A new fertility test is changing women's lives - Macleans.ca

A new fertility test is changing women’s lives

Levels of the hormone AMH correspond to to the number of eggs a woman has left in her ovarian reserve

Time is not on your side

Photograph by Simon Hayter

A woman’s biological clock is actually more like an hourglass that’s turned over when she’s born. Each grain of sand is one egg, and eventually they all run out. Rina Clarke had run through most of her eggs by last summer, when she was just 32. Sitting inside her fertility specialist’s office, Clarke learned that a new test indicated she had a “low ovarian reserve” for her age. For a while, Clarke couldn’t comprehend the doctor’s message. But it was simple: fewer eggs equals fewer chances for babies. “I felt cheated—like, how is this possible? I’m a [young] woman, what do you mean I have this reserve issue?” she recalls. “You wind up in a position where you are disappointed and [asking], ‘Why didn’t anybody tell me this sooner?’ ”

That test, which measures how much “anti-müllerian hormone” a woman produces in her ovarian follicles, is fast becoming the pre-eminent tool for fertility specialists in North America and Europe to determine the chances of their patients getting pregnant. “I [am] screamingly in favour of this test,” says Dr. Tom Hannam of the Hannam Fertility Centre in Toronto, who has offered AMH testing for two years. “It’s changed women’s lives. It has absolutely changed my practice.”

Until now, any woman who ever wondered about how many more years she could wait to have children—how many more dates she could go on before finding her ideal mate, how many more promotions she could attain, how many more professional letters she could add after her last name—had two choices: start trying and find out soon, or don’t start trying yet and find out later. AMH testing promises to pinpoint her chances of getting pregnant today, how that might change, and whether there is anything to be done about it.

“It’s a very good test because it tells people something about their biological clock that we really didn’t have a widely available, accessible and reliable test for before” explains Dr. Beth Taylor, co-director of Genesis Fertility Centre in Vancouver and a professor at the University of British Columbia. “Information is very empowering. As a woman, I would want to know where I am on that fertility scale.”

For $225 or less, a woman can find out by getting a blood test at any point during her menstrual cycle from a private clinic or lab. It reveals her level of AMH, which corresponds to the number of eggs she has left, or her “ovarian reserve.” That declines with age, but not every woman is born with the same number of eggs or loses them at the same rate. Genetics, exposure to chemotherapy and radiation and some medical conditions can influence ovarian reserve.

As such, a woman as young as Clarke might have as few eggs as a woman much older than her. But she’d never know it unless she was tested after being unable to conceive for more than a year. By then, heartache and headaches have long set in. “The number one thing we can do to help women plan for themselves and their families and set expectations is check their ovarian reserve. It defines everything,” says Hannam. “If you have a good ovarian reserve, you are all but certain to get pregnant. And if you don’t, then it’s extraordinarily unlikely that you will.”

Until now, a woman’s ovarian reserve was checked using methods that have been around for decades. Follicular-stimulating hormone must be measured using a blood test on day three of a woman’s menstrual cycle, but it can fluctuate from month to month, unlike AMH. Antral follicle count is done using vaginal ultrasound, but it is highly dependent on equipment quality and the precision of the technician. Both tests are, however, covered by provincial health care plans and common. AMH, on the other hand, is not yet familiar to all family doctors and gynecologists, who would need to refer a woman to a fertility specialist for the test.

That explains a paper entitled, “Is there a place for AMH testing in Canada?” that was published last June in the Journal of Obstetrics and Gynaecology Canada, noting, “AMH has emerged as an important and novel marker” and concluding that “as more Canadians become aware of the potential usefulness of AMH measurements, the medical community must begin to discuss and investigate what role [this test] can play in the management of health and fertility issues in Canadian women.”

This is all the more important as growing numbers of women delay having children. Canadian researchers are increasingly alerting women and the doctors who see them about how their chances of getting pregnant are actually much lower than they believe. Last November, the “Advanced reproductive age and fertility” guideline was published in the JOGC, which warned that women should be made aware “of the realities of the biological clock” and “have realistic expectations if they choose to delay child-bearing.” How little time they can wait may surprise them. “Ovarian aging will have begun before women notice any changes to their menstrual cycles,” the experts noted, so “they are often unaware that they may be at greater risk of infertility.”

