Have you had patients ask for an AHM test?

A new study found GP requests for the test have increased more than 13-fold over the last decade, with an increasing number of women using the blood test to assess their fertility.

However, there is growing evidence it cannot predict whether a woman will become pregnant naturally.

According to researchers at Flinders University, while AMH is often marketed as a fertility test or ‘egg count’ because it measures ovarian reserve, many women and clinicians misunderstood what the results can tell them.

What the study found

Researchers analysed health records from almost 1.4 million Australian women from the period 2011 to 2021.

Lead author Associate Professor Luke Grzeskowiak, a pharmacist and researcher with the Flinders Health and Medical Research Institute said the findings highlighted a gap between public perception, clinical practice and scientific evidence.

“Many women seek AMH testing because they want to understand their future fertility,” he said.

“But while AMH can measure ovarian reserve, it cannot tell a healthy woman how likely she is to conceive, how quickly, or how much reproductive time she has left.

“One of the biggest concerns is the psychological impact. Women may feel pressured to bring forward plans for children after a low result, while a normal result may provide false reassurance if other fertility issues are present."

Women aged 30 to 34 accounted for the sharpest rise in requests for test, increasing almost 20-fold.

Researchers said the rise in testing was likely linked to delaying having children, a growing awareness of fertility issues, social media messaging and commercial promotion of the test as a simple way to gauge reproductive potential.

The study found nearly one in five women received a result classified as low. However, among women who repeated the test after a low result, around one-third later received a result in the normal range.

Assoc Prof Grzeskowiak said age remains the most important factor affecting fertility.

“Women deserve clear, evidence-based information about what AMH testing can and cannot tell them. For younger women, in particular, an AMH result should not be viewed as a crystal ball for their reproductive future.”

Researchers said the study, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, had implications for practice, noting that a recent randomised controlled trial found that when provided evidence-based information on AMH testing, many women had less interest in having the test.

“Our findings highlight the need for better education of both clinicians and the public,” Associate Professor Grzeskowiak said.

“AMH testing can be useful in some specialist fertility settings, but it should not be mistaken for a test that predicts whether a woman will be able to have a baby. The best way to support women is with accurate, evidence-based information, so they can make informed decisions about their reproductive health and future family plans.”

Talking to your patients

Dr Johannah Scaffidi, a Perth obstetrician and gynaecologist who specialises in fertility said she had seen patients panic after receiving their AHM results.

“I often see patients in the fertility clinic saying they’ve done the test and the results mean they can never get pregnant, so I think pre-test counselling is really important," she said.

Dr Scaffidi said AHM test results were a tool that could assist fertility specialists to guide treatment but patients and doctors needed to treat them as just that - "one tool in the basket".

 “Where I worry about it the most is when the AMH level is normal and people think that it means they'll be fine and they have plenty of time."

She encouraged GPs to raise the topic of fertility and future plans for children with women during consultations.

“I think that any woman who's in their early 30s who isn't imminently trying to have a baby should definitely consider egg freezing. For women who are 34 and over, or who have medical problems that we know will impact their fertility, egg freezing is actually Medicare funded, so it ends up being a lot cheaper than a lot of people think and it's a bit of an insurance policy for the future."

Dr Scaffidi said fertility specialists often saw women in their late 30s who have started trying to have a baby.

"I think it's really important for GPs to just put it on the radar with patients, have a chat about it, and offer them a discussion with a fertility doctor if they think that pregnancy is not in their near future to explore their options," she said.

“It's about having the conversation early, so it could be when a patient comes to see their GP for their contraception or pap smear. Healthy young women aren't popping to their GP often so raising family planning is really important."

Acknowledging time constraints, she also suggested directing patients to websites such as Your IVF success and Egg Freezing Australia.