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AMH testing: the most misunderstood number in fertility – what it can and can’t tell you

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Article produced in association with Spital Clinic

AMH has become one of the most-requested blood tests in private women’s health. The number it gives back is useful, but only when it is read in context.

AMH testing in the UK has gone mainstream over the past few years. Home-testing kits sell it as a snapshot of “your fertility”.

Private clinics include it in screening packages. On social media, individual AMH results are now routinely treated as a verdict on whether a woman will be able to have children.

That reading isn’t accurate. Anti-Müllerian Hormone (AMH) does carry useful information, but only inside a wider clinical picture.

Looked at on its own, it produces a lot of unnecessary anxiety, and often hides the questions that matter more.

What AMH measures

AMH is a hormone produced by the small follicles in the ovaries, the ones that haven’t yet been recruited for ovulation. Because these follicles are relatively stable across the menstrual cycle, the test can be done on any day, without needing to be timed to a period.

A higher AMH level tends to indicate a larger pool of these follicles. A lower level suggests the pool is smaller. That, broadly, is what the result shows.

The HFEA, the UK’s independent regulator of fertility treatment, describes AMH as an indicator of ovarian reserve, while making clear that fertility test results of this kind “are not guaranteed” as a predictor of fertility outcomes.

Put simply: AMH is a count of what is there. It says nothing about how well the body will use it, and it cannot predict if or when conception will happen.

Where AMH fits in a modern fertility assessment

In current UK private practice, AMH is rarely tested in isolation. A meaningful fertility assessment will pair it with a fuller hormone profile (FSH, LH, oestradiol, prolactin and thyroid function), along with markers such as Day 21 progesterone, vitamin D and rubella immunity where relevant.

This is the structure used in a trying-to-conceive screening, and there is a reason for it: each of these tests answers a different question that AMH on its own cannot.

It is this combination, not the AMH number on its own, that gives a clinician enough information to say anything meaningful about an individual’s reproductive picture.

Misconception 1: “A low AMH means natural pregnancy isn’t possible”

This is the misconception that causes the most distress, and it is consistently wrong.

Several large prospective studies of women in their 30s and 40s trying to conceive naturally have found that women whose biomarkers, including AMH, pointed to a diminished ovarian reserve were no less likely to conceive within twelve cycles than women with reassuring results.

That is why neither UK regulators nor national guidance treat AMH as a test that can predict natural fertility in women who have no known infertility issue.

The reason is simple. Natural conception only requires one good egg, released in a normal cycle, in the right window.

AMH doesn’t measure egg quality, and it doesn’t reveal whether ovulation is happening. A woman with low AMH may still ovulate every month with high-quality eggs.

A woman with high AMH (often the pattern seen in polycystic ovary syndrome) may not be ovulating regularly at all.

The NHS emphasises that age is the strongest single predictor of natural fertility. A 35-year-old with a low AMH and regular cycles is, on average, more likely to conceive naturally than a 40-year-old with a normal AMH and irregular ones.

If AMH comes back low for someone who is trying to conceive, the more useful question isn’t whether pregnancy is still possible (the answer is almost always yes), but whether there is reason to investigate the wider picture now rather than waiting twelve months.

Misconception 2: “A normal AMH means everything is fine”

The opposite assumption is just as risky.

AMH tells you about egg quantity. It does not tell you about:

  • Egg quality, which is closely tied to age
  • Whether ovulation is happening regularly
  • Whether the fallopian tubes are open
  • Whether there are structural issues such as fibroids, polyps, ovarian cysts or endometriosis
  • Sperm parameters in a male partner
  • Whether implantation will succeed

A reassuringly normal AMH at 38 still sits alongside age-related changes in egg quality. A slightly lower-than-average AMH at 28 may carry no real-world implications at all.

That is why no UK clinical body recommends AMH as a routine screening test for healthy women who have no fertility concerns. NICE’s fertility guideline, NG73, treats AMH as one component of a broader investigation, not as a verdict in itself.

Imaging is the natural counterpart to the blood test. A transvaginal pelvic ultrasound directly visualises the small follicles that produce AMH, the antral follicle count. It also picks up structural findings a blood test will never reveal, including ovarian cysts, fibroids, polycystic ovarian morphology, and abnormalities in the uterine cavity. A full ovarian reserve assessment normally includes both.

Where the AMH number actually matters

There are three settings in which AMH carries real, decision-relevant information.

Before IVF or egg freezing. AMH is one of the better predictors of how the ovaries are likely to respond to stimulation medication.

A higher AMH usually predicts more eggs collected per cycle, and a very low AMH may shape decisions about protocol or whether to bank cycles before treatment.