For Dr. Allison Case, a primary author of the guideline and medical director of the assisted reproductive fertility centre at the University of Saskatchewan in Saskatoon, that misconception among women is becoming alarmingly familiar. “What strikes us is how women don’t appreciate the true effect that age has on their fertility. If you talk to women, they say, ‘Yeah, I know it’s harder to get pregnant,’ but I don’t think they really appreciate just how hard. It’s as if they’re in denial or thinking, ‘I’m going to be fine,’ because of whatever reason they use to justify” waiting to have children, says Case. The fact is that “fertility starts to drop off after age 30.”

And yet, many women are waiting until at least then. Between 1991 and 2009, the number of first-time mothers in their 30s or 40s climbed nearly every year, from 23 per cent to 37 per cent, reports Statistics Canada. Meanwhile the number of women in their late teens and 20s having their first children steadily dropped, from 76 per cent to 62 per cent. Most stunning of all, the number of babies born to women aged 35 to 39 doubled over those 18 years—and tripled among women aged 40 to 44. Among those 45 to 49, the increase was more than sixfold.

What the data doesn’t indicate, however, is how much more trouble these women might have experienced. Suzanne Tough, a community health professor at the University of Calgary and scholar for the Alberta Heritage Foundation for Medical Research, published a paper in the January issue of the JOGC, indicating the many risks women face when they delay child-bearing—and highlighting how few actually realize it. “They’re not very aware that they’re more likely to have a preterm birth or to miscarry. They’re more likely to have problems conceiving and carrying. And they’re more likely to have multiple births even if they aren’t using fertility treatments,” says Tough.

All the more reason a test such as AMH could prove useful in educating women about their personal fertility status earlier than has historically been done. Like Hannam and Taylor and Case, Dr. Ken Cadesky uses AMH mostly on women in their 30s who’ve had difficulty conceiving. But they all agree that, in theory, any woman could choose to have their level measured to help them plan their future. “Sometimes it’s a wake-up call for women that if they’re going to be doing something they should probably speed it up,” says Cadesky, director of the LifeQuest Centre for Reproductive Medicine in Toronto. “I wouldn’t say it’s the one concrete test that a woman should change her life as a result of, but it’s a valuable piece of information.”

And if the information isn’t what a woman is hoping to hear? “It’s better to know the results and live in the reality,” says Clarke, who is pursuing in vitro fertilization with her husband, because “once you know your limits, then you’re open to additional possibilities” too.


A new fertility test is changing women’s lives

  1. Based on clinical data AMH is not a good predictor of whether a woman can become pregnant or not.  Based on the studies about AMH it is only a good predictor of how women will respond to IVF drugs. And based on new data recently published in 2004, 2006 and 2012 by Dr. Jonathon Tilly the theory of women being born with x number of eggs and running out of them may even be false as he has now shown human stem cells turning into egg cells, see http://haveababy.blogspot.com or google jonathon Tilly eggs.  And through clinical data we have noted that in some patients who undergo lifestyle changes and optimising hormone balance and overall health, we have seen amh levels increase by 70-100 %  This also indicates that AMH could not be a marker for egg count if the old theory that we only have a certain number of eggs and gradually run out of them is true.

    • Note:
      1. This article’s basis explains that AMH screening is a great way to track ovarian reserve, and with low amounts if may be time to think about getting pregnant if it is in a couple’s future. The article never says AMH is a predictor of whether a woman can become pregnant or not. IVF patients with High AMH may have trouble getting pregnant and similiarly, patients with Low AMH levels may have difficulty getting pregant. But for women prolonging pregnancy I agree with this article’s premise, patient’s knowledge of their AMH levels earlier than later could help “plan” for the best strategy based on their lifestyle to begin trying to become pregnant, may if be naturally or through IVF.
      2. Dr. Tilly’s, albeit amazing and groundbreaking work, was conducted with a mouse model which can be easily manipulated while humans are very different. The findings are great in theory, but it will take a long time before it is translational in humans.
      3. A combination of FSH and AMH is essential for IVF patients, and is a better predictor of a women’s ovarian reserve and follicular development.

  2. Time is on your side if you use it well! AMH is a very controversial marker and

    much is still unknown about it. There is an excellent article that cites studies and clinical research

    about low AMH and fertility written by Julia Indichova, the author of The Fertile Female.

