By now you probably heard about this simple blood test to measure your fertility called Anti-Müllerian Hormone or otherwise known as AMH. Maybe you have seen some egg freezing ads on Facebook or saw watched one of the #BachelorNation girls on Instagram tell you to buy a kit to know where you stand with your fertility, welp — either way, I’m here to help break down the who, what, where, why, and how of AMH testing.

As a three-time egg freezer and working in the field of fertility for over a decade, I would agree and tell you that testing your AMH is a great place to start. What you should understand is how AMH can vastly differ from testing facility to fertility clinics to at-home kits you can receive in the mail. Also, AMH is not the sole predictor of your fertility time stamp or if you can have a family someday in the future. It is only one piece of the puzzle.

So what do you need to know about your fertility to get an accurate picture of how you are doing? OBGYNs and specialists will tell you that “trying to get pregnant” is the only real predictor if/when you can conceive a child, but if you are like me and not ready to “try” at all .. then egg freezing might be the right choice for you too. Want to know more? You can watch the docu-series This Is Egg Freezing film showing you each step in this process from the initial testing to egg collecting.

Here is my advice if you feel overwhelmed or having “deer-in-headlights” anxiety over the fertility topic. Start with talking to a fertility specialist (NOT just your OBGYN), because they hold more tools to adequately give you a baseline about where you stand in the fertility timeline. A fertility clinic will not only take your blood to measure your AMH levels but also give you a vaginal ultrasound to count the number of resting follicles you have in that month’s cycle called basal Antral Follicle Count or AFC.

A reproductive endocrinologist (RE) doctor will also listen to your past reproductive history. That is especially important to take into account not just your age and your test results but explain any of the complicated scenarios to answer questions you might be having regarding fertility and family planning choices. Your physician should present all the options, explain how egg freezing works, and strategize a game plan for you. If not, just contact me and I will help create you {her}strategies timeline guide. If it is too overwhelming and difficult to choose a fertility clinic right now or perhaps there is not a clinic nearby where you live, your next best option is an AMH blood test kit at-home. It is private, it is safe, and fast!

Here is what you need to know before you drop some cash on the at-home kit:

— There are a few startup and fertility companies offering at-home kits on the market to test AMH and different fertility hormones such as Estrogen, Progesterone, Follicle Stimulating Hormone, Luteinizing Hormone, Prolactin, or Oestradiol. Know that when you choose one of these test providers, if you re-test later down the line, it is best you choose the same brand again to compare equal results. Like comparing apples to apple and oranges to oranges. See the list below for select companies offering at-home AMH tests that you can order online.

— Timing when you take the test does matter and can influence your outcome. There are several factors that can influence your AMH numbers and results. It is important to realize that being on birth control to artificially deflate your real numbers. Equally what day of your cycle that you take the test will affect the test. Understanding how to interpret your results with each test can be the trickiest part. Knowing what action steps to do after you have the results is equally challenging for meeting your overall family planning goals.

— If you mix and match, you should not compare your previous test results from a fertility clinic or different at-home kit tests to each other as they use different equipment in the lab to measure the results. Most fertility clinic uses sensitive equipment in the office like Roche’s FDA-cleared 18 min test called Elecsys^® for measuring anti-Müllerian hormone immunoassay since they run this test a hundred times a day. Likely your OBGYN or primary care doctor will outsource the AMH test with a lab provider like Quest or LabCorp similar to taking one of the at-home kits. Those tests measure the assays with different, less sensitive equipment and can report varying results.

— If you have FSH or HSA cards with your insurance, they might be accepted with the at-home kit companies. You may struggle with insurance to pay for basic fertility testing at the fertility clinic, so it is a good idea to ask HR about your employer’s health plan or call your insurance card to check and see if you have coverage before ordering a baseline test. Some fertility clinics offer complete fertility baseline checks (AMH/AFC/Consult) for a flat rate if you attend an egg freezing or fertility education seminar. So look for those on social media. Another key thing to note is how currently there are 17 US states that mandate infertility insurance coverage and 7 more have fertility preservation laws for cancer-related cases. More states are adding coverages in 2020, but even in these states that offer to pay, coverage is never free, as it usually only available once you’ve met the criteria for infertility which can require experiencing infertility for up to five years. ⁠

— Most at-home kit companies offer counseling or a physician consult complimentary with ordering a test. I recommend you talk to the specialist about your individual results and make sure you understand what your results mean. There are general numbers that are average or good for each age group. Just know the higher the number, the better your “egg count” or ovarian reserve is. Usually, in the USA anything above 1 is good. AMH does NOT measure quality however which is currently not possible to know and is only one part of a 4 part puzzle. You still have to factor in your age, AFC, and sperm source to fertilize your eggies.

I personally completed and measured my AMH/AFC testing with 3 different fertility clinics and multiple times between cycles with 2 different at-home fertility AMH testing kit companies over the last 6 years. What have I learned? My numbers have been all over the map. I do believe arming yourself with knowledge is important, but the AMH test is NOT the end-all, be-all to your fertility timeline. Even Fertility Sterility — ASRM’s research study has come to a similar conclusion: https://www.fertstertdialog.com/posts/59741-kyweluk-consider-this?fbclid=IwAR1W0di_jYBwCsOX4viUXK1vu8wHZ2QKM9Sc-aDm4Mq9x5x7PCoshqdU17k

Understanding your results is critical for long term success to use the test results. For example, an AMH of 2.0 – 6.0 ng/mL in women between ages 28-35 years old is normal. This can give you confidence that for the next several years your fertility is about average or about a 20% chance per month of getting pregnant. It also means this could be the best time to freeze your eggs.

But for example, an AMH of 1.0 – 2.0 ng/mL for women under 35 is lower than expected and should be looked at closely by your fertility doctor. An AMH lower than 1.0 and lower than 0.5 in particular, requires immediate attention to recruit and freeze eggs as quickly as possible. While it is certainly possible to get pregnant with AMH levels under 1.0, the chances naturally are very low. A test under 1.0 means it will generally take longer and more treatment cycles for women who opt for fertility treatments. This could mean a higher risk of miscarriage.

In general, the higher the AMH, the better. However, for any woman with an AMH above 4.0 ng/ mL a more careful examination is required to rule out Polycystic Ovarian Syndrome (PCOS). Patients with PCOS often have infertility, weight gain, and excessive hair growth among other problems.

Tune back next week to review all of my AMH testing results and learn what a fertility doctor thinks about each of my AMH numbers and multiple different testing sources. Meanwhile, watch here how simple it can be to test your own AMH using My Lab Box at-home kit. Use code “EGG CLUB” for a discount.

The current at-home kits for AMH and fertility tests on the market include:

— My Lab Box $139 USD
Ovarian Reserve (AMH) Test — includes free Physician-reviewed counseling, lab results in 2-5 days, free shipping, FSA & HSA cards accepted.

— Modern Fertility $159 USD
Your Modern Fertility Test — includes free Physician-reviewed reports, free 1:1 call with fertility nurse, free access to the Modern community and phone app.

— Let’s Get Checked $139 USD
Ovarian Reserve Test — Free shipping, FSA & HSA cards accepted.

— Future Family membership/subscription $USD can vary
Fertility Hormone Test™ — measures three hormones (AMH, FSH, E2) that can flag any early pre-menopause or decreased ovarian reserve for compare with other women your age.

Interesting article from Fertility Sterility and ASRM talking about how direct-to-consumer (DTC) ovarian reserve testing benefits the company, not the consumer. What do you think? Do the at-home kits help you as the consumer make fertility choices sooner, are they easier than visiting your doctor, or do they leave you feeling more confused about the topic of fertility?