During a fertility investigation. If a couple has been trying for twelve months, or six months if the woman is over 35, AMH becomes part of a wider assessment that should also include ovarian ultrasound, a fuller hormone profile, semen analysis and an assessment of tubal patency.

As context for women planning ahead. Women who want to understand their reproductive options before they are ready to conceive (for example, ahead of a decision about egg freezing) can find AMH informative, provided it is interpreted alongside age, antral follicle count, and other markers, by a clinician who can place the number in context.

Reading the number properly

For anyone who has had an AMH test, three things make the result more useful:

  1. Pair it with age. A “normal” AMH at 25 means something very different from the same number at 38. Age is doing more work in the equation than the AMH value itself.
  2. Pair it with imaging. Ultrasound shows what is actually in the ovaries today, rather than relying on a single biochemical marker.
  3. Read it with a clinician. A number on a screen, with no context, no follow-up and no plan, is the worst way to use a test that, properly interpreted, can be very informative.

AMH is a useful tool. It just isn’t the headline it has often been turned into.

Disclaimer

This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published HFEA, NHS and NICE information available as at May 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.

Insight

Fertility rate in England and Wales hits record low, new figures reveal

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The fertility rate in England and Wales fell to a record low of 1.39 children per woman in 2025, down from 1.41 a year earlier.

New figures show that parts of London and cities with major universities accounted for many of the areas with the lowest local fertility rates.

The City of London recorded the lowest rate in 2025 at 0.37 children per woman, followed by Cambridge at 0.87 and the London boroughs of Islington and Westminster at 0.90.

The Office for National Statistics (ONS) defines the fertility rate as the average number of live children women would expect to have over their childbearing lives.

Brighton & Hove recorded a rate of 0.95, followed by Southwark at 0.97 and Norwich at 0.98.

Exeter, Oxford and York, along with the London boroughs of Camden and Hammersmith & Fulham, each recorded 1.01 children per woman.

At the other end of the table, Pendle in Lancashire and Luton in Bedfordshire had the highest rate at 1.93.

They were followed by Oldham in Greater Manchester at 1.87, Bradford in West Yorkshire at 1.84 and Barking & Dagenham in London at 1.83.

The overall fertility rate for England and Wales declined from 1.41 in 2024 to 1.39 in 2025.

A rate of around 2.1 is needed for a population to remain stable over time when the impact of migration is excluded.

Twelve of the 25 local authorities with the lowest fertility rates in 2025 were in London.

In Wales, Swansea recorded the lowest fertility rate at 1.18, while Carmarthenshire, the Isle of Anglesey and Newport each had the highest rate at 1.48.

There were 585,396 live births in England and Wales in 2025, down from 594,677 in 2024 and the lowest number since 1977.

Live births fell across every region in England. The West Midlands recorded the largest percentage decline at 3.1 per cent, while the North East had the smallest at 0.3 per cent.

The average age of parents also increased slightly.

Mothers had a provisional standardised mean age of 31.1 in 2025, compared with 31.0 in 2024. Fathers had an average age of 34.0, up from 33.9.

In 1975, the average age was 26.4 for mothers and 29.5 for fathers.

The proportion of births where the mother was born outside the UK also increased, from 20.8 per cent in 2005 to 27.5 per cent in 2015 and 34.6 per cent in 2025.

India was the most common country of birth for non-UK-born mothers in 2025 for the fourth consecutive year.

It was followed by Pakistan, Nigeria and Romania.

In 2025, 56.4 per cent of births were to parents who were both born in the UK, down from 62.7 per cent in 2015.

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Fertility

Weight loss surgery improves menstrual health and PMOS symptoms, study finds

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Weight loss surgery was linked to more regular periods and fewer polyendocrine metabolic ovarian syndrome (PMOS) symptoms in women aged 18 to 45 living with obesity in a recent study.

The researchers recommend that women undergoing the procedure have access to preconception care and reproductive counselling to support their reproductive health.

Researchers at the University of Surrey analysed data over 24 months from 84 women who underwent bariatric surgery and 18 women living with obesity who did not have surgery.

Of those who underwent surgery, 49 had gastric bypass procedures and 35 had gastric sleeve surgery.

Women who underwent metabolic bariatric surgery lost more than 30kg on average at 12 and 24 months after the procedure.

Among women with polycystic ovaries, the condition persisted in only 10 per cent after 24 months.

Women also reported a resolution of clinical hirsutism, or excess body hair, by 12 months.

Women who had previously experienced irregular periods reported more regular menstrual cycles after surgery.

