The AMH (anti-mullerian hormone) test is just one of many tests you may get when seeking answers about your fertility. But we know you’re not about to head to the doctor’s office for a blood draw without understanding what you’re getting yourself into. So here’s the full scoop on what to expect.
The lowdown on the AMH test
Think of the AMH blood test as a peek into a woman’s ovarian reserve. Here’s how it works: The AMH hormone is secreted by follicles in the ovaries. As you may know, follicles are the beginnings of human eggs, and a woman only has a finite number of eggs—the number of eggs decreases with age. This test measures the level of AMH in your blood.
“A higher level of AMH correlates to a higher ovarian reserve, or as we say, ‘the more gas left in the tank,’ says Dr. Joshua Hurwitz, MD, senior physician and partner at Reproductive Medicine Associates of Connecticut (RMACT).
About those eggs...
Unfortunately, women with a lower ovarian reserve may retrieve fewer eggs during egg freezing, so understanding your ovarian reserves is an important step in informing yourself and your doctors about what’s going on in your body. That way, you can make the right plans for you, depending on your goals.
Probably the most common reason to have an AMH blood test is as part of a fertility evaluation for any female patient interested in egg freezing or IVF, says Dr. Hurwitz. Any woman who’s trying to understand her future fertility potential could decide to have her AMH levels tested as well. In other words, you also might want to get the AMH blood test if you fall into any of these categories:
- You’re considering becoming an egg donor
- You might be freezing your eggs
- You’re thinking about getting pregnant and want to know if there’s a reason to act quickly
This isn’t like looking into a crystal ball. While having a normal ovarian reserve gives you a snapshot of what your fertility looks like now, it’s not a guarantee for what will happen in the future. Still, the results could help a woman more confidently decide to wait to try to become pregnant, or to freeze her eggs for potential use in the future, says Dr. Hurwitz.
What AMH do I need to freeze my eggs?
Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure.
In general, says Hurtwitz, patients can interpret their AMH level this way:
- Above 1.0 ng/ml (nanograms per deciliter): Normal
- Below 1.0 ng/ml: Showing weakness in the ovarian reserve
- Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve
But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require specific fertility treatment and/or medications. When AMH is over 5.0 nanograms per deciliter, for example, Dr. Hurwitz says it’s worth addressing if there are other potential signs of PCOS. Also, FYI: younger women tend to have higher AMH levels, and older women tend to have lower AMH levels.
What AMH do I need to donate my eggs?
If you are looking to donate your eggs, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.
AMH as part of a full work-up
It’s important to know that the AMH really isn’t a one-and-done test. It’s often done as part a full fertility evaluation, which may also include:
- Hysterogram (a.k.a. Sonohystogram or SHG), an ultrasound in which saline is added to the uterus (sort of a weird sensation but not so bad), so doctors can see inside and identify any problems with the uterus or fallopian tubes.
- Semen analysis, a test of a male partner’s sperm that gauges sperm count, as well as motility (the way they move) and morphology (size, shape and structure). Guys are so lucky this is their only major test.
- Hysterosalpingogram (HSG), an X-ray of the uterus and fallopian tubes (with a liquid dye in your bod!), which also can help identify or rule out certain problems.
In fact, the AMH probably isn’t the only ovarian reserve test you’ll get. It’s often done alongside:
- FSH blood test, another blood test. This is used to measure a different hormone called the Follicle Stimulating Hormone. FSH is released at the beginning of the menstrual cycle, so you’ve got to have your blood drawn at day 2, 3, or 4 of your period. A high level of FSH is associated with low ovarian reserve, and a low level of FSH is associated with a normal ovarian reserve.
- Basal Antral Follicle Count, an ultrasound in which the doctors will count the number of follicles they can see. The more follicles, the greater the ovarian reserve.
A woman’s age is also a huge factor in ovarian reserve and is really the most accurate way of gauging the quality of the remaining eggs, says Dr. Hurwitz.
It’s painless (mostly)
Since this is just a low-key blood test, there’s really not much to worry about. It can be done at any time during your menstrual cycle, and you don’t need to prep for it by fasting or in any other way. Think of it like getting a blood draw at your annual physical. You’ll have blood taken as usual through a needle into a syringe, and a Band-Aid will be placed on the site. Then, you’ll be able to go about your day as normal.
Dr. Hurwitz says his patients usually receive their AMH test results within a few days up to about a week, and they’re given over the phone by a nurse who can answer any questions they may have about their AMH levels. Then, after all their initial testing is done, the doctor sits down with his patients and discusses the results of all their tests to give a 360-degree picture of their fertility status.
Plotting your next steps
AMH level alone won’t tell you what your next steps will be. If you’ve had all the ovarian reserve testing done, there isn’t anything further that needs to be measured in that regard.
Remember, AMH level should never be the sole measure of a woman’s fertility. In fact, one recent Journal of the American Medical Association study found that AMH levels didn’t predict which women would get pregnant over the course of a year. This is a reassuring sign for women who have low AMH levels, but Dr. Hurwitz notes that it doesn’t mean that the AMH test results aren’t important. They can help your doctor understand what’s going on in your body.
Taking your AMH results into consideration with all your other test results and health history, you and your doctor will come up with a course of action. There’s no one answer for what this will be based on AMH level, but a low ovarian reserve might prompt a woman to begin egg freezing sooner.
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