Fertility Testing and AMH#

Ovarian reserve is the pool of eggs remaining in the ovaries. A person is born with all the eggs they will ever have. Most stay dormant; a small number mature each cycle. Ovarian reserve naturally declines with age. Tests like AMH and day-3 FSH estimate the size of this pool but do not measure how well any individual egg will work.

Think of fertility as your ability to actually get pregnant. Ovarian reserve is just one ingredient. A useful analogy: ovarian reserve is the fuel in the tank; fertility is whether the whole car can get where it needs to go. You can have plenty of fuel and still have a flat tire (blocked tubes, ovulation problems, low sperm count in a partner, uterine issues), and you can have a low tank and still arrive (many people with low AMH conceive naturally).

Not necessarily. A normal AMH or normal day-3 FSH only tells you that egg quantity is in the expected range for your age. You could still have ovulation problems, blocked fallopian tubes, low sperm in a partner, or other issues that affect conception. A normal result can be falsely reassuring.

No. Many people with a low AMH or higher-than-expected day-3 FSH conceive naturally. A low result means fewer eggs are available; it does not mean none of those eggs work. Younger people with low ovarian reserve often have good egg quality and still conceive. A low result mainly matters if you are planning IVF, considering egg freezing, or trying to decide how long to wait before seeking specialist help.

Canadian, American, and European guidelines do not generally recommend pre-conception fertility testing in people with regular cycles. The reasons: results often do not change what is recommended (try naturally first), abnormal results can cause anxiety that itself affects conception, and a normal result can falsely reassure someone into delaying. If a clinic outside Canada has recommended testing, you can still complete it, but it is not required by Canadian standards.

About 85 of every 100 people with regular cycles and no known fertility issue conceive within 12 months of regular unprotected intercourse. By 24 months, that number rises further. This is why specialist referral is generally deferred until the 12-month mark in people under 35.

Yes, and they are worth knowing:

1. Abnormal results can cause anxiety that affects fertility. Stress is associated with lower conception rates and worse sperm quality in partners.
2. Abnormal results often lead to more tests that would not have been needed if you had just tried first.
3. No single lab test answers "am I fertile?" The information is partial.
4. A normal result can be falsely reassuring and lead you to delay trying when age is actually the bigger factor.
5. Most people who eventually conceive naturally would have had a "normal" result anyway and never needed the test.

AMH is a protein hormone produced by small developing follicles in the ovaries. The blood level is roughly proportional to the number of these small follicles, which in turn reflects ovarian reserve. AMH is usually highest in young adulthood and declines with age, with lower levels becoming more common through the late 30s and 40s. By menopause, AMH is usually very low or undetectable. AMH does not measure egg quality, does not tell you when you will go through menopause to a precise date, and does not directly predict natural pregnancy.

AMH reference ranges vary widely by lab and assay, so your result should be interpreted using the reference interval printed on your own lab report. The table below shows one example of age-related AMH reference intervals reported by LifeLabs British Columbia. These are not universal "normal" ranges and should not be used as strict cutoffs.

A result can be "within range" but still lower or higher than expected for a person's age and fertility goals. For counselling, many clinics consider AMH below about 7 pmol/L, or about 1 ng/mL, to be low, but the meaning depends strongly on age, the lab assay, cycle pattern, and the reason for testing.

Very high AMH can support a PCOS diagnosis in adults when interpreted with the rest of the clinical picture (irregular ovulation, clinical or biochemical hyperandrogenism, exclusion of other causes). It is not diagnostic on its own. AMH is not recommended as a diagnostic test for PCOS in adolescents.

AMH is most informative when you are:

• Considering IVF - it predicts how the ovaries will respond to stimulation. Higher AMH usually means more eggs retrieved; very low AMH usually means a more modest yield. AMH helps predict egg yield, but it should not by itself be used to decide that IVF is not worthwhile.
• Considering egg freezing - helps estimate how many eggs might be retrieved per cycle.
• Planning fertility-preserving treatment before chemotherapy or pelvic radiation.
• Investigating early menopause or premature ovarian insufficiency - a very low AMH alongside a high FSH supports the diagnosis.
• As one piece of a PCOS workup in adults - elevated AMH can be used as an alternative to ultrasound evidence of polycystic ovarian morphology, but only as part of the full diagnostic assessment. It is not diagnostic by itself and is not recommended for diagnosing PCOS in adolescents.
• Monitoring ovarian function after ovarian surgery, endometriosis treatment, or chemotherapy.

AMH is not especially useful for telling someone with regular cycles in their 20s or early 30s whether they will conceive naturally, pinpointing when menopause will occur, or diagnosing infertility on its own.

No. Very low AMH can be seen as menopause approaches, especially when combined with older age, irregular cycles, and elevated FSH. However, a single AMH result cannot reliably tell an individual when menopause will occur.

Different labs use different test kits to measure AMH. Two labs can give two different numbers from the same sample. If you are tracking AMH over time, try to use the same lab each time so the values are comparable.

