At-Home Fertility Tests and AMH: What They Cannot Tell You

What is being sold

Direct-to-consumer fertility testing has become a substantial market: postal hormone panels, clinic "fertility MOTs", subscription hormone tracking, and at-home semen tests. The pitch is usually some version of knowing your numbers, or checking your egg count, so that you can plan.

The HFEA describes what a fertility MOT actually is: an assessment of ovarian reserve — the number and quality of eggs — by testing for two hormones, follicle stimulating hormone and anti-Müllerian hormone. It adds the qualification that matters: the tests can give some indication of how fertile a woman is, although the results are not guaranteed.

The gap between that and the marketing is where the money is.

What NICE actually recommends

NG257 was updated in 2026 and its recommendations on ovarian reserve testing are precise. Read them together, because they only make sense as a set.

• Use maternal age as an initial predictor of the overall chance of becoming pregnant through spontaneous conception, or with IVF.
• Do not use anti-Müllerian hormone measurement as a predictor of clinical pregnancy through spontaneous conception.
• Use AMH measurement or antral follicle count as predictors of ovarian response, to inform clinical decision-making and counselling about the likelihood of live birth following assisted conception.
• Do not use follicle stimulating hormone measurement as a predictor of ovarian response or the outcome of assisted conception.

Put plainly: AMH is a useful test if you are having IVF, because it helps predict how your ovaries will respond to stimulation and therefore how many eggs might be collected. It is not a test of whether you will conceive naturally this year. And FSH, which is included in most commercial panels, is not recommended even for the purpose the panels imply.

Quantity is not the same as quality

This is the conceptual error the marketing depends on. Ovarian reserve tests estimate how many eggs are likely to be available. They say nothing about whether those eggs are chromosomally normal, and it is chromosomal normality that drives both the chance of conception and the chance of miscarriage.

The best available proxy for egg quality is age, which is exactly why NICE names maternal age as the initial predictor. A low AMH result at 32 and a low AMH result at 42 do not mean the same thing, because the ages do not mean the same thing. A reassuringly high AMH at 42 does not make the eggs younger.

This cuts both ways, and both are harmful. A low result can produce panic, rushed decisions and expensive treatment that was not indicated. A normal result can produce false reassurance and delay in someone who has an entirely different problem — blocked tubes, or a male factor — that the panel never tested for.

What a real work-up contains

The contrast is instructive. NICE's investigation set is short, and most of it is not in a postal kit.

• Semen analysis for a male partner, compared against WHO reference values, with a repeat if abnormal — ideally at three months, unless azoospermia or severe oligozoospermia is found, in which case sooner. Male factors are involved in around 30% of couples.
• Mid-luteal serum progesterone to confirm ovulation, even where cycles are regular, timed to your cycle length rather than to day 21 by default, and repeated weekly until the next period where cycles are long.
• Serum gonadotrophins where cycles are irregular.
• Tubal assessment — hysterosalpingography where there are no relevant comorbidities, or laparoscopy and dye where there are.
• Chlamydia screening before instrumentation of the uterus.

Tubal patency cannot be assessed by any home test. Neither can uterine anatomy. NICE also recommends against routine post-coital testing of cervical mucus, because it has no predictive value on pregnancy rate — a useful reminder that not every test that can be done should be.

Home semen tests

These usually measure a single parameter, most often concentration. A semen analysis assesses volume, concentration, total sperm number, total and progressive motility, vitality and morphology, and NICE reproduces the WHO reference values for each. A device that reports one of those can be normal while the sample is abnormal on others.

The practical harm is delay. A reassuring home result can postpone a proper analysis by months in a situation where male factor is the actual explanation, and where a single laboratory test would have resolved it.

When these tests are worth having

There are real uses. If you are considering egg freezing, AMH or antral follicle count informs the conversation about how many eggs might be collected. If you are about to start IVF, the same tests inform the stimulation protocol and expectations. If you are having medical treatment likely to affect fertility, testing is part of planning preservation.

What they do not do is function as a screening test for the general population, and NICE's wording — do not use AMH as a predictor of clinical pregnancy through spontaneous conception — is not ambiguous.

If you have already had a worrying result

Take it to a clinician rather than to a search engine, and ask three questions: what does this result mean for my age specifically, what would change based on it, and what has not been tested. A private panel that produced a frightening number has usually not assessed your tubes, your partner, or whether you are ovulating.

The thresholds for seeking a full assessment have not changed: after a year of trying, or six months if you are 36 or over, or sooner if you have irregular or absent periods, a known condition such as PCOS or endometriosis, previous pelvic infection or surgery, previous cancer treatment, or repeated miscarriage. That pathway is free in most of the UK, it tests things a kit cannot, and it is the one NICE actually recommends.