Buyer beware: The AMH test is not a fertility fortune teller

Until recently, common knowledge (backed by solid evidence) was that, while the level of anti-Müllerian hormone (AMH) in a woman's blood indicates the number of eggs remaining in her ovaries, it does not predict current or future fertility.

Then, in 2024, a study published in a reputable journal (see BioNews 1276) appeared to challenge this as it concluded that low levels were 'independently associated with a modest but significant reduction in the chance of conception'. However, when scrutinised, this study was found to have significant bias and conflicts of interest that led to inaccurate results and conclusions.

To make informed decisions about their reproductive health, women need evidence-based and accessible information. This can be hard to come by in this era of increased commercial interests in healthcare, and persuasive marketing, such as advertising that co-opts feminist narratives of increasing women's autonomy and empowerment to promote health interventions that are not evidence-based.

AMH testing is useful in the context of controlled ovarian stimulation for IVF treatment or egg freezing where it is helps determine the optimal dose of fertility drugs. However, according to the American Society for Reproductive Medicine and the American College of Obstetricians and Gynaecologists, the AMH test should not be used to counsel women without a diagnosis of infertility about their reproductive status or future fertility potential. Despite these clear recommendations, marketing of the AMH test as a way for women to find out about their fertility has been ramping up in recent years.

Our research shows that advertising on fertility clinic websites and on websites selling AMH tests direct to consumers often features statements about the test that are not supported by evidence, including that it can reliably predict fertility potential or age of menopause. This misleading marketing can lead to serious harms. For example, a low AMH reading can cause unwarranted anxiety and prompt women to consider freezing their eggs or trying for pregnancy sooner than planned. On the flip side, women who receive a normal or a high reading might get a false sense of security about delaying pregnancy, when age is the most important factor in female fertility.

Despite not being predictive of fertility potential, AMH testing to gauge fertility potential is concerningly common. A population-based survey of women in Australia aged 18-55 years found that seven percent had had the test. Of those, about one third had had it to understand their chances of conceiving, out of curiosity, or because they were considering freezing their eggs or delaying pregnancy.

Our research also shows that health professionals have an inadequate understanding of the limitations of the AMH test. A survey of 362 general practitioners, gynaecologists and reproductive specialists in Australia found that 40 percent had previously ordered the test to help with reproductive planning and 21 percent to provide reassurance about fertility. Concerningly, half of the surveyed clinicians reported that they lacked confidence interpreting and explaining an AMH result to their patients.

To help women make informed decisions about whether to have the AMH test, we co-designed an evidence-based information sheet about what the test can, and can’t, do with women of reproductive age. We then tested its effect in a randomised controlled trial where half of the women viewed the evidence-based information, and the other half viewed existing information about the AMH test from a website which markets the test direct-to-consumers. Participants then completed a questionnaire which gauged their interest, knowledge, and attitudes relating to the AMH testing.

The findings from this study of almost 1000 women showed that those who had viewed the evidence-based information had lower interest in having an AMH test, less positive attitudes towards, and higher knowledge about the test than women who viewed the control information.

Based on our research and the solid evidence that AMH levels don't predict fertility potential, we believe online marketing of the AMH test should be more strongly regulated to ensure it doesn't mislead. We also believe that efforts are needed to support clinicians in the judicious use of testing, navigating patient requests for the test, and interpreting the results of the test. Lastly, we hope that wide dissemination of the resource we have developed will help women make well-informed decisions about AMH testing.