AMH, fertility and pregnancy explained

Infertility can be defined as the inability for a couple to conceive naturally despite having regular, unprotected sexual intercourse. In the UK, up to 1 in 7 couples have difficulty conceiving, which adds up to around 3.5 million people. 

It is thought that 84% of couples that have regular unprotected sex will conceive naturally within a year, and up to 92% will conceive naturally within two years. For couples who have been trying to conceive for more than three years without success, there is a 25% chance of becoming pregnant within the following year. 

Therefore, it is advised that such couples seek medical advice, and for couples having trouble after one year of trying as well. A specialist will be able to identify the cause of your fertility problems by assessing your medical history and by running certain tests. Using this information, a treatment plan can be put in place to help you get pregnant. Mr David Ogutu, a leading fertility specialist, explains what the AMH test is, and why it can be helpful for both women looking to become pregnant and those who aren't.

How can AMH hormone levels be a fertility test?

Women are born with a finite supply of eggs, and through their lifetime, this reserve declines in quantity as well as quality. Anti Mullerian Hormone (AMH) testing is one test carried out in fertility centres to investigate infertility. 

AMH is produced by developing eggs (called antral follicles). A higher egg reserve will have a higher number of these antral follicles, and therefore, testing AMH levels can help to indicate egg reserves. However, whilst egg quantity is determined with this test, egg quality is not. 

Do my AMH levels predict my chances of conception?

A study of 750 women in North Carolina, USA who were trying to conceive for up to three months between April 2008 and March 2016 were investigated to try and determine whether AMH levels can predict chances of conceiving. These women were aged 30 to 44 and had no history of infertility. The findings of the research showed that the probability of conceiving was not any lower for those with low AMH levels. Hence, ovarian reserve on its own is not a clear prediction of the likelihood of conceiving. 

However, for women with a high ovarian reserve receiving IVF treatment, studies have shown that they will:

• Have lower cycle cancellation rates.
• Have more eggs retrieved.
• Have a higher probability of better quality embryos available to freeze.

These studies have also shown that women with high ovarian reserve are more likely to be at risk from ovarian hyperstimulation syndrome (OHSS).

When women age, their egg quality declines and when these eggs are fertilised there is a higher chance that they will be chromosomally abnormal, which can result in miscarrigage. Therefore, age rather than ovarian reserve is considered to be the best predicator of a chance of pregnancy.

How is AMH tested?

Testing AMH levels is done with a simple blood test that can be done at any point in the menstrual cycle, with results being available in 2-5 days.

Why have your AMH tested? Knowing your AMH allows you to plan...

For younger women who want to postpone motherhood, it can be useful for them to check their fertility potential. Often women will assume their fertility is fine as long as they are having regular periods, however, this is not always the case. If a younger woman has low AMH levels, their plans to postpone motherhood may change.

For older women who have irregular periods or who show signs of impending menopause, an AMH test can help with decisions involving alternative options, such as egg donation or adoption. 

Lastly, AMH testing can be useful for women looking to freeze their eggs.

If you would like more information about AMH or AMH testing, make an appointment with a specialist.