You may have come across AMH testing and have wondered if it is a test you should consider. Especially if you are over the age of 35, and wondering how long you have left before your fertility leaves you out in the cold. We know that a woman is born with all the eggs she will have for her reproductive life. We loose many naturally during our reproductive life, and when they are gone, they are gone.
Today’s busy and pressured life is very different from a world where women married in their early 20’s and had children soon after. Many women now choose to delay motherhood until later and concentrate on forging a career first, or decide to wait until they are more financially secure before starting a family.
Life is literally… a gamble
For some women, making the decision to delay motherhood is a gamble (Subrat et al 2012) and can have devastating consequences, if their eggs are running low. It is estimated that 10% of women in the general population are at risk of early ovarian aging. Ovarian aging is generally genetically determined but is also influenced by certain medical conditions and lifestyle factors such as smoking.
However, women do have an option to make an informed decision about their fertility and find out about their ovarian aging. I recommend that my patients who are over 35 consider this option carefully. Finding out about your ovarian aging may help you to decide when to start conceiving and how long you have left, and for some women who have been trying to conceive for some time, it may help in making treatment decisions.
What is AMH testing?
So how do you check your ovarian aging? The first way is by a blood test checking for levels of Anti-Mullerian Hormone (AMH). AMH is a protein hormone produced by the granulosa cells within the ovaries. AMH can be measured by a blood test at anytime in the menstrual cycle. For an accurate assessment there is a second way of determining ovarian reserve that should be combined with an AMH testing. This is an Antral Follicle Count scan (AFC). This scan counts the numbers of follicles within both ovaries.
AMH levels are naturally lower in women over the age of 40 and higher in women with PCOS. Approximately 1% of the female population will have what is called premature ovarian aging, which occurs in her 20’s or early 30’s. Below is a table to help you understand AMH results. However please make sure that the values of your result are the same as indicated here, and that you discuss your result with your doctor, as the table below is for the purposes of a guide only.
AGE MEDIAN AMH LEVEL (pmol/l)
(Adapted from Nelson et al, 2010)
Currently in the UK, AMH testing and AFC scans are not available on the NHS, therefore if you are considering this option, you would need to approach a private fertility clinic or contact me to arrange privately.
Subrat P, Santa SA, Vandana J. The Concepts and Consequences of Early Ovarian Ageing: A Caveat to Women’s Health. J Reprod Infertil. 2012;14(1):3-7.