Why AMH...

As a Fertility Specialist, I know today we can help most women to achieve their
dream of having a child.
We can overcome most causes of infertility using IVF or other fertility treatments.
However, there is one fertility problem we cannot cure.
When we face this problem, we often concede the defeat and throw in the towel.
Only advice we can give is to stop trying to have a biological child.
Unfortunately, this is also a common cause of infertility today.
This is a Diminished Egg Reserve.
In this condition the reserve of eggs is so low or absent, the odds of success with IVF is
extremely low or non-existent.
Equally, we know if the patient came a few years earlier, we could have helped her.
If she tried a little earlier, she could even have conceived naturally.

Why didn’t she?

Because she did not know she was running out of eggs.
No one told her so.
If someone told her about AMH Test, she could have known about impending fertility
disaster and would have done something about it.
She could have started trying to have a child earlier.
If she was not ready, she could have frozen her eggs and use when she needed them.
Once missed the opportunity, no amount of knowledge or treatment can help her.
No matter how advanced our Science, Technology or Clinics are, we cannot help women
when it is too late.
If we acted earlier, though, only a simple test and advice would have sufficed.
Hence the saying, “An Ounce of Prevention is Better Than a Pound of Cure”.
As a scientist who dedicated his professional life to research on

Egg Reserve and AMH Test,

it is hard for me to come to the terms with the fact that today women are not offered AMH
Test as a routine screening of Egg Reserve.
Given we already know.
Women are born with all the eggs they will ever have.
The number of eggs they are born with determines their Egg Reserve.
Egg Reserve declines gradually as women get older.
Egg Reserve determines how long each woman stays fertile.
Some women have High, some Average and others have Low Egg Reserve.
Women with Low Egg Reserve run out of eggs in their ovaries earlier.
They are at risk childlessness if they start trying to conceive late.
Anti-Mullerian Hormone (AMH) can accurately measure Egg Reserve.
Reliable AMH Tests have been around for last 10 years

Egg Reserve declines predictably over time, which we can track using AMH Chart.

Using AMH Chart, we can reliably predict when women will run out of egg reserve and
help them plan their fertility accordingly.
Having read these, I am sure, you agree women should be offered AMH Test if they wish
to have kids in the future.
But you may wonder, how big of a problem it is.
Is it common enough problem to offer a screening test to all women.
Yes, it is. Given the facts below.
30% of all women have low egg reserve. If they delay conception to their late thirties or
early forties, they are at risk of infertility. This is one in three women.
8% of all women at risk of Early Menopause, which is defined by stopping menstrual
period between ages of 40-45 years.
Women have diminished Egg Reserve approximately 5 years prior to menopause.
Hence, 8% of women loose ovarian function and become infertile between ages of 35-40
years. This is one in twelve women.
1% of all women at risk of Premature Ovarian Insufficiency (POI).
In this condition women can stop having menstrual period at any age between 15-40 years.
Since Diminished Egg Reserve Precedes menopause approximately 5 years, women with
POI have Diminished Egg Reserve before the age of 35 years.
Yes, Diminished Egg Reserve is common.
AMH Test can reliably detect who is at risk.
Yes, these are a decade all established facts on Egg Reserve and AMH Test.
Yet during this period, millions of women did not use the opportunity to track their Egg
Consequently, today they are suffering from infertility or childlessness due to
Diminished Egg Reserve.
It is regretful that, despite having a such a reliable test, so far, we did not offer it for
screening of Egg Reserve to all women.

Why didn’t we?

So far, as a Fertility Community and Public, we have not properly understood the true role
of AMH Test.
Because women with low AMH can conceive, we have dismissed it.
We said, as women can get pregnant with low AMH, it is not a test of fertility.
Yes, women with low AMH can get pregnant, as they still have some eggs.
But as the level of Egg Reserve declines, odds of conception also declines and once women
run out of egg reserve, they cannot get pregnant.
Hence, AMH is a hormone of Egg Reserve.
So, AMH should be used as a screening test to monitor egg reserve, predict how long
women stay fertile and plan their future fertility.
In short, AMH should be used as an Egg Reserve Test.
It is also said, taking AMH Test makes women anxious.
The anxiety of users was always a concern before introduction of other health screening
tests. However, always, the contrary turned out to be true.
Knowing if you will have a health problem in the future and having an opportunity to
prevent is empowering.
Women rather want to know if they are going to have a serious and irreversible fertility
problem before too late and do something about it.
They certainly prefer it to being falsely reassured and finding out when it is too late.
Hence, doing AMH Test is reassuring whether you get Low Risk or High Risk result.

If AMH Result is low, women can be reassured that they found out it before it is too late.
If AMH is normal or high, women again can be reassured that they are at low risk of
Diminished Egg Reserve.
They do not need to worry too much about their “Fertility Clock”.

Hence stated reasons for not implementing AMH Test as an Egg Reserve Screening are not
based on strong scientific, clinical, or public health foundations.
Whatever is the reason, I am acutely aware so far we have missed the opportunity to
explain the problem to women.
As a result, many women are facing only three hard options today:
Donor Egg IVF, Adoption or Childlessness.

A simple explanation would have allowed to prevent it.

Now at Fertl, we are working tirelessly to explain women following.
“Low Egg Reserve is a common problem”
“In the past it did not cause much problem, because most women started having kids early
and by the time they run out of eggs they had completed their family.”
“Today many women delay having a child, hence women with low egg reserve are getting
caught off guard. They are finding out when it is too late.”
“However, today there is a reliable AMH Test to tell your egg reserve”
“If you wish to have children and delaying it, you should consider doing AMH Test”
“If you have low level of AMH, you should either plan to have kids earlier or consider
preserving your fertility by freezing your eggs.”
We know knowledge on Egg Reserve is Empowering.
We know knowing your own Egg Reserve is Enlightening.
We also know, knowledge alone is not sufficient.
To prevent any disease, we should provide an easy access to a screening test and medical consultation.

Hence, we have created an online service for easy access to affordable AMH Test & Fertility Telehealth Consultation.



Chief Medical Officer, Fertl

Fertility Specialist, Obstetrician & Gynaecologist,
Clinical Director, Adora Fertility Brisbane, Australia

Sub-Specialty Training in Reproductive Medicine & Surgery
Cambridge University Hospitals, 2013-2015

Doctor of Medicine (MD)
University of Manchester, 2011-2014
Thesis: The Role of Anti-Müllerian Hormone in Assisted Reproduction in Women

Scientific Work on Egg Reserve & AMH
High Impact Journal Articles: 9
Textbook Chapters: 2
International Conference Presentations: 17

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