result of AMH tests between laboratories, this should be minimal as UK laboratories are considered to be quite consistent. Some laboratories measure AMH levels using different units which can mean that if your AMH levels are checked by two separate laboratories, it can look like there is a large discrepancy between results, and so it is always recommended where possible to have results explained by a consultant.
A woman’s egg count directly impacts her ability to undergo egg freezing and/or IVF and so if you’re considering fertility treatment, your consultant will need to know that you have enough eggs to collect to give you the best chance of success. As such, the AMH test is essential to not only indicate whether you can go ahead with IVF treatment, but to allow your fertility consultant to predict the most likely response of the ovaries and help them determine the best treatment options for your and your partner.
Research from The Endocrine Society has shown that AMH levels are positively associated with IVF outcome. The results of the AMH test will be compared against a baseline for different age brackets. But simply put, the higher the number, the better. A high ovarian reserve suggests good fertility potential. Generally speaking, younger women will have a high ovarian reserve. A low ovarian reserve, more common in older women, indicates fewer remaining follicles and declining function of the ovaries. That said, as with anything, there are exceptions and differences between individuals, and it’s important to remember that the results from an AMH test result will not indicate whether you will become pregnant or not.
AMH levels drop as you age and once the ovarian reserve is depleted there isn’t anything that can be done to replenish it. The biggest factor in low AMH levels is considered to be a woman’s age, and low AMH levels suggest that menopause is closer. AMH levels can also be affected by lifestyle factors like stress, poor diet, heavy drinking and/or smoking and certain illnesses. For women with low ovarian reserves IVF can still be an option. However, if the reserve is very low, egg donation may be the best way forward.
High AMH levels can alert your fertility specialist that there is a risk of the ovaries over-responding to the fertility drugs given during an IVF cycle, increasing the risk of ovarian hyperstimulation syndrome (OHSS), which can be life-threatening.
If your test shows high levels of AMH this can indicate a condition called Polycystic Ovary Syndrome (PCOS), where the ovaries develop lots of follicles but don’t release an egg. PCOS is a complex endocrine disorder, one of the main symptoms of which is irregular periods, and the condition directly impacts fertility. If you have high levels of AMH an ultrasound may be required for closer examination of the ovaries.
The AMH measures quantity of eggs, not quality, and doesn’t account for other factors that may influence fertility, like lifestyle factors, illnesses, pelvic operations and chemotherapy.
The AMH test is just one of many different indicators of fertility and is just one piece of a much bigger picture. It should be considered in conjunction with a transvaginal ultrasound for a detailed look at the uterus, ovaries and fallopian tubes, and medical history, family history and lifestyle should all be taken into consideration. It’s important to remember that no test is 100% accurate and no individual test will tell you definitively how fertile you are; if your results show low ovarian reserve doesn’t mean you won’t become pregnant and if you have a high reserve, this doesn’t guarantee you will become pregnant.
However, if have been trying to get pregnant without success and are being investigated for fertility issues, an AMH test will be very useful for helping your consultant to determine and plan the appropriate treatment.
If you’re experiencing fertility problems and would like to speak with me, you can book a consultation by calling 020 7224 1880 or emailing firstname.lastname@example.org.
Article by Dr Amin Gorgy, Fertility Academy