Australia’s birth rate is in freefall as more young people delay parenthood or forego it entirely, either by choice or because they miss their fertility window.
With that in mind, it’s easy to imagine why a magic-looking ball that could help people get a glimpse into their future family planning would be a game changer.
Indeed, this is how the anti-Müllerian or AMH test is often framed by IVF clinics and commercial brands – as a “fertility test”, despite warnings from experts that it cannot tell us anything about someone’s likelihood of conceiving.
So, what is it? What are the risks? And what can it tell us?
What is an AMH test – and is it accurate?
The anti-Müllerian hormone (AMH) blood test is a measure of ovarian reserve, or egg count. AMH is produced by follicles in the ovaries and helps follicles and eggs grow during the menstrual cycle. As the number of follicles drops with age, so do AMH levels.
It is most commonly used during IVF and egg freezing, as it can indicate how many eggs a woman may get when her ovaries are stimulated with fertility drugs.
However, Dr Tessa Copp from The University of Sydney’s School of Public Health, says it is often falsely promoted as a fertility or “egg timer” test, particularly by fertility clinics and a growing number of companies selling commercial, at-home tests.
But research over recent decades has found women with a low AMH have the same chance of conceiving as those with a high AMH.
In March, world-leading medical journal Fertility and Sterility published the most damning indictment of the test from professionals yet, writing that the routine use of AMH as a measure of fecundity is “fundamentally flawed”, calling for an “end to this misguided practice”.
For general fertility screening, the test is not covered by Medicare, making it difficult to know exactly how many people are accessing it. A 2023 survey by Copp of over 1700 women found 13 per cent had heard of the AMH test, while 7 per cent had had one.
Dr Karin Hammarberg, adjunct senior research fellow at Monash University’s School of Public Health and Preventive Medicine, points out that not only is the test unable to determine fertility, but it can be unreliable.
“There are several studies that show a woman with a low AMH, on a retest it can be quite different, and much higher. So there’s not even consistency in how it operates within one woman,” she says, pointing to one commercial brand she’s seen that advocates for retaking the test every few years.
“You can see how this is becoming a very lucrative idea.”
So, can you test your fertility?
Unfortunately, there is no test for egg quality or fertility. “The only real test is trying to get pregnant when you’re ready. And that’s scary for many people,” says Copp.
Nor is there a means of improving one’s egg quality – despite what social media posts about “restorative fertility” or “fertilitymaxxing”, through individual choices like diet, may make improve your chances of conceiving.
“You’re not going to change biology – an egg that’s had its time is not going to be restored, improved or changed in any way,” says Hammarberg.
“The only thing we know for sure is that age is the factor that drives the quality and quantity of eggs … It varies between women [too] – some women might just have better-quality eggs.”
What are the risks?
While the test itself may not pose any physical risks, experts are concerned about the risks of psychological and financial harm.
Associate Professor Michelle Peate, program leader for The University of Melbourne’s Psychosocial Health and Wellbeing Research Unit, has researched women’s perceptions of the test and how it shapes reproductive decision-making.
“For women who perceive their AMH to be low, it can cause emotional harm – stress about their fertility. They would bring forward reproductive plans, things like that,” Peate says of her findings. “Conversely, those who perceive their AMH to be normal or high tended to feel more reassured.”
While Peate says the test does have a place – like for IVF, egg freezing or in certain populations, like those with cancer – for the general population, healthcare providers should exercise extreme caution.
“If it’s delivered to you by someone who completely understands how the test works and its implications, you’re lucky,” says Peate, recalling a woman who was told by her GP her low AMH meant she was sterile.
Hammarberg says not only is the test itself a “waste of money” for the general population (out-of-pocket cost generally ranges from $90 to $120 per blood test), but within the context of a profit-driven, multibillion-dollar IVF industry, risks pushing women towards unnecessary procedures, like egg freezing if they receive a low AMH.
These companies co-opt the language of feminism, says Copp, with “slogans like ‘empower your fertility’ or ‘information is power’.
“Especially on social media, there is no nuance whatsoever. You’re only getting a snapshot, and I think it’s really unethical to present the test in that way.”
She thinks healthcare providers have a “responsibility to provide accurate information”, so patients can provide informed consent about their reproductive decisions.
Copp says she has been filing complaints to Australia’s medicines regulator, The Therapeutic Goods Administration (TGA), for years, to no avail.
A TGA spokesperson said all advertising of therapeutic goods must comply with their code and that while they have not approved any AMH self-tests to date, there are a number of laboratory devices on the ARTG.
“These tests are performed in a laboratory setting and require referral by, and /or interpretation of results from, a medical professional to ensure appropriate clinical assessment and diagnosis.
“We are unable to provide advice on whether specific websites, advertisements or online content may breach therapeutic goods legislation. All reports of alleged unlawful advertising, importation, manufacture, or supply of therapeutic goods are subject to assessment and, where appropriate, further compliance or investigative action.”
Peate says women are exposed to a “mist of misinformation”, particularly on social media, and that having publicly available trustworthy, evidence-based resources would give patients the autonomy to make informed decisions.
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