Anti-Mullerian hormone (AMH)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Planning ovarian stimulation protocols in women undergoing assisted reproduction at a fertility clinic [2]
• —As an alternative to pelvic ultrasound within the PCOS diagnostic algorithm, in adults only, alongside the other required diagnostic criteria [4]

Not indicated when

• —Predicting natural fertility or 'time left' in a woman not seeking fertility treatment: a large prospective cohort found low AMH was not associated with reduced fecundability [1], and ACOG states this use 'is not currently supported by data from high-quality sources' [2]
• —Diagnosing premature ovarian insufficiency: NICE specifically advises against routine use of AMH for this [3]
• —General wellness 'egg count' screening with no fertility treatment or PCOS assessment in view

Why not

In a prospective cohort of 981 women aged 30-44 trying to conceive, women with low AMH did not have a significantly different probability of conceiving than women with normal AMH, and the authors concluded these biomarkers should not be used to assess natural fertility [1]. ACOG's committee opinion agrees that using AMH for fertility counselling in a woman without an infertility diagnosis is not supported by high-quality data [2], and NICE advises against using it to diagnose premature ovarian insufficiency [3]. A low result in a woman not trying to conceive can cause significant worry, or prompt premature decisions about fertility treatment or family planning, without good evidence it predicts her actual chance of pregnancy.

Better first step

If fertility is an active concern, refer to or involve a fertility specialist for a full assessment, of which AMH may be one part when planning treatment, rather than ordering AMH alone as a stand-alone 'egg count' or reassurance test.

Typical ND rationale

An ND may order AMH for a woman asking how much reproductive time she has left, or as part of a PCOS work-up, reasoning that it is a simple, convenient blood test that reflects ovarian reserve and can inform family-planning decisions or support a PCOS diagnosis.

Ontario coverage & CONO orderability

OHIP status

uninsured

AMH is not listed by name anywhere in the 2026 Schedule of Benefits for Laboratory Services (confirmed by direct review of the Schedule text), so its OHIP status when physician-ordered could not be established