http://theafa.typepad.com/theafablog/2010/07/the-amh-test-a-good-or-a-bad-thing-one-womans-take-on-the-debate-across-the-pond.html - see this link to the same on the AFA Blog
There has been a lot of discussion in the United Kingdom media over the last month as to the use of the AMH test. Two new uses are suggested: one is as a predictive tool for women to know when they will hit menopause and to be able to decide therefore when to try for a family; the other is for the National Health Service (NHS) to use as the deciding factor on whether the State pays for IVF treatment or not. Currently age is one of the key criteria applied.
With respect to the latter, some of the concerns are financial and political relating to a person's view as to whether fertility treatment should be paid for by the State or not. (It should be noted that the State discounts monies from each working person's income to contribute to the pot to pay for health coverage for all.) People fear that this will open floodgates to more IVF being provided by the State and in many cases people don't feel that it should be covered in the first place, and that couples should pay for it themselves. The arguments aren't dissimilar to those in the USA regarding how contributions to insurance schemes should be applied.
The other concerns however relate to how the AMH test result will be used by women. Will they rely too much on this result and forget the other factors which may affect their fertility? A woman with a good AMH number may assume she can delay having children into her late thirties and forget that there are other relevant factors – e.g. as she gets older the quality of her eggs reduces, there is a greater risk of chromosomal defects, miscarriages are more of a risk. The best age physically to have a child is between 18 and 30 apparently, and while in today's world it isn't always possible to have children in that bracket, it isn't necessarily a good idea to put off having children much past thirty or thirty five if you can help it. The fear is that over reliance on the AMH result will exacerbate the modern problem of couples electing to delay child-birth later than they should.
So is AMH testing a good or a bad thing?
I don't propose to try and discuss whether it should be used as criteria for determining who gets State paid IVF and who doesn't. That is one for the politicians and medical professionals to decide. My only observation is that fertility is a very complicated issue, and someone with a low AMH isn't always the poor responder, so it is dangerous to be overly simplistic in the evaluation criteria.
In relation to how an AMH test can help women to understand how fertile she is, though, I do think it is a good thing. But with one huge caveat; which is this:
It has to be relayed and given to women in the correct factual context. You can't just say to a woman that she has a good AMH number and allow her to think that she should be fine to delay having a family if she wants to. She needs to be given all the other relevant facts and risks and be told that this is just one indicator as to her fertility. There are many others risks and factors which are relevant and so that she cannot rely only on a good AMH. She has to be told to not ignore all the other risks that come with age – for example if she has fibroids or endometriosis, this could be more of a complication as the years go on. And further, she should be reminded that even if she is absolutely fine it doesn’t rule out that her partner/husband may have issues – male fertility problems are the sole cause of at least a third of cases.
Any initiative which enables women to be more aware of her fertility from early on, as opposed to having an unpleasant surprise when it may be too late, has to be a positive thing in my opinion. But she needs to be made to understand her AMH number in the context of all of the other risk factors that come with age and fertility. And that she is only half of the equation, albeit an important half. And while presently AMH testing seems to be less popular in the US than in the UK, in our modern world of internet, ideas can cross the pond pretty swiftly. So everyone needs to be aware of this as it relates to an issue which applies to all couples, irrespective of their nation. The goal is the same – reducing the number of infertility cases and improving education on fertility.
There has been a lot of discussion in the United Kingdom media over the last month as to the use of the AMH test. Two new uses are suggested: one is as a predictive tool for women to know when they will hit menopause and to be able to decide therefore when to try for a family; the other is for the National Health Service (NHS) to use as the deciding factor on whether the State pays for IVF treatment or not. Currently age is one of the key criteria applied.
With respect to the latter, some of the concerns are financial and political relating to a person's view as to whether fertility treatment should be paid for by the State or not. (It should be noted that the State discounts monies from each working person's income to contribute to the pot to pay for health coverage for all.) People fear that this will open floodgates to more IVF being provided by the State and in many cases people don't feel that it should be covered in the first place, and that couples should pay for it themselves. The arguments aren't dissimilar to those in the USA regarding how contributions to insurance schemes should be applied.
The other concerns however relate to how the AMH test result will be used by women. Will they rely too much on this result and forget the other factors which may affect their fertility? A woman with a good AMH number may assume she can delay having children into her late thirties and forget that there are other relevant factors – e.g. as she gets older the quality of her eggs reduces, there is a greater risk of chromosomal defects, miscarriages are more of a risk. The best age physically to have a child is between 18 and 30 apparently, and while in today's world it isn't always possible to have children in that bracket, it isn't necessarily a good idea to put off having children much past thirty or thirty five if you can help it. The fear is that over reliance on the AMH result will exacerbate the modern problem of couples electing to delay child-birth later than they should.
So is AMH testing a good or a bad thing?
I don't propose to try and discuss whether it should be used as criteria for determining who gets State paid IVF and who doesn't. That is one for the politicians and medical professionals to decide. My only observation is that fertility is a very complicated issue, and someone with a low AMH isn't always the poor responder, so it is dangerous to be overly simplistic in the evaluation criteria.
In relation to how an AMH test can help women to understand how fertile she is, though, I do think it is a good thing. But with one huge caveat; which is this:
It has to be relayed and given to women in the correct factual context. You can't just say to a woman that she has a good AMH number and allow her to think that she should be fine to delay having a family if she wants to. She needs to be given all the other relevant facts and risks and be told that this is just one indicator as to her fertility. There are many others risks and factors which are relevant and so that she cannot rely only on a good AMH. She has to be told to not ignore all the other risks that come with age – for example if she has fibroids or endometriosis, this could be more of a complication as the years go on. And further, she should be reminded that even if she is absolutely fine it doesn’t rule out that her partner/husband may have issues – male fertility problems are the sole cause of at least a third of cases.
Any initiative which enables women to be more aware of her fertility from early on, as opposed to having an unpleasant surprise when it may be too late, has to be a positive thing in my opinion. But she needs to be made to understand her AMH number in the context of all of the other risk factors that come with age and fertility. And that she is only half of the equation, albeit an important half. And while presently AMH testing seems to be less popular in the US than in the UK, in our modern world of internet, ideas can cross the pond pretty swiftly. So everyone needs to be aware of this as it relates to an issue which applies to all couples, irrespective of their nation. The goal is the same – reducing the number of infertility cases and improving education on fertility.
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