Professor Martin Whyte, co-author of the study and professor of metabolic medicine at the University of Surrey, said: “A large proportion of those undergoing bariatric surgery are women of reproductive age, who may be planning a pregnancy in the coming years.

“So much remains unknown about the impact of this type of surgery on women who are planning to have children.

“This raises the question of when the ideal time after surgery is to conceive.”

Women have a higher prevalence of obesity than men, with 57 per cent of women in the UK classified as overweight and 27 per cent living with obesity, which can affect fertility and the health of an unborn baby.

The researchers said 17 women had healthy pregnancies following surgery.

Although this was not specifically examined in the study, no difference in birth weight was observed between babies conceived within or after the first year.

Dr Kathryn Hart, co-author of the study and associate professor in nutrition and dietetics at the University of Surrey, said: “What we have found is that bariatric surgery positively affects the reproductive health of women living with obesity and can improve the likelihood of them having a healthy pregnancy after surgery.

“Dysregulated hormone levels, irregular periods and conditions such as polycystic ovaries are affected by obesity.

“By reducing this, what we have seen is that it can lead to improvements without the need for medication.

“We would suggest that clinicians consider medical intervention for obesity to treat irregularities in the menstrual cycle and issues with fertility.”

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Fertility

Scottish gov to consider IVF for single women

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The Scottish government has launched a national review into whether NHS IVF access should be extended to single women.

The review will also consider whether wider access should be offered to couples who have children from previous relationships.

Health secretary Angela Constance said: “Access to NHS IVF treatment should be fair, timely and reflect the way people’s lives and families look today.”

Most single women are not currently eligible for NHS IVF treatment in Scotland.

Campaigners have welcomed the review.

Katie Rollings of Fertility Action said: “It’s an essential and long-awaited decision that will impact a huge number of people who are struggling to grow their families.

She said there is “no evidence” that having two parents rather than one determines whether a child will thrive.

She added: “What matters is whether a child is loved, safe, supported and has stable, positive relationships around them.”

Figures from the Human Fertilisation and Embryology Authority show Scotland is the only UK nation where NHS-funded IVF cycles outnumber privately funded cycles.

In 2024, more than 6,000 cycles of fertility treatment were carried out among more than 4,000 patients in Scotland. Both figures were slightly lower than the record highs recorded in 2022.

The past 20 years have also seen a rise in the number of same-sex female couples and single women receiving fertility treatment.

In 2024, 625 IVF cycles were carried out for women in same-sex couples in Scotland, with more than one third funded by the NHS.

There were 330 cycles involving single women, of which 50 were NHS-funded.

In England, single women can access IVF through the NHS, although eligibility varies according to the local health trust’s policy.

Current Scottish rules state that couples are eligible if they have been living in a stable relationship for two years and neither partner has been sterilised.

Couples where one partner already has a child can be eligible, but those where both partners have children from previous relationships are not.

Eligibility rules also require a body mass index above 18.5 and below 30, and state that couples must not smoke, drink alcohol or take drugs during treatment. The mother must be under 42.

The Scottish government said the review would also examine consistency of access to fertility preservation, including during cancer treatment, as well as reducing waiting times for donor eggs and sperm.

Same-sex female couples already have access to NHS IVF, but they can face long waits for donor eggs or sperm, as can heterosexual couples who require donor treatment.

The National Fertility Group will lead the review and make “costed, demand-modelled recommendations”, which are due to be published by early summer 2027.

The group will include fertility experts from Scotland’s four NHS-assisted conception units in Glasgow, Edinburgh, Aberdeen and Dundee.

Prof Sarah Martins Da Silva, an NHS consultant and chair of fertility medicine at Dundee University, said there were questions to be answered in a resource-stretched NHS.

“As a fertility specialist I’m never going to be disappointed if the criteria is widened,” she said.

“But with single people, as an NHS clinician looking at the competing demands we have, I’d ask the question about whether being single is a health condition that needs to be funded.”

Da Silva said NHS waiting lists were full of couples who require donated eggs or sperm because of medical conditions including cancer and could face longer waits.

“It’s slightly a disservice to them,” she said.

“There would need to be a real investment and resource without making everybody wait an extraordinary long time.

“With the current financial environment we work in, if you’re talking about new money, where would that come from?”

She said she would welcome changes that encouraged more people to donate eggs or sperm and questioned whether arguments about children needing two parents were necessarily relevant to the debate.

“On the one hand bringing up a child is quite an expensive process, and if you don’t have that support, it can be very difficult.

“But on the other hand, many people start off as a couple and divorce.”

Da Silva also welcomed plans for the review to consider eligibility for couples who already have children, describing the move as “fantastic”.

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