Not significantly. AMH mostly reflects follicle number and age-related ovarian reserve. Lifestyle changes generally do not meaningfully raise AMH. Quitting smoking, maintaining a healthy weight, sleeping well, and limiting alcohol can support overall reproductive health, but they should not be expected to substantially increase the AMH number.

In most cases, no. In your 20s the result rarely changes what you would do. Exceptions: family history of menopause before age 45, prior chemotherapy or pelvic radiation, prior ovarian surgery, irregular cycles, known PCOS, or a strong preference to know a baseline before making family-planning decisions.

Yes. AMH helps estimate how many eggs might be retrieved per stimulation cycle. A low AMH may suggest more than one retrieval cycle to bank enough eggs. The actual decision about egg freezing also depends on age, partner status, finances, and your personal timeline.

No. A low AMH at 32 means a smaller egg pool than expected for your age, but egg quality at 32 is generally still good and many people in this situation conceive naturally. If you are planning to have children, the practical implication is usually: do not delay trying for many more years if you have a choice, and consider talking to a fertility specialist about whether egg freezing makes sense for your situation.

PCOS ovaries have an unusually high number of small antral follicles, and each one produces AMH, so the total adds up to a high AMH number. In adults, AMH can support a PCOS diagnosis when interpreted with the rest of the clinical picture (irregular ovulation, clinical or biochemical hyperandrogenism, exclusion of other causes), but it is not diagnostic by itself. AMH is not recommended for diagnosing PCOS in adolescents. High AMH in PCOS does not mean better fertility; the difficulty in PCOS is usually irregular ovulation. See the PCOS page for more.

Yes. Chemotherapy can damage ovarian follicles. AMH before treatment helps with fertility-preservation planning; AMH after treatment helps estimate remaining ovarian function. If chemotherapy is planned and you want children later, ask about fertility preservation before treatment starts.

No. AMH is stable across the menstrual cycle and can be drawn any day. This is one reason it is convenient compared with FSH and estradiol, which need day-3 timing.

Yes, hormonal contraception can modestly lower the measured AMH result. Combined pills, the vaginal ring, progestin-only pills, implants, injections, and hormonal IUDs may make AMH read lower than it would off hormones, often by roughly 10-30%, though the effect varies by method and person. AMH measured while using contraception is still useful, but it should be interpreted as a possible underestimate. If the exact value will affect a major decision, such as egg freezing planning, a fertility clinician may suggest repeating it after stopping hormonal contraception for a period of time.

AMH often decreases during pregnancy and can be unstable in the early postpartum period. It is usually not useful to measure AMH during pregnancy or soon after delivery unless a specialist has a specific reason.

Sometimes, but not as a routine test. AMH can help evaluate suspected premature ovarian insufficiency or recovery after childhood chemotherapy. AMH is not recommended for diagnosing PCOS in adolescents, because normal puberty overlaps with PCOS-like ovarian findings. Adolescents with suspected PCOS should be assessed using menstrual pattern, clinical or biochemical hyperandrogenism, and exclusion of other causes.

FSH is released by the pituitary gland in the brain and tells the ovaries to mature follicles each cycle. Early in the cycle (day 2-4) FSH should be relatively low. When the egg pool starts to run low, the pituitary has to "shout louder" to recruit a follicle, so FSH rises. A high day-3 FSH suggests reduced ovarian reserve. After menopause FSH stays persistently high.

Canadian labs report FSH in IU/L. A day-3 FSH under about 10 IU/L is generally reassuring; 10-15 IU/L is borderline; above about 15-20 IU/L suggests reduced reserve.

LH triggers ovulation. It surges sharply about 36 hours before an egg is released. Over-the-counter ovulation predictor kits measure LH in urine. On day 3, LH is normally low. In PCOS, the LH:FSH ratio is often elevated (LH higher than FSH); on its own it is not diagnostic.

Estradiol is the main estrogen produced by developing follicles. On day 3 it should be low (typically under about 200 pmol/L). A high day-3 estradiol can artificially suppress FSH and make a borderline result look normal, which is why clinicians look at FSH and estradiol together.

The basic day-3 panel usually includes FSH, LH, and estradiol. It is a quick snapshot of ovarian reserve and pituitary signalling.

The advanced panel adds prolactin (PRL) and thyroid-stimulating hormone (TSH) to look for hormonal causes of ovulation problems. AMH is often added on as well. Canadian labs report prolactin in mIU/L and TSH in mIU/L.

No. Hormonal contraception (pills, patch, ring, hormonal IUD, the birth control shot, the arm implant) suppresses your natural FSH, LH, and estradiol pattern. Day-3 testing is most useful after you have been off hormonal contraception for at least 1-2 months. AMH is somewhat affected but still informative.

FSH rises during the menstrual cycle and surges around ovulation. A late-follicular or mid-cycle FSH does not mean anything about ovarian reserve. Day 2-4 is the natural low point of FSH; that is what we are measuring against. If you missed the window, repeat at the next cycle.

• High mid-luteal progesterone (typically above about 16 nmol/L in Canadian labs, sometimes higher cutoffs are used) suggests ovulation likely occurred.
• Low mid-luteal progesterone suggests you may not have ovulated that cycle, the test was timed wrong, or ovulation happened on a different day than expected.

