Episode 3 - AMH, interpreting results and next steps - Dr Andrew Wong

Anti-Müllerian hormone (AMH) testing has become one of the most commonly ordered fertility investigations in general practice. It is accessible, relatively inexpensive, and gives a measurable indication of a woman's ovarian reserve - the number of eggs remaining in the ovaries. But as its use has grown, so too has the potential for misinterpretation. A low AMH result does not mean a patient cannot conceive naturally. A normal AMH does not guarantee fertility. And the clinical decisions that follow an AMH result are rarely straightforward.

In this episode of Fertility in General Practice, Dr Andrew Wong - obstetrician, gynaecologist and fertility specialist at Genea Orange - joins host Dr Ali Hodgkinson to cut through the uncertainty around AMH testing. He addresses how GPs can use AMH as a meaningful part of the clinical picture, what the results do and do not indicate, and how to have clear, honest conversations with patients about what comes next.

AMH is produced by small follicles in the ovaries and reflects the size of the remaining egg pool - what clinicians refer to as ovarian reserve. It is useful because it is relatively stable across the menstrual cycle, can be tested at any time of the month, and correlates reasonably well with how a patient is likely to respond to ovarian stimulation during an IVF cycle.

What AMH does not measure is egg quality. A patient with a low AMH may still have eggs of good quality; a patient with a high AMH is not necessarily more likely to conceive. Age remains the strongest predictor of egg quality, and it is important that GPs contextualise AMH results alongside the patient's age rather than treating the number in isolation.

AMH results are also influenced by factors including hormonal contraception (which can suppress AMH levels), vitamin D status, and certain medical conditions such as polycystic ovary syndrome (PCOS), which can artificially elevate AMH. A high AMH result in the context of PCOS does not reflect a fertility advantage - it reflects a higher number of small, often anovulatory follicles.

Dr Andrew Wong brings over three decades of regional fertility practice to this conversation, along with a clear, myth-busting approach to one of the most misunderstood tests in general practice. If AMH results are a regular source of patient questions in your clinic, this episode is essential listening.