Research analyzing 1.4 million health records cautions that ovarian reserve biomarkers cannot determine reproductive potential or likelihood of pregnancy.
Requests by general practitioners for anti-Müllerian hormone (AMH) blood tests surged more than 13-fold between 2011 and 2021, despite evidence demonstrating the test cannot predict whether a woman will conceive naturally, according to a retrospective cohort study led by Flinders University and published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.
AMH testing measures ovarian reserve, or the number of eggs remaining in the ovaries, but researchers warn that patients and clinicians frequently misunderstand what the results can actually tell them about overall fertility. Analyzing health records from nearly 1.4 million Australian women, the research team found that test volume climbed significantly across the 10-year period, with women aged 30 to 34 experiencing the sharpest increase at nearly 20-fold.
“Many women seek AMH testing because they want to understand their future fertility,” says Luke Grzeskowiak, PhD, associate professor and researcher at the Flinders Health and Medical Research Institute, in a release. “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.”
Limitations in Clinical Interpretation
The study revealed that nearly one in five women tested had an AMH level categorized as low. However, among those who underwent repeat testing following a low result, approximately one-third subsequently registered results within the normal reference range.
“A low AMH result does not mean a woman is infertile, and a normal result does not guarantee future fertility,” says Grzeskowiak in a release. “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.”
The researchers noted that female age remains the single most critical determinant of fertility. They also pointed out that the steep rise in testing is likely driven by delayed childbearing, increased public awareness of fertility challenges, social media messaging, and direct commercial marketing that positions the assay as a simple metric of reproductive potential.
Practice Variation and Clinical Utilization
The investigation also identified significant geographical, socioeconomic, and clinical disparities in test utilization. Women residing in major urban centers and higher-income areas were substantially more likely to undergo testing, whereas concession card holders had lower testing rates. In Australia, AMH tests are not subsidized by Medicare and can cost patients over $100 out of pocket.
Furthermore, testing patterns varied widely across medical practices. More than 10% of GP clinics ordered zero AMH tests during the decade analyzed, and approximately 21% of the overall variation in test ordering was attributable to practice-level differences rather than underlying patient characteristics.
“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,” says Grzeskowiak in a release. “Our findings highlight the need for better education of both clinicians and the public.”
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