I come from a large family. I am one of five siblings—the youngest of the brood—and four of us are women. As you can imagine, the discussions that take place around our dinner table frequently skirt into more colorful mealtime topics like chin hair, powdered placenta pills, gynecological horrors, bad exes, and of course, the terrors and delights of children.
I recently had the pleasure of meeting my newest niece at a rare family reunion. One night, I found myself lounging with my older sister, a new mom, as she struggled to get her infant daughter to burp. She sat forward in her chair, slung the baby over her shoulder, and patted her tiny back like she’d been doing it her entire life. I was utterly fascinated by the spectacle.
Despite being less than ten pounds, newborns have quite the physical presence! My niece was precious— new and pink and unbelievably small. It’s hard to think any of us adult humans are ever that little. I couldn’t take my eyes off of her. Babies were on the mind and there to stay.
I ended up asking my sister about all things labor and delivery, fertility and infertility, maternity and postpartum. I wanted to drink in her experience. I couldn’t help but think that it was informing the excited hush in the room. And while we talked, the little pixie did end up relinquishing a few burps, so it was a victory all around.
Anyway, one of the things my sister mentioned regarding reproductive health was something called an Anti-Müllerian Hormone test, otherwise called an AMH test. I like to think I’m well-educated on things like this, so I was surprised I’d never heard of it before.
“Get an AMH test.” She told me. “It will tell you about your ovarian reserve. It could have saved my friend…” She went on to tell me the story of a woman she knew who, in her late twenties, went through menopause. The woman and her husband decided to purchase and fertilize donor eggs in order to have biological children. Each egg ‘batch’ (usually consisting of six to ten viable eggs) cost them over $100,000. According to my sister, an AMH test could have informed her about her premature ovarian aging years before that point, thus saving them the astronomical financial and emotional expense of “missing their chance.”
That hit. So, I decided to do some research. This article is a compilation of everything a week of online sleuthing has availed me: what AMH testing is, what it does, and what it costs.
What is an AMH test?
In the words of Dr. Allison Lange, “a woman is born with all of the eggs she will ever have,” and “Anti-Müllerian Hormone, or AMH, is a protein made by the cells that surround each egg.” To translate, AMH is every egg’s natural companion. A friendly protein halo.
Because of this, AMH can be used to accurately measure how many eggs a woman has left. In general, higher AMH levels are better predictors of reproductive potential and lower AMH levels may indicate that the infamous ‘fertile window’ is closing. Makes sense, right? The more eggs there are, the more protein haloes there are. Simple mathematics.
It is a bit more complicated than that, but for introductory purposes, that’s enough knowledge to build on.
What does an AMH test do?
Obviously, the purpose of AMH testing is to support women in making informed choices about their health and futures. An AMH test should “help patients start a conversation” with their doctors about their fertility.
The test itself is identical to a blood test. Your physician will draw a few vials of blood and have them sent off for analysis. When the results are in, they will determine the next steps. Here are some numbers to keep in mind (please be aware that AMH test results currently have no standardized interpretation, so these numbers have some wiggle room):
If a patient’s AMH value is higher than 3.0 nanograms per milliliter of blood, that could mean that the follicles in the ovaries are being overstimulated. This is oftentimes an indicator of PCOS, a condition that can make it more difficult to become pregnant naturally. It is possible to have too much of a good thing.
If a patient’s AMH value is lower than 3.0 ng/ml and higher than 1.0 ng/ml, that would be considered excellent, normal, or within a healthy range.
If a patient’s AMH value is lower than 1.0 ng/ml and higher than 0.6 ng/ml, that is considered mildly concerning— not low enough to indicate a dire prognosis, but low enough to jumpstart a more intense discussion about ovarian reserve and planning for the future.
If a patient’s AMH value is lower than 0.6 ng/ml, that may be an indicator of poor or even severely low ovarian reserve. Patients should expect further consultations and treatments.
What does an AMH test cost?
This is the tricky part. From what I can tell, there are a lot of different opinions about how doctors determine the necessity of an AMH test for their patients.
For instance, Dr. Mark P. Trolice, MD, and director of Fertility CARE: The IVF Center, believes that AMH tests “shouldn’t be ordered for people who aren’t infertile,” meaning patients who have not been given a formal infertility diagnosis. “In fact, testing AMH if you’re younger than 35 and not diagnosed as infertile may cause unnecessary alarm,” and that’s because “AMH doesn’t predict natural fertility in any accurate manner.” Or, in other words, AMH can only give you an estimate as to how many eggs a patient has left (ovarian reserve). AMH can’t tell you how quickly those eggs are being expelled, when they’re being expelled, or the quality of the remaining eggs. It’s a quantity measure, not a quality measure.
Additionally, Dr. Jessica Scotchie, MD, REI, OB-GYN of Tennessee Reproductive Medicine says that “AMH levels don’t predict the time it will take to conceive, and they don’t predict infertility.” They are most useful when employed as part of a holistic “infertility workup,” which can help doctors “predict how ovarian stimulations will progress when used in creating IVF protocols,” something that’s only considered once a patient is already diagnosed with infertility.
Dr. Marcy F. Maguire, MD, FACOG, and professor at the Department of Obstetrics, Gynecology, and Reproductive Sciences at Rutgers-Robert Wood Johnson Medical School, seems to take a different stance. “AMH is a great tool to assess a woman’s current ovarian reserve…” she says. “I am a big proponent of women being educated about their fertility so they feel empowered to make decisions regarding their health… AMH values can help you determine if you want to do something NOW for your fertility.” That could mean something as simple as making a general life plan with your doctor, or something as involved as freezing viable eggs for future pregnancies (as is commonly the case with women undergoing early menopause).
If you’re interested in getting an AMH test done, it’s important that you and your doctor are on the same page as to the actual necessity of the test. The insurance codes they use when processing the exam with your provider could automatically categorize it as a simple diagnostic—something that many insurance plans cover in total—or something extra, which you could end up paying for completely on your own. It’s important to be an up-front advocate and work with your insurance and your physician so that you’re not stuck with a bill you cannot afford.
“The price [of a single AMH test] will vary based on the clinic or lab that you use,” Dr. Maguire asserts. “Testing can range from $20 to slightly higher” for an insured patient. Other sources claim that the test is much more expensive, starting at $95 and going up to $170. I couldn’t find any information on cost estimates for the uninsured.
Nevertheless, it’s clear that patients will need to work closely with their insurance companies and their physicians to ensure that they can receive the information they’re looking for without straining their finances.
Another reason why the price ranges for AMH tests are difficult to find online is because they’re often done in tandem with other tests. All of my sources claimed that AMH testing is not the only valuable measure of ovarian reserve. If you demonstrate an interest in getting an AMH test, many doctors will also check for Follicle Stimulating Hormone (FSH) and estradiol (E2) in the blood. An ultrasound may also be ordered to check antral follicle count (AFC), which will mark up the cost substantially. Together, all of these tests combined could create a more accurate picture of a woman’s reproductive potential.
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