    Highly recommend that the author of this article read it.


  3. you know, it’s funny:

    whenever we talk about low fertility rates and about why people don’t have children, we always couch it in terms of what women need and what they are not receiving and in terms of how our society disadvantages women; evidently, if we give women everything humanly possible, that will resolve the baby deficit in Canada. Men, when they are thought of at all, are an afterthought or, more commonly, treated as the enemy – the lazy, selfish buffoon who should “man up” and do his part to make the life of a woman better whilst receiving nothing in return.

    In 2012, we live in a canadian gynocracy where male suicide rates are through the roof; young men are alienated and aloof and alone (largely because the society communicates to them that they are inferior, and stupid and shiftless); and male academic under-performance is a going concern. Until such a time as parthenogenesis becomes a fact and not just the wet dream of feminists in our stunted universities, women will still need men to have children – and men are undercut and marginalized at every turn in our society. Fathers have no reproductive rights (sorry, guys: if your girlfriend wants your son or daughter to disappear via abortion, then that child is going to disappear whether you like it or not); fathers are clearly the second option (oftentimes the third option) in the nation’s custody courts; men are routinely the victims of false allegations of sexual violence and domestic violence; and men have to endure a popular culture that tells them that, no matter how high male unemployment may be, or how high male depression may be, or how high male mental illness as a whole may be – they simply do not count and their problems do not count.

    I have no sympathy for women in this culture. They had a choice – and have had a choice since the 1970s: demand true equality and act like adults – or act like they do now and have throughout my lifetime, as mean-spirited, vindictive children who raise themselves by diminishing men. In a world where boys are told everyday that they “suck” and where we try to drill the manhood out of them, how can any one of us be surprised that boys never become men and those that do want no part of fatherhood or marriage to a north american caucasian woman? Can you blame them? It baffles me why a man should vie for the privilege of beggaring his own life to make the life of a woman better.

    By the way, why do we assume that women are such wondrous parents with these transcendent maternal qualities when so many of them fight with steely-eyed determination to expand and consolidate abortion in our society? I guess, to a lot of women – at least the many affluent ones in canada – a child is only worth loving (and only worthy of life) when it’s the perfect designer baby. 

    Hey honey: if you can’t have kids, maybe it’s just as well.

    • You’ve taken this on a path not at all covered by the article. There is nothing about designer babies, or denograting men. It’s simply saying that women may know more about how many eggs they may have. You must have some agenda…

  4. Congratulations, Dr. Taylor on your Maclean’s Interview!!! I know many more interviews will follow….

  5. this test change my life too .. dont put off motherhood if u really think ismimportant for you.
    as for the price ..pffff .. come to germany.. is 15 euros !

  6. I don’t even understand why this is an issue. More information is better – knowledge is power. In Belgium, this is a STANDARD blood test done for all women considering IVF. Canada, and BC in particular, is so behind the rest of the world when it comes to fertility and the right to have children via fertility assistance. This test, including the IVF procedure, should be covered by medicare, as it is in the majority of the rest of the developed world. When will BC provide it’s citizens with equal access to such important health care?

  7. Home fertility tests are gaining in popularity as women increasingly delay baby-making. Some haven’t found the right guy; others are sailing ahead in their careers. When they decide the time is right for baby, more than a few are turning to home fertility tests to assess their chances. Inaccurate assessments of infertility could lead otherwise healthy women to seek unnecessary fertility interventions. http://fertility.medicalxtourism.com/

  8. I really llike this post. You write about this topic very well. I think you know what you have written about. I like your blog and I will definitely bookmark it! Keep it up !

  9. thank you doctor for your help with my issue i never believe that i will ever be able to give birth to my own child after all i have been through with my mother in law Dr Maxwell you are really the best that i have ever seen your spell work so fast and everything that you told me was going to happen came through and now me and my mother in law are now happy again together i will advice anyone in need of help with the issue of getting pregnant to contact him on this email: ugbakhuanspelltemple@gmail.com

  10. Always blaming women. Women do not “delay pregnancy.” Men delay marrying us. That’s the reason why women are having children later and later. I know many women who would have started a family a lot sooner had they found the right person willing to commit.