Fertility tests are not a reproductive crystal ball
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Increasing numbers of Australian women are using a blood test to assess their fertility, but new research suggests it may not provide the answers many are looking for.
A study led by Flinders University and published in the Australian and New Zealand Journal of Obstetrics and Gynaecology found requests by GPs for anti-Müllerian hormone (AMH) tests increased more than 13-fold between 2011 and 2021, despite growing evidence that the test cannot predict whether a woman will become pregnant naturally – not now or in the future.
AMH is often marketed as a fertility test or “egg count” because it measures ovarian reserve, or the number of eggs remaining in the ovaries. However, researchers say many women and clinicians misunderstand what the results can tell them.
Analysing health records from almost 1.4 million Australian women, the researchers found testing increased dramatically over the decade they analysed. Women aged 30 to 34 experienced the sharpest rise, with test rates increasing almost 20-fold.
Associate Professor Luke Grzeskowiak
Lead author Associate Professor Luke Grzeskowiak, a pharmacist and researcher with the Flinders Health and Medical Research Institute (FHMRI), says the findings highlight a gap between public perception, clinical practice and scientific evidence.
“Many women seek AMH testing because they want to understand their future fertility,” says Associate Professor Grzeskowiak.
“But while AMH can measure ovarian reserve, it cannot tell a healthy woman how likely she is to conceive, how quickly, or how much reproductive time she has left.
“One of the biggest concerns is the psychological impact. Women may feel pressured to bring forward plans for children after a low result, while a normal result may provide false reassurance if other fertility issues are present.”
Researchers say the rise in testing is likely linked to delayed childbearing, a growing awareness of fertility issues, social media messaging and commercial promotion of the test as a simple way to gauge reproductive potential.
The study found nearly one in five women received a result classified as low. However, among women who repeated the test after a low result, around one-third later received a result in the normal range.
“A low AMH result does not mean a woman is infertile, and a normal result does not guarantee future fertility,” says Associate Professor Grzeskowiak.
“Our concern is that women may be making important decisions about relationships, family planning or egg freezing based on information that cannot answer the questions they are most concerned about.”
The researchers say that age remains the most important factor affecting fertility.
“Women deserve clear, evidence-based information about what AMH testing can and cannot tell them,” says Associate Professor Grzeskowiak.
“For younger women, in particular, an AMH result should not be viewed as a crystal ball for their reproductive future.”
The study also revealed substantial differences in testing rates across Australia. Women living in major cities and more advantaged areas were more likely to have the test, while concession card holders were less likely to be tested.
Researchers note that AMH testing is not covered by Medicare and can cost more than $100.
Large differences were also seen between GP practices. More than one in 10 practices had no patients who received an AMH test during the study period, and around 21% of the variation in testing rates was linked to differences between practices rather than patient characteristics.
“Our findings highlight the need for better education of both clinicians and the public,” says Associate Professor Grzeskowiak.
“AMH testing can be useful in some specialist fertility settings, but it should not be mistaken for a test that predicts whether a woman will be able to have a baby.
“The best way to support women is with accurate, evidence-based information, so they can make informed decisions about their reproductive health and future family plans.”
The paper, ‘Trends in anti-Müllerian hormone (AMH) testing for fertility assessment in Australian general practice, 2011–2021: a retrospective open cohort study,’ by Gizat M. Kassie, Tessa Copp, Sarah Lensen, Danielle Mazza, Jacqueline A Boyle and Luke E. Grzeskowiak, was published in Australian and New Zealand Journal of Obstetrics and Gynaecology. DOI: https://doi.org/10.1111/ajo.70179.
Acknowledgements: Luke Grzeskowiak receives salary support by a Channel 7 Children’s Research Foundation Fellowship (CRF-210323). The research was supported by SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care (SPHERE CRE), which is funded by the National Health and Medical Research Council (Project number APP2024717).
