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The Egg Timer Test

Introduction
The Egg Timer Test is also known as the Anti-Müllerian hormone test (AMH test). We generally use this test to give us an indication, (alongside other tests) as to where your fertility level lies in relation to other women of your age. In the AMH test we actually test the levels of the Anti-Müllerian hormone protein that is a member the Transforming Groth Factor-b (TGF-b) family.

AMH is produced in ovarian cells called Granulosa Cells that are involved in the early development of early ovarian follicles called preantral and early antral follicles.  With increasing age, as the ovarian reserve decreases, so does the AMH level.  It is really important to remember that individual variations do occur between women such that the pool of early “Antral Follicles” varies between people and the rate this pool of eggs depletes with time also varies between individuals and their specific circumstances.

A diminished ovarian reserve can result in diminished egg number and quality. it may be extrapolated that a lower AMH level impact on reproductive potential. That’s why an AMH test is an important part of any initial fertility health assessment that your doctor would want to consider, so that a low ovarian reserve can be identified and acted upon early.

Determining the ovarian reserve is especially important if you are presenting for fertility investigations at a more advanced age or if you have had previous surgery on your ovaries, or have undergone previous treatment that may affect your fertility such as chemotherapy and so on.  It is also important to seek advice if there is a strong family history of early menopause or fertility issues affecting family members.

What is the AMH test?
An AMH test is a simple blood test that can be taken at any time of the menstrual cycle.   AMH level appears to be a reliable indicator of ovarian function. It is important to remember that some medications may alter the result of AMH. Furthermore, once you have done your AMH the result will provide you with snapshot of where your fertility currently is, what it won’t tell you is how fast your fertility may decline in future.  This is an important consideration, especially if you are thinking of freezing in the future.  Many patients we see have had fertility investigations performed overseas and find that their results are on occasion very different when they are repeated locally.  This is because there could have been a time lag between the two tests but also different labs use different platforms to assess this and different labs and countries have different reference ranges to work from.

How does knowing AMH levels help with fertility treatment?
In many patients we tend to use medications to bolster fertility with the aim of achieving a pregnancy.  For example, with Ovulation induction when we use gonadotrophins or in IVF treatment for example, we want to optimise your medication dose to achieve success and also minimise risks of complications.

In general terms an AMH level is a good biomarker for predicting poor and excessive ovarian response with treatment. It is crucial to remember however that the AMH level cannot predict the chance of actual successful pregnancy.

AMH will not predict fertility potential or the time it may take to fall pregnant naturally, and should not be used to predict reproductive status or onset of menopause.

Interpreting AMH levels
There is no international standard for the interpretation of AMH levels. The interpretation of AMH levels depends on the laboratory conducting the test. There are different ranges for different labs.

In general, an AMH level well above the laboratory’s lower threshold for normal suggests adequate ovarian reserve. If the level falls below the lower limit of normal, the probability of diminished ovarian reserve progressively increases. If a patient has very low levels of AMH, it suggests pregnancy is less likely to occur and the patient will have a poor response to IVF.

Concerned about your AMH levels?
If you’re concerned about your AMH level and ovarian reserve, I would recommend booking an appointment. I can interpret your AMH results and may order more tests to assess your fertility. I can also discuss your options with you, which may include egg freezing or IVF. We have all seem plenty of patients with very low AMH levels that go on to successfully conceive, so please don’t jump into any conclusions solely based on your AMH results.