15/09/2023
Direct-to-consumer (DTC) testing has become increasingly popular in recent years, with many companies offering tests that claim to evaluate fertility or ovarian reserve. One key component of these tests is the measurement of Anti-Müllerian Hormone (AMH test), which is produced by follicles in the ovaries and is known to reflect functional ovarian reserve.
A recent study1 has raised concerns about claims made by some companies selling at-home AMH tests. Authors found that many websites selling DTC AMH tests included false claims about the utility of AMH testing to predict fertility and menopause onset.
At Randox Health, we believe information about testing and your health is essential to your well-being, and misinformation surrounding tests and results should be combatted with as much vigour as the conditions to which they relate. This article will explore the findings of the study, the concerns raised, and the truth about AMH testing.
Anti-Müllerian Hormone or AMH Test
AMH is a hormone produced by granulosa cells of small, growing ovarian follicles. Its main physiological role is to inhibit the recruitment of primordial follicles and the follicle-stimulating hormone sensitivity of late antral follicles2
Oogenesis
Clinical Utility of AMH Testing
Let’s discuss where this test’s usefulness truly lies. AMH is the best reflection of a woman’s functional ovarian reserve, or in other words, the pool of growing follicles in any given month. This can be used to estimate the response to stimulation, for example, by In Vitro Fertilisation (IVF) but does not correlate with pregnancy success. It is a measure of the quantity of follicles but not their quality3. Simply put, a low AMH test result suggests that there are a low number of growing follicles but does not provide any indication of the health of these follicles. Similarly, a high AMH test result suggests a high number of follicles but does not provide evidence that these follicles are healthy enough for fertilisation. Both factors, along with many others, play a role in fertility. In fact, conception is still possible even when AMH levels are low.
AMH data can be used by clinicians to determine the correct stimulation protocol and dosage to optimise the response to follicle stimulation in those with a low AMH result, and to avoid ovarian hyperstimulation syndrome (OHSS) in those with a high AMH result.
Ovarian Hyperstimulation Syndrome
In relation to menopause, a low AMH result may indicate a shortened reproductive window but cannot independently or accurately predict the age at which menopause will occur, the length of time remaining before the onset of menopause or current fertility3. AMH may be useful for young women to indicate if they are likely to enter early menopause but there is not currently enough evidence to support this claim. Currently, the utility of a single AMH test to predict the onset of menopause is rife with controversy. Some studies show a single AMH test can be used in a mathematical model to predict the age at which menopause will begin4. This is however, an area which requires more research before it becomes clinically useful.
Complications
Polycystic ovary syndrome (PCOS) affects up to 15% of women worldwide3. It is characterised by hormonal imbalances, irregular periods, excess androgen levels, and the presence of cysts in the ovaries. PCOS can cause difficulties with ovulation, making it challenging to become pregnant and is associated with various complications, including metabolic problems and an increased risk of diabetes5. PCOS can commonly cause levels of AMH to increase up to 3-fold, which may be mistaken for a high follicle count4. It is important to note that a high AMH result should not be used independently to diagnose PCOS.
Low levels of AMH may be caused by hypogonadotropic hypogonadism, a condition characterised by a failure of the gonads (testes or ovaries) to function properly due to deficient production of gonadotropins (hormones that stimulate the gonads) from the pituitary gland. Treatment takes the form of exogenous gonadotropins. AMH results, used in combination with other data, can help determine a safe and effective therapeutic strategy3.
Fake News about AMH Testing
The investigation mentioned above was conducted at the University of Sydney, Australia1. The authors scoured the web to find websites selling DTC AMH tests and evaluated the claims that accompanied these tests. The authors identified 27 websites selling these tests across 7 countries and determined that 74% of them made false claims about the clinical utility of AMH testing1. Below is a summary of their troubling findings:
- 74% of retailers claimed that AMH was a measure of fertility and could predict the likelihood of conception.
- 11% claimed AMH results provided an indication of menopause timing.
Even to the trained eye, these claims may seem legitimate. Some of the wording and terminology around AMH testing can be confusing. Recent, robust studies have shown that many of the claims made about AMH testing are simply not true, or at least, there is not enough evidence for the results to be used in this way2–4. This creates several concerns: Women receiving an AMH result that they are told may indicate infertility, may experience unnecessary anxiety and distress when, in fact, evidence shows AMH is not useful in predicting fertility2–4.
Further claims that AMH can predict time-to-menopause are also flawed. While population studies show this may be the case, there is no evidence that AMH testing is useful in determining time-to-menopause at the individual level4. This may also cause undue stress and anxiety for women receiving AMH results. In contrast, these results may instil a false confidence in a woman’s reproductive health. The false claims surrounding AMH testing may have some data to back them up but are not considered by the medical and scientific community as standard or accepted practice.
Randox Health
At Randox Health, we believe a preventive and preemptive approach to health is crucial to maintaining well-being and vitality. Our aim is to shift the dynamic of healthcare from a reactive method of sickness management to a more proactive strategy. Access to true, science-based information about your health is a crucial part of this, empowering you to make the right decision for you and your well-being.
AMH testing is available in-clinic and at-home for women who wish to find out more about their ovarian reserve and to help make informed decisions on IVF or egg freezing. Results reports include detailed explanations of your results, and what they mean for you.
If you’re interested in learning more about your fertility, Randox Health’s Fertility Health Check analyses over 45 data points, helping you better understand your hormones, fertility, as well as your ovarian reserve. If you have taken hormonal contraceptives in the last 3 months or have recently had an irregular menstrual cycle, your results may be affected. It is recommend that you book your test for day 3 of your menstrual cycle (the third day of blood flow) to ensure the most accurate results.
Reference List
References
- Johnson A, Thompson R, Nickel B, Shih P, Hammarberg K, Copp T. Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests. JAMA Netw Open. 2023;6(8):e2330192. doi:10.1001/jamanetworkopen.2023.30192
- Tehrani FR, Firouzi F, Behboudi-Gandevani S. Investigating the Clinical Utility of the Anti-Mullerian Hormone Testing for the Prediction of Age at Menopause and Assessment of Functional Ovarian Reserve: A Practical Approach and Recent Updates. Aging Dis. 2022;13(2):458. doi:10.14336/AD.2021.0825
- Cedars MI. Evaluation of Female Fertility—AMH and Ovarian Reserve Testing. J Clin Endocrinol Metab. 2022;107(6):1510-1519. doi:10.1210/clinem/dgac039
- Russell N, Gilmore A, Roudebush WE. Clinical Utilities of Anti-Müllerian Hormone. J Clin Med. 2022;11(23):7209. doi:10.3390/jcm11237209
- Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P T. 2013;38(6):336-355.