This afternoon I gave two lectures at a family medicine conference. During the question period there was considerable interest in Anti-Mullerian Hormone (AMH) testing. If family doctors want to learn more about AMH, others probably do too.

There are lots of causes of infertility and most of them we can treat except low egg number. As egg number declines, so does egg quality and hence fertility. Lower quality eggs are hard to fertilize and are more often genetically abnormal, so any embryo that does come from these eggs is likely of low quality and unlikely to result in a pregnancy. This means it's quite important to identify women with low egg numbers so we can intervene (e.g. IVF) to help them conceive before the egg count is too low for a pregnancy to occur. Egg count is referred to as "ovarian reserve."

The three best tests of ovarian reserve are:

• day 3 FSH and estradiol blood test
• AMH blood test
• transvaginal ultrasound to assess the antral follicle count (AFC)

All three tests are available to us, but the AMH level is not covered by our provincial health plan. It costs about $150 at Lifelabs or BC Biomedical to have it done. AMH can be done on any day of the menstrual cycle and is not only predictive of fertility and response to IVF but also can roughly predict when a woman will enter menopause. Furthermore, it doesn't fluctuate like FSH and estradiol levels can.

I do not send every patient for an AMH, though many infertility doctors do. I find it most helpful if the day 3 FSH and estradiol and/or the AFC is completely normal. In the future, when our provincial health plan covers AMH, I will send patients for an AMH instead of day 3 FSH and estradiol levels for the reasons listed above.

Information is our key to making good decisions on fertility treatments. Knowing your ovarian reserve is one of the best pieces of information you can have if you are trying to conceive.