Cheryl Phua on why AMH blood test should be covered by Medicare

Fertility specialist Cheryl Phua explains why she doesn’t think it’s fair that this test, used by women, isn’t covered by Medicare — and why it should change.

This $90 test that helps women is not covered by Medicare – and I think that’s extremely sexist.

I’m talking about the Anti-Müllerian Hormone (AMH) test, also known as the egg timer test.

It is a blood test that helps women considering fertility treatment get a guide about how many eggs they could retrieve from a cycle.

Cheryl Phua, a respected fertility specialist, believes it is sexist the AMH test is not covered by Medicare.

I think it’s sad that it’s not covered by the government and lets women down.

By contrast the prostate-specific antigen (PSA) test which screens for prostate cancer for example, is covered by Medicare.

The AMH test should be covered, too, in my opinion.

What is an AMH test and why is it controversial?

This simple blood test has become controversial because it is too often promoted on social media to be a predictor of fertility.

That’s the wrong message to be sending and it is sad women are worrying about their results or correlating it to their fertility status.

Fertility is complex and it certainly does not do that.

The AMH test is also known as the egg timer test.

The AMH test – which measures a hormone secreted by cells in the ovaries – only gives you an indication of the pool of eggs you have left, or your ovarian reserve.

It does not predict your likelihood of getting pregnant or how long it will take you to conceive.

It also gives no indication of your egg quality and also can’t tell you when you will go into menopause.

What you should know about your count if you get an AMH test

Every woman is born with a finite number of eggs.

You will typically lose up to 1000 each month during ovulation.

If there are less eggs in the ovaries, your AMH levels will be lower.

That’s why the AMH is a really useful guide to show how many eggs a woman may get from an IVF cycle or round of egg freezing after stimulation.

AMH levels typically peak when a woman is 25 and start to go down after that.

The AMH will lower with time because women release eggs and the reserve is constantly declining.

For a 30-year-old the median AMH count is about 20 pmol/L.

For someone who is 35 it is about 14 pmol/L.

The AMH test helps someone know their ovarian reserve, but it is not a predictor of fertility.

When a woman has gone through menopause the hormone will usually be undetectable because there are no eggs in the ovaries.

It doesn’t matter when in your cycle you do an AMH test, it will remain pretty consistent.

That’s different to an ultrasound which is used to measure the number of follicles during a particular time of your cycle.

This does vary from month to month and is best to do on day 2 to 5 of your period.

Each follicle, contained within the ovaries, may contain an egg that can be released.

So if you have 12 follicles on a particular cycle, then you may get a maximum of 12 eggs from a round of IVF if they all mature.

It is really important to remember that not every follicle will have an egg and eggs cannot be seen on an ultrasound, sadly.

How fast will your AMH drop?

It can be unpredictable how fast your AMH levels will drop.

I’ve had patients come in and see me who have a really awesome count so they think they have plenty of time to have a baby, but then they’ve come back and it’s dropped a lot more than expected in that time frame.

Long-term pill use in some women can reduce the count by 30 per cent, which is usually reversible.

Women who are on the pill and are worried about their AMH level have the option to stop the pill and repeat the test again three months later to see if it’s gone up.

When should you have an AMH test?

Women who undergo IVF or egg freezing will generally always do an AMH test before starting treatment.

If you’re thinking of conceiving and having troubles, definitely go to see your GP or specialist and talk about if an AMH test is right for you.

Someone who is curious about their fertility window could also get one and if their AMH is low it might make them consider starting a family sooner rather than later if they are in a position to.

Dr Cheryl Phua is a distinguished specialist offering personalised fertility and gynaecological care with IVF Australia in Sydney. She is also among the 5 per cent of gynaecologists and obstetricians with a subspecialty in reproductive endocrinology, which focuses on hormone health, fertility assessments and therapeutic options.

You can follow her on Instagram at @drcherylphua

Originally published as Cheryl Phua on why AMH blood test should be covered by Medicare