Fertility blood tests can tell you a lot about how your ovaries and hormones are working. But no single test can tell you whether you will get pregnant, and AMH in particular is often misunderstood.
Imagine paying for an at-home AMH test out of curiosity at 32. Your result is described as “low for your age”. You panic that you have left it too late. Your healthcare provider explains what the number can and cannot tell you.
When fertility tests are usually offered
Many guidelines suggest seeing a healthcare provider if you have been trying to conceive for a year without success, or after six months if you are 35 or older. Earlier assessment is recommended if you have irregular or absent periods, known conditions such as endometriosis or PCOS, previous pelvic infections or cancer treatment, or if your partner has known fertility issues.
AMH (anti-Müllerian hormone)
AMH is made by small follicles in the ovaries and gives an estimate of ovarian reserve, meaning roughly how many eggs remain. It can be measured at any point in the cycle.,AMH is very useful in fertility clinics for planning IVF, because it helps predict how the ovaries will respond to stimulation medicines. However, AMH does not measure egg quality and does not reliably predict whether you will conceive naturally in the near future. Women with a low AMH can still get pregnant naturally if they are ovulating.
FSH and LH
Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are made by the pituitary gland and control the ovaries. They are usually measured on days 2 to 5 of the cycle.,A raised FSH can suggest reduced ovarian reserve or approaching menopause. A raised LH relative to FSH can occur in polycystic ovary syndrome (PCOS). Very low levels can suggest a problem with the pituitary or hypothalamus, for example from very low body weight or excessive exercise.
Progesterone: checking ovulation
Progesterone rises after ovulation. A blood test about seven days before your next expected period (often called a “day 21” test in a 28-day cycle) checks whether you have ovulated. If your cycles are longer, the test should be timed later, for example day 28 in a 35-day cycle.,A raised level suggests ovulation has happened. A low level may mean the test was mistimed or that ovulation did not occur that cycle, and it may be repeated.
Other common tests
- Thyroid function (TSH): both underactive and overactive thyroid can affect fertility
- Prolactin: high levels can stop ovulation
- Testosterone and SHBG: to check for PCOS
- Rubella immunity: to make sure you are protected before pregnancy
- Chlamydia screening: as past infection can damage the fallopian tubes
Other fertility investigations
- Pelvic ultrasound to look at the womb and ovaries and count antral follicles
- Tests to check whether the fallopian tubes are open, such as HyCoSy or HSG
- Laparoscopy in some cases, for example if endometriosis is suspected
- Semen analysis for your partner
At-home fertility tests
At-home hormone tests, including AMH, are widely marketed. They may give some information, but results can cause unnecessary worry or false reassurance without proper interpretation. If you are thinking about using one, or have a result you are unsure about, discuss it with a healthcare provider who can consider your age, cycle and overall health.
Age and fertility
Female fertility gradually declines with age, more noticeably after about 35, because both the number and quality of eggs fall. This is a general trend, not a fixed deadline, and many women conceive in their late 30s and 40s. If you are thinking about the timing of a family, it can help to talk to a healthcare provider about your own situation.
Looking after yourself while trying to conceive
- Take folic acid daily before conception and in early pregnancy
- Aim for a healthy weight
- Stop smoking and limit alcohol and caffeine
- Track your cycles to understand your fertile window
- Look after your emotional health; trying to conceive can be stressful
Frequently asked questions
Does a low AMH mean I am infertile?
No. It suggests fewer eggs remain, but it does not mean you cannot conceive.
Do I need to fast for these tests?
Usually not.
Can the contraceptive pill affect results?
Yes. Hormonal contraception can affect AMH, FSH and other results. Tell your healthcare provider if you use it.
But my AMH is low for my age. Should I panic?
No. Talk to a healthcare provider about what it means for you. If you are ovulating, natural conception is still possible, and there may be time to plan.
Your next step: Track your cycle for the next three months, noting the first day of each period, so any blood tests can be timed correctly.
Related: Semen analysis · PCOS
Sources: National Institute for Health and Care Excellence (CG156), Human Fertilisation and Embryology Authority, American Society for Reproductive Medicine, Royal College of Obstetricians and Gynaecologists.
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