Why Are So Many Women Testing This Fertility Hormone?
Sometime during the pandemic, I noticed a trend among my 30-something friends: It seemed like everyone was suddenly talking about—and testing—their anti-müllerian hormone (AMH), sometimes referred to as an “egg timer” or a “biological clock” test. I’d never heard of this fertility hormone before, but it wasn’t long before my Instagram feed was flooded with ads for at-home versions or swanky concierge centers that seemed designed to attract millennial women drawn to glossy-leaved plants and midcentury modern furniture.
According to Aimee Eyvazzadeh, MD, an ob-gyn and reproductive endocrinologist who hosts the popular podcast The Egg Whisperer, AMH is a “hormone secreted by cells that surround our eggs, which declines as we get older and becomes undetectable once we’re in menopause. Unfortunately, for so many women, our AMH disappears before our longing for a child disappears.” Essentially, an AMH test can indicate your ovarian reserve, i.e. the number of eggs you have left in the bank—which, admittedly, sounds like a solid starting point for assessing your fertility. Plenty of direct-to-consumer sites are running with that notion, making bold claims about the test’s ability to predict how likely you are to conceive and help you plan when to start a family.
Medical experts beg to differ. The American College of Obstetricians and Gynecologists’ official guidance clearly states that AMH testing “should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential.” Yikes. None of my friends who were getting tested were infertile, and many of them were basing ideas of their future fertility potential on the result.
So what was going on? Was there any point in knowing your AMH at all? “It just tells me how many eggs are available for ovarian stimulation [in fertility treatments]—nothing else,” says Lucky Sekhon, MD, a reproductive endocrinologist and ob-gyn based at RMA of New York. “It's not a marker of egg quality, and therefore it’s not really a marker of your natural fertility.” A scientific meta-analysis published in 2021 examined the outcomes of 11 studies and came to the same conclusion, stating that “AMH levels have poor predictive value for natural pregnancy” and that “low-serum AMH levels are not associated with reduced fertility.”
Eyvazzadeh explains: “It’s the closest thing to a semen analysis [which tests sperm count, morphology, and motility] women have, but just because you have eggs doesn’t mean that they’re going to be good. I use it as a test to project what a woman’s fertility could look like in the future, but I can’t tell her, ‘Your AMH is great; it means you’re fertile,’ because there’s so many other things that go into what fertility means for a woman.” (More on that below.) Although AMH has been shown to have little bearing on the ability to conceive naturally, it is a key indicator of how well someone is likely to respond to the ovarian stimulation part of IVF or egg freezing. Low AMH means that the ovaries will generally produce fewer eggs in each cycle, making the process less efficient—meaning women may need multiple rounds to get the same number of eggs as someone with higher AMH. “But whether those eggs will actually successfully turn into embryos that are genetically normal is more based on your age,” says Sekhon.
This is definitely not the message from many companies pushing these tests. Last August, an academic study highlighted the extent of the misleading information out there, drawing on 27 different English-language websites in English-speaking countries: Seventy-four percent contained statements that the test results would indicate a woman’s likelihood of conceiving, and 41 percent claimed that the results would enable women to adjust their reproductive timeline. “I find this outrageous. It’s blatant false and misleading information,” says Tessa Copp, a postdoctoral research fellow at the University of Sydney School of Public Health, who led the study. “Women are making very significant life decisions based on this invalid test. I advise women not to do it, because it can cause false reassurance or needless anxiety.”
And there’s one more red flag (in case you needed one): Your AMH number changes all the time. “I call it the ‘always meandering hormone,’” says Eyvazzadeh. “It’s very normal for it to fluctuate from month to month, day to day.” It also can fluctuate from lab to lab. Eyvazzadeh has seen cases where a patient has been falsely reassured by the results of a test and decided against freezing her eggs, only to discover that the first AMH level was wrong—potentially the result of a lab error.
The bottom line: If you’re concerned about your fertility, both docs recommend talking to your ob-gyn about a fertility workup. Eyvazzadeh uses the acronym TUSHY to spell out the components she includes: T for checking your fallopian tubes; U for an ultrasound of the uterus; S for semen analysis; H for hormone testing; and Y for your reproductive genetic profile. Sekhon says that AMH tests she orders will be evaluated alongside other hormones, such as FSH and estradiol, as well as a pelvic ultrasound. “I actually care way more about how the ovaries look,” she says, adding that oftentimes, an AMH test will be covered by insurance when ordered by your physician, versus the $100-plus you’re likely to pay for an at-home version. There’s also the question of quality with tests bought online: “If a patient comes with a piece of paper or an app showing their direct-to-consumer AMH level test results, I don’t even believe it. I would be a bad doctor if I only relied on that. So they’ve just spent however many hundreds of dollars to do a test that I’m going to repeat anyway.”
Sekhon also advises against going to a clinic “that’s going to check your AMH and then just talk about egg freezing, with one-track tunnel vision.” Instead, she recommends seeing an ob-gyn or fertility specialist who’s going to talk to you about your medical history and family history, and explain what issues to look out for once you start trying.
So don’t be seduced by the slick ads or soothing, pastel-hued centers in your neighborhood (talking to you, New York friends). “I would question the validity of any individual doctor or company that makes AMH the focal point,” concludes Sekhon. “It’s one small tool that’s so often taken out of context.” As much as no one wants to hear it, there is a number you can look at easily to determine your likelihood of having a baby naturally, and that number is your age.
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