When it comes to fertility, there are many factors that play a role: age, general health, medical history, lifestyle, and more. In recent years, one blood test has gained a lot of attention: the Anti-Müllerian Hormone (AMH) test. It’s often described as an “egg count test,” but like most things in medicine, the reality is a little more nuanced.
In this article, we’ll explore: what the AMH test can (and can’t) tell us; how it’s used in gynaecology and fertility care; and why it might (or might not) be useful for you.
What is Anti-Müllerian Hormone (AMH)?
AMH is a hormone made by the small follicles in your ovaries: the tiny sacs that contain immature eggs. Unlike other fertility hormones such as follicle-stimulating hormone (FSH) or estrogen, AMH stays relatively stable across your menstrual cycle, so it can be tested at almost any time of the month.
Because AMH reflects the number of follicles developing in your ovaries, it gives doctors an estimate of your ‘ovarian reserve’ – the number of eggs you have left.
How is the AMH test used in fertility and gynaecology?
In clinical practice, AMH testing has become a helpful tool in several situations:
- Assessing ovarian reserve: it helps give an idea of egg quantity, which can guide decisions about fertility planning
- Fertility treatments: AMH is used when planning IVF, to predict how many eggs a woman might respond with during stimulation
- Egg freezing: for women considering egg freezing, AMH provides valuable context about timing and likely yield
- Chemotherapy or ovarian surgery: AMH can be useful in monitoring ovarian function after treatments that may affect fertility, such as chemotherapy
AMH levels by age
One of the most common questions women have is: ‘what’s a “normal” AMH level for my age?’
The truth is that AMH levels vary widely, but they do naturally decline as women get older, just as fertility naturally declines as women age. According to Melbourne IVF, a rough guide as to the range of ‘normal’ AMH for various age groups is as follows:
- 25 – 30yo: 20 – 60pmol/L
- 30 – 35yo: 15 – 50pmol/L
- 35 – 40yo: 5 – 40pmol/L
- 40 – 45yo: 1 – 25pmol/L
Having an AMH result within the ‘normal’ range for your age indicates that your ovarian reserve is likely to be ‘average’ for your age. AMH should always be interpreted in the context of your age, cycle history, and overall fertility picture.
AMH and fertility treatments: IVF, egg freezing, and beyond
For women undergoing fertility treatment, AMH plays a particularly important role.
- IVF stimulation: a higher AMH often means a stronger response to IVF medications, while very low AMH may predict a lower number of eggs collected. This helps doctors individualise treatment to reduce risks such as ovarian hyperstimulation
- Egg freezing: AMH testing is a key part of counselling women about when to freeze eggs and how many cycles may be needed
- Donor eggs or advanced treatment: in some situations, very low AMH can guide discussions about using donor eggs, or setting realistic fertility expectations.
That said, it’s crucial to emphasise: AMH reflects egg quantity (number), not egg quality. Even women with low AMH can (and do) conceive, sometimes naturally.
Limitations of the AMH test: what it can’t tell you
Like any test, AMH has limitations. It’s important to keep perspective so you don’t lose sleep over your result.
- An AMH test result can’t predict natural fertility: many women with low AMH still conceive naturally
- Your AMH test doesn’t measure egg quality: age is still the strongest predictor of egg quality
- It won’t pinpoint menopause: while AMH declines before menopause, it can’t tell you the exact timing
- It’s not a general health test: AMH is only meaningful in the context of ovarian function and fertility planning
This is why professional guidance is key. A single number on a blood test can’t define your fertility future.
Should you get an AMH test?
Not everyone needs an AMH test. But it may be helpful if you:
- Are planning to delay pregnancy and want more information
- Are considering egg freezing or fertility preservation
- Have a medical history that could affect your ovarian reserve (e.g. chemotherapy, endometriosis, ovarian surgery)
- Are starting fertility treatment
On the other hand, if you are not actively planning pregnancy or fertility treatment, routine AMH testing isn’t generally recommended. The American College of Obstetricians and Gynecologists specifically advises against using AMH to predict fertility in women not seeking fertility care, as the result may cause unnecessary anxiety.
Frequently Asked Questions (FAQs)
Can AMH predict natural fertility?
Not reliably. AMH is more useful for predicting ovarian response in fertility treatment, not natural pregnancy chances.
Does a low AMH mean early menopause?
No. AMH falls with age, but it can’t tell you exactly when menopause will happen.
What if my AMH level is high?
This can happen in women with PCOS, but high AMH doesn’t always mean a problem: it just means more follicles are present.
How often should AMH be tested?
For most women, a single test is enough. In special situations (such as after chemotherapy), your doctor may recommend repeat testing.
Conclusions
- AMH is a useful tool for understanding ovarian reserve, especially in the context of fertility treatment and planning
- It has limits: it can’t predict natural conception or egg quality
- Age matters most: egg quality declines over time, regardless of AMH level
- Always seek professional guidance: a fertility specialist can help you to interpret your results in the context of your health and goals
If you’re concerned about your fertility, or considering treatment such as egg freezing or IVF, the best step is to speak with your GP or gynaecologist. Together, you can decide whether AMH testing is appropriate and what it might mean for your next steps.
AMH is just one piece of the puzzle. Your fertility story is unique, and no single test can define it. Empowering yourself with knowledge (and expert guidance, such as from Maven Centre’s Dr Melissa Cameron) can help you make the choices that are right for you.
