Have you ever come across something called the “egg timer test”?
A while ago we wrote an article about it. It’s a nickname given to the anti-mullerian hormone (AMH) test, and it is used to assess a woman’s suitability for IVF treatment. But there have been concerns about the use of this test by women more generally, to give them an indication of how likely they are to get pregnant naturally.
So we invited women to share their experiences of having the test.
Here are a few of the stories we received.
Nicole was a professional woman in her late 20s, in a relationship with a man who was much older than her, when she came across the egg timer fertility test.
He wanted to have children one day, but this was not something on Nicole’s agenda.
“In my head I didn’t really think I was going to even have children,” she says.
But the subject didn’t go away.
“As our relationship progressed I thought this might be a sticking point,” Nicole says.
At the time she noticed some media reports about a blood test that could, it was claimed, tell you how much time you had left to have children — the so-called “egg timer test”.
Nicole thought it would be useful to do the test. She hoped it would buy her some time, or put the subject off the agenda once and for all. So off she went to the GP to ask for one.
Her results were very low. The test measures the level of anti-mullerian hormone (AMH), which is secreted by ovarian follicles, and gives an indication of the number of eggs a woman has.
The doctor told her she would have difficulty conceiving and immediately referred her to an IVF clinic.
“I remember leaving the GP — it was my lunch break at work — and I couldn’t go back to work,” Nicole says.
What ensued were some “really hard conversations”, which even included discussing the idea of her partner going to have children with someone else.
After a whole lot of tests that all “came out fine”, the fertility specialist suggested the couple should try to conceive naturally.
After two months of trying, Nicole got pregnant and has since given birth twice, which she says seems to be “the exact opposite of what the [AMH] test indicated”.
While she now has “two wonderful children”, Nicole feels the test gave her a false idea about how much time she had left to have them.
“I’m surprised that it’s still being marketed as ‘egg timer’,” she says.
“I feel like it’s been marketed incorrectly — at professional women like me who may want to delay having children for reasons of a career or whatever, and who think they can have this test as a bit of a security blanket, to wait for an extra couple of years.”
Melissa had an AMH test at the age of 27, after trying to conceive for a year without success.
She says discovering she had a very low result was “devastating”, especially since she thought it was too low to do IVF.
Years later, in a new relationship, Melissa had another test and got an even lower value.
“I wasn’t cycling normally, with irregular periods, and presumed the worst based on my GP’s assessment,” she says.
When Melissa changed specialists to one who “didn’t place much weight on the test”, she was encouraged to try getting pregnant anyway.
After losing one pregnancy, she had a further AMH test that came back with a puzzling normal result. Then she had a pleasant surprise.
“Within another month I was pregnant again, and now have a healthy 18-month-old,” she says.
“Ultimately the AMH test caused me a lot of unnecessary stress, contributed to my relationship breaking down, and seemingly had no predictive value for pregnancy at the end of the day.
“A number of them are now fearing the worst, creating stress, which is probably impacting on their actual fertility.”
Reason for AMH test commonly misunderstood
A number of women who wrote to the ABC said getting a low AMH result distressed them — in some cases increasing their panic about running out of time to have children.
Most women who told us they had low AMH results went on to conceive naturally despite this.
Another ended up being diagnosed as infertile despite having a good AMH result.
One woman who wrote to us was happy to have had an AMH test, as she felt it gave her information about her body she would not otherwise have.
Certainly, extremely high or low AMH levels can flag possible medical problems that need to be investigated further. But, in general, the women who wrote to us misunderstood the function of the test when they took it — believing it gave them an idea about how long they had to get pregnant naturally.
Fertility expert Dominique de Ziegler, a consultant in the gynaecology department of Paris’ Foch Hospital, emphasises that while AMH testing can indicate the number of eggs a woman has left, it does not indicate the quality of those eggs.
Professor de Ziegler says there is a lack of informed use of the test by women and doctors, and publicity about women’s declining fertility rates with age is encouraging this.
“It’s becoming more and more common because people are scared of not being able to conceive,” he says.
