Medically reviewed by Dr. Farhan Mukhtar, M.B.B.S., M.Phil (Pb.), Consultant Chemical Pathologist, Al-Nasar Lab & Diagnostic Centre. Updated September 2026.
Quick answer: AMH, or Anti-Mullerian Hormone, reflects how many eggs remain in the ovaries. It can be tested on any day of the cycle, unlike most fertility hormones which must be taken on day 2 or 3. The crucial distinction: AMH indicates egg quantity, not egg quality, and it does not tell you whether you can conceive naturally.
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Which hormones are tested, and when?
| Test | When in the cycle | What it shows |
|---|---|---|
| AMH | Any day | Ovarian reserve, meaning remaining egg quantity |
| FSH | Day 2 or 3 | How hard the body is working to recruit an egg. A high level suggests reduced reserve |
| LH | Day 2 or 3 | Interpreted with FSH. A raised LH to FSH ratio can point to PCOS |
| Estradiol (E2) | Day 2 or 3 | Needed to interpret FSH correctly, as a high E2 can falsely lower FSH |
| Progesterone | Day 21, or 7 days before the next period | Confirms whether ovulation actually occurred |
| Prolactin | Any day, morning, rested | A raised level disrupts ovulation and is treatable |
| TSH and thyroid | Any day | Thyroid disorders disrupt cycles and affect pregnancy |
| Testosterone and DHEAS | Any day | Raised levels support a PCOS diagnosis |
Day 2 means the second day of full bleeding, not spotting, counting the first day of proper flow as day 1. Getting this wrong is the most common reason fertility bloods have to be repeated.
What does AMH actually tell you?
AMH is produced by the small developing follicles in the ovaries. The more of those you have, the higher the level. It therefore acts as a measure of ovarian reserve, the size of the remaining egg pool.
It has two practical advantages over older tests. It can be taken on any day of the cycle, and it is relatively stable from month to month, whereas FSH swings considerably.
But AMH is widely misunderstood, so it is worth being precise about what it does not do.
- It does not measure egg quality. Quality is determined largely by age. A woman of 40 with a high AMH still has 40 year old eggs
- It does not predict whether you can conceive naturally. Women with low AMH conceive naturally, and women with normal AMH sometimes do not. Only one egg per cycle is needed
- It does not tell you when menopause will happen, though a very low level suggests it may be closer
Where AMH genuinely earns its place is in predicting response to IVF stimulation. It helps a fertility specialist choose the drug dose and anticipate how many eggs are likely to be collected. That is its real clinical value.
How is AMH interpreted?
- Low: reduced ovarian reserve. Fewer eggs likely to be retrieved in IVF. Not a statement that pregnancy is impossible
- Normal: reserve appropriate for age
- High: often seen in polycystic ovary syndrome, where many small follicles are present. A high AMH is a supporting finding for PCOS and also flags a risk of over response to IVF stimulation
Reference ranges vary by laboratory, assay and age band, and units differ between ng/mL and pmol/L. Always read the range printed on your own report, and use the same laboratory for repeat testing.
One practical point: hormonal contraception can lower AMH modestly. If you have recently stopped the pill, mention it, as the result may under represent your true reserve.
Why is progesterone on day 21 important?
Because it answers a different question from all the others. FSH, LH and AMH describe the ovarian reserve. Day 21 progesterone confirms whether an egg was actually released.
Progesterone rises only after ovulation. A raised mid luteal level confirms it happened. A low one suggests it did not, which is a common and treatable cause of difficulty conceiving.
The name is slightly misleading. It should be taken seven days before the expected period, not rigidly on day 21. For a 28 day cycle those coincide. For a 35 day cycle the correct day is 28, and testing on day 21 will produce a misleadingly low result in a woman who is ovulating perfectly well.
When should fertility hormones be tested?
- Trying to conceive for 12 months without success, or 6 months if you are over 35
- Irregular or absent periods
- Suspected PCOS, particularly with irregular cycles, acne or excess hair growth
- Before starting IVF or other fertility treatment
- Recurrent miscarriage
- Before planned egg freezing
- Symptoms suggesting early menopause under 40
- Before certain cancer treatments that affect ovarian reserve
One point worth stating plainly: a male factor contributes in roughly half of couples having difficulty conceiving. Testing the woman extensively while the man is untested is a common and avoidable mistake. A semen analysis is simple, inexpensive and should be done early.
What else is usually checked?
Fertility assessment is rarely hormones alone. Commonly included are:
- Thyroid function, since even mild dysfunction affects cycles and pregnancy
- Vitamin D, commonly deficient and relevant to pregnancy outcomes
- Blood sugar and HbA1c, particularly where PCOS or insulin resistance is suspected
- Blood group and Rh factor
- Thalassemia carrier screening for both partners
- A pelvic ultrasound, which counts the antral follicles and assesses the uterus and ovaries directly
How to prepare
- Know your cycle day. Day 1 is the first day of proper bleeding. Tell the laboratory which day you are on
- AMH needs no particular day and no fasting
- Prolactin should be a morning sample, taken after sitting quietly for a while, since stress and recent exercise raise it
- Mention hormonal contraception, fertility medicines or any hormone treatment
- Mention pregnancy or breastfeeding
- Use the same laboratory for repeat testing, as assay differences are substantial
Fertility testing at Al-Nasar Lab
Al-Nasar Lab & Diagnostic Centre has provided laboratory and imaging services in Lahore since 1996 and holds ISO 15189:2022 accreditation from the Pakistan National Accreditation Council. AMH, FSH, LH, estradiol, progesterone, prolactin and thyroid testing are all available, with home sample collection across Lahore.
Because fertility assessment usually needs both bloods and a scan, having laboratory testing and ultrasound on the same Johar Town campus means both can often be completed in one visit. See our accreditations, find your nearest collection centre, or contact us to book.
Frequently Asked Questions
Can AMH be tested on any day of the cycle?
Yes. Unlike FSH, LH and estradiol, which need day 2 or 3, AMH is stable through the cycle and needs no particular day or fasting.
Does a low AMH mean I cannot get pregnant?
No. AMH measures how many eggs remain, not whether you can conceive. Women with low AMH do conceive naturally, since only one egg is needed each cycle.
What does a high AMH mean?
It is often seen in polycystic ovary syndrome, where many small follicles are present. It also flags a risk of over responding to IVF stimulation.
Which day should progesterone be tested?
Seven days before your expected period, not rigidly day 21. In a long cycle, testing on day 21 gives a falsely low result.
Should my husband be tested too?
Yes, early. A male factor contributes in around half of couples with difficulty conceiving, and a semen analysis is simple and inexpensive.
This article is for general information and is not a substitute for medical advice. Please discuss your results with a qualified doctor or fertility specialist.