A single low result does not necessarily mean a problem. Many people have an occasional anovulatory cycle. Repeat testing or a different approach (urine LH testing, ultrasound tracking) may be helpful.

If your cycles are very irregular (for example, 28 days one month and 60 days another), you are likely not ovulating regularly. A "day-21" test without a predictable ovulation date is less helpful. In that situation, talk to a clinician about other ways to evaluate ovulation, such as urine LH testing or assessing for PCOS or thyroid causes.

Yes. AMH can be ordered any day of the cycle. The result goes to your TeleTest account; a clinician reviews it and sends a written interpretation.

Not at this time. The day-3 panel (FSH, LH, estradiol) is under review by our medical team and is not currently offered through TeleTest. If you need a day-3 panel, ask your family doctor or a fertility clinic - they can order it and time it to day 2, 3, or 4 of your cycle. We will update this page when our scope changes.

Yes, if your partner has a TeleTest account. We can order semen analysis for them and discuss the result. See the Semen Analysis page for prep and drop-off rules.

Currently we can order AMH as part of a pre-IVF workup. Other panels a fertility clinic typically wants (day-3 hormones, TSH, prolactin, infectious disease screening, blood group, and others) are under review by our medical team and are not yet offered through TeleTest. Plan to have the rest of the workup done by your IVF clinic, your family doctor, or another provider. We cannot replace the consultation with the IVF clinic, and most clinics will want to repeat some tests in their own lab regardless of what was done before.

AFC is a count of small antral follicles seen on a transvaginal ultrasound, typically done early in the cycle. It is a direct measure of ovarian reserve and is often combined with AMH. TeleTest does not perform ultrasound; if AFC is recommended you will need an imaging clinic or fertility clinic.

Timed intercourse is having sex around your fertile window, defined as the 5 days before ovulation and the day of ovulation itself. Sperm can survive for up to 5 days in the reproductive tract. There is no good evidence that having sex more frequently, less frequently, or on specific days dramatically changes outcomes. Most guidance suggests intercourse every 1-2 days during the fertile window.

Urine LH kits are very reliable at detecting the LH surge that precedes ovulation. One large study showed about 97% agreement with ultrasound for predicting ovulation. They are the most practical at-home tool for timing intercourse.

Moderately reliable, but it tells you ovulation has already happened (temperature rises after ovulation, not before). It is not useful for timing intercourse in the same cycle. Some studies report 30-77% agreement with LH-based prediction.

Cervical mucus changes can signal the fertile window (clear, stretchy, "egg-white" mucus around ovulation). It is reasonable as an adjunct but is less reliable than urine LH testing alone.

The number of eggs declines steadily from puberty. The rate of decline accelerates after about age 37. AMH and antral follicle count both fall over time; FSH on day 3 rises. By menopause, AMH is undetectable and FSH is persistently high.

POI is when the ovaries stop functioning normally before age 40. It is sometimes called premature menopause, though POI is the more accurate term because some people still ovulate occasionally. Lab findings include a low AMH, high FSH, and low estradiol. Causes include genetics (including Turner syndrome and Fragile X premutation), autoimmune disease, chemotherapy or radiation, and most commonly no identifiable cause. If you have absent or very irregular periods before 40, talk to a clinician about screening.

Yes, but check with the fertility clinic first. Many clinics prefer to do their own bloodwork in their own lab to avoid result-transfer issues. If TeleTest orders the labs, results land in your TeleTest account; you would then forward them or share access with the fertility clinic.

For fertility planning, AMH and day-3 results are usually considered useful for about 12 months. After that, they may need to be repeated, especially if you are 35 or older or your circumstances have changed.

POR is a fertility-clinic term for someone whose ovaries respond poorly to IVF stimulation. The Bologna criteria say two of three must be present: age over 40, prior poor IVF response (fewer than 3 eggs retrieved), or a low ovarian reserve marker (low AMH, low antral follicle count). POR is not a label most people need to worry about unless they are in active IVF treatment.

Stress does not meaningfully change AMH. It can affect cycle regularity through the hypothalamic-pituitary axis, which can disturb FSH/LH/estradiol patterns. Severe or chronic stress can also affect ovulation and partner sperm quality. Anxiety about an abnormal test result is itself a known driver of conception delay, which is one reason guidelines do not recommend routine pre-conception testing.

Male-factor causes account for roughly a third to a half of fertility difficulties. A semen analysis is the first step for a male partner. TeleTest can order this; see the Semen Analysis page for lab-collection rules.

Endometriosis can damage ovarian tissue, especially if there are endometriomas (ovarian cysts) or you have had ovarian surgery for endometriosis. Checking AMH is reasonable, particularly if you are considering surgery or planning pregnancy.

Yes. Any ovarian surgery can reduce ovarian reserve. A post-operative AMH gives you a baseline to plan against.

Yes. Common things we look for when periods are irregular or absent: thyroid problems (TSH), elevated prolactin (PRL), PCOS (testosterone, SHBG, DHEA-S, sometimes 17-OHP), and pregnancy itself. A morning random cortisol is sometimes added if Cushing-type features are present. TeleTest can order this workup.