This is not helped by websites that potentially mislead people about the proper use of the test.
Information about AMH testing on some IVF clinic and pathology websites — and in online women’s magazines and newspaper articles — suggests doing the test can either give a woman peace of mind, or tell her whether her time to have children is running out.
According to fertility expert Karin Hammarberg, from Monash University, it’s important to be properly informed about what a test does and to think carefully before having it done.
“Just because a test is there it doesn’t mean we should always use it,” she says.
Some women who wrote to us said they were not counselled properly about the purpose of the test.
“Sometimes people don’t want to be faced with the decision it raises,” Dr Hammarberg says.
“And in some instances it may make things worse.”
Melanie started trying for a baby at the age of 38. It only took her four months to conceive, but she miscarried. She fell pregnant again within two months, but again miscarried.
She had been doing some online searching about fertility and came across an IVF clinic website that mentioned the egg timer test and she believed it would tell her how much time she had.
Melanie made an appointment at the IVF clinic to have the test.
“I was there just to have the egg timer test. I didn’t want to talk about IVF or anything at that stage,” she says.
The results of the AMH test came back as being at the “lower end of the normal range” for her age and the fertility expert urged her to do IVF.
“She said ‘At your age, I wouldn’t consider anything else. I’d go straight to IVF sooner than later’,” Melanie says.
“When I got a ‘normal for your age group but at the lower end of the range’ result that was really hard to hear and not what I expected, and it influenced our decision to try IVF.”
After a few months more of trying to conceive naturally, Melanie and her partner started “getting nervous” and decided to do IVF, but it didn’t work.
Two months after stopping the IVF, at 39, she ended up conceiving again naturally. She gave birth to her first child — a healthy baby girl.
“Six months after that, at 40, I fell pregnant again without even trying!” she says.
Melanie says she now regrets taking the AMH.
“It was used by the IVF doctor to scare me into abandoning efforts to fall pregnant naturally in favour of trying IVF.”
Choosing how to spend limited time
Dr Hammarberg says miscarriages become more common in women over 35, and by age 40, 75 per cent of eggs have chromosomal abnormalities.
But, she says, one option for a woman of this age who has no problem conceiving is to just keep trying — having sex every month at ovulation time — to maximise the chance of fertilising a normal egg.
Dr Hammarberg says this would be the best approach if a woman prefers to conceive naturally, since having IVF can result in missed opportunities to conceive naturally.
But Professor de Ziegler emphasises a low AMH reading in a woman in her late 30s having miscarriages could indicate she has a limited time left to try IVF.
This is because the loss of pregnancy suggests there is a decline in the quality of eggs and a woman’s low AMH indicates an overall lower number of eggs.
“Low AMH is not a reflection of her chances to conceive naturally,” he says.
“However, with low AMH, IVF loses its efficacy. The success rate drops more rapidly in IVF than for natural pregnancy.
So as long as a woman is prepared to have IVF, an AMH test could provide useful information, Professor de Ziegler says.
“But if a woman isn’t interested in IVF, it won’t [provide useful information],” she says.
Either way, there are no guarantees — but time is of the essence for women in their late thirties.
One 27-year old single professional woman, Fiona, was recommended an AMH test after being diagnosed with endometriosis.
Dr Hammarberg says a third of women with endometriosis have fertility problems, but the condition can itself lower AMH levels.
Based on her AMH results being low for her age, Fiona was encouraged to have IVF or freeze her eggs. She says this caused her “excruciating” distress, as she felt IVF was not an option for her.
“Even if it works and I have eggs in the freezer, it doesn’t mean that I’ll have the opportunity to use them, or that it will work when I/we pay out significant funds to utilise the frozen eggs.”
A second opinion advised against IVF given the drugs involved could impact on other health issues she had. Fiona has meanwhile sought the help of a psychologist.
“I’ve decided not to have my AMH retested, because I don’t know what I will do if the level drops significantly,” Fiona says.
“It feels like it puts more pressure on my future, both to find a partner and to procreate. Children were always something I pictured — but life isn’t going to the image I had in my head, so maybe it’s time to adjust that.”