SMH - False Information: Doctors denounce popular 'fertility' test

‘False information’: Doctors denounce popular ‘fertility’ test

By Christine Lee and Kate Aubusson

After her mother took years to conceive, Jessica Scard worried she and her fiance may also face challenges having a baby when they were ready.

So the 30-year-old Sydney speech pathologist visited her GP, who advised her to get an AMH test.

Also known as the “egg count” or ovarian reserve test, the AMH test measures the level of anti-Mullerian hormone in the blood to estimate the number of eggs in a woman’s ovaries.

Dr Devora Lieberman says it is misleading to call an AMH test a fertility predictor, and is left to counsel patients like Jessica Scard when they receive a “low” result.I

Scard’s initial level was 20, within the average range for her age. But, three months later, a routine follow-up test showed it had dropped to nine. She became convinced her next step would be to start IVF.

But what Scard wasn’t told was the AMH is an unreliable test: it can give false readings for women with polycystic ovarian syndrome or on hormonal contraceptives, and levels can fluctuate over a matter of weeks. At the time Scard was tested, she had just come off the pill.

In the most damning indictment of businesses and clinics offering AMH testing to date, an editorial in world-leading medical journal Fertility and Sterility last month “strongly discouraged” using the test to predict a woman’s fertility.

The authors warned the test provided “false information” and its use was “likely driven by financial incentives”.

They cited several studies that confirmed AMH levels were not associated with women’s ability to conceive naturally, or predicted time-to-menopause.

Fortunately, Scard’s fertility specialist Dr Devora Lieberman, medical director at City Fertility’s Sydney CBD clinic, reassured her the results were not a reliable predictor of her ability to conceive.

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“I walked out of her office with a different mindset,” Scard said. “If we froze embryos now versus in two or three years, it wouldn’t make a drastic difference.”

Leiberman said she has seen patients fall “down a deep, dark hole of anxiety” after receiving a low AMH result.

Conversely, “normal AMH level may give a woman false reassurance that everything is okay”, Lieberman said. While the test estimates the number of eggs, it cannot determine their quality.

“I have concerns about marketing any service or product to healthy women and preying on fears, whether that is egg freezing or AMH testing,” Lieberman said.

Leiberman said AMH testing was only appropriate in the context of considering egg freezing or IVF to guesstimate how many eggs they may be able to retrieve.

“It’s not suitable if you’re just curious about your fertility,” she said.

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) board director Associate Professor Jared Watts said the college did not recommend women “base lifelong decisions” on AMH testing.

“Whether it be career choices or egg freezing … which can be time-consuming and costly,” he said.

The college has endorsed a pamphlet highlighting the limitations of the test, which typically costs between $80 and $120 and is not subsidised by Medicare.

That pamphlet says AMH results may be useful for doctors to estimate how a woman’s ovaries may respond to fertility treatments, such as IVF and egg freezing. However, it denies that the AMH test can predict fertility or menopause, stating that a woman’s age is the biggest predictor of their fertility.

The University of Sydney’s Dr Tessa Copp’s research has tracked fertility clinics and online companies, which she says co-opt feminist language using phrases such as “empower your fertility” to market AMH testing to asymptomatic women.

“At the bottom of the page in tiny legal print, it might say, ‘not predictive of fertility’,” Copp said. “But who’s going to scroll right to the bottom of the page and read the fine print? I think it’s incredibly unethical and misleading.”

University of Sydney researcher Dr Tessa Copp is concerned by marketing approaches used. Credit:Janie Barrett

Copp contacted several companies about these concerns. She said some have updated their websites, while others have not responded.

Dr Mary Wong, chief medical officer at women’s telehealth clinic SISTR, said interest in their AMH test was increasing.

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“A lot of our patients are in their early to mid-30s, delaying family for work or study, and they’ve heard about AMH through the news or social media,” Wong said.

However, she also urged women to understand what their AMH level actually means, stressing other factors impacted fertility.

“[Fertility] is not just an AMH number. It also depends on age, health and partner factors,” she said.

The anti-Mullerian hormone (AMH) test: Is it reliable?

What is the anti-Mullerian hormone (AMH)?

Follicles are small sacs that contain eggs in the ovaries. These follicles produce the anti-Mullerian hormone. As women age, the number of follicles in the ovaries declines, and AMH levels decrease along with it.

What does the AMH test measure?

It measures the levels of AMH in the body through a blood test. The test gives an estimate of how many eggs remain in the ovaries. However, it does not reveal the quality of those eggs.

Can the AMH test predict fertility or menopause?

No. A woman’s age is the biggest factor affecting fertility. Women of the same age generally have the same monthly chance of getting pregnant regardless of AMH level, and people with low AMH have been shown to conceive naturally. Similarly, the test cannot accurately predict the timing of menopause for an individual.

Who might benefit from having an AMH test?

Doctors may use AMH results in the process of assisted reproductive treatments (ART), like IVF or egg freezing. The test can help estimate how the ovaries will respond to fertility drugs and give women general expectations about how many eggs can be collected.