A simple blood test called the Anti-mullerian Hormone (AMH) Test can help women who want children understand if they should feel a sense of urgency about becoming pregnant sooner rather than later. Although the AMH Test is not invasive or expensive, it is rarely suggested by family doctors and OB/GYNs when women turn to them for counselling regarding their plans for reproduction. Most women first learn about the AMH Test only after they have experienced difficulty becoming pregnant and are a patient within a fertility clinic. A greater awareness among women of the utility of this test can help protect them from the heartache of infertility.
The AMH Test, which can be taken on any day of a woman’s menstrual cycle, provides information about the status of a woman’s ovarian reserve. A woman’s “ovarian reserve” refers to the quantity of eggs remaining in her ovaries. The diminishment of a woman’s ovarian reserve is an inescapable fact of reproductive biology. Women are born with a finite number of eggs in their ovaries and this number declines as they age, with a slight dip at age thirty, a significant decline at age thirty-five, and an accelerated attrition at age thirty-eight. When a woman’s ovarian reserve is diminished, many of the eggs that remain available in her ovaries are genetically abnormal and incapable of resulting in the birth of a healthy baby. Women with diminished ovarian reserve often struggle to become pregnant.
While diminished ovarian reserve is rare in young women, it does occur in some young women. The average age of menopause is 51.7, however ten percent (10%) of women reach menopause by age 45 and their ovarian reserve can be diminished approximately thirteen years prior, by age thirty-two (32). The beauty of the AMH Test is that it gives women insight into the status of their personal ovarian reserve based on the quantity of eggs in their own ovaries, rather than based on general guidelines focused on age. The AMH Test indicates whether a young woman’s ovarian reserve is as one would expect it to be at her age. If it is, she may have time to spare before attempting to become pregnant, and can test her AMH level over time to get a good sense of the rate at which her ovarian reserve is declining. However, if a young woman discovers that her AMH level is low for her age, she will be advised that she is likely to enter menopause early, that it would be wise not to postpone attempting to become pregnant, and that she might want to consider attempting to achieve pregnancy as aggressively as possible via in-vitro fertilization (IVF).
If attempting pregnancy is not an immediate option, the AMH Test can also help young women make decisions relating to fertility preservation. If a woman is in a committed relationship with a man and they have decided they would like to have children together but do not yet feel ready, and the woman’s AMH level is low for her age, this can alert the couple to consider freezing embryos now for future use. If a woman does not have a partner with whom she wishes to have a child, and her AMH level is low for her age, this can alert her to consider freezing her eggs now for future use.
Although it is a relatively new test, the AMH Test is now considered the most precise, informative and reliable method of assessing a woman’s ovarian reserve. Many clinics use this test exclusively to evaluate a woman’s ovarian reserve, however some fertility specialists use the AMH Test in combination with other tests, including a transvaginal ultrasound to count the number of antral follicles, the testing of other hormone levels such as the follicle stimulating hormone (FSH) level and the estradiol (estrogen) level on day 3 of the woman’s menstrual cycle, and the clomiphene citrate challenge test (CCCT).
If you are a woman in your early thirties or older who wants to have children but is considering delaying pregnancy, I urge you to make an appointment with a board certified reproductive endocrinologist without delay to request an AMH Test. The result of this simple blood test can inform your decision-making process and potentially protect you from the heartache that I witness daily in my efforts to help women overcome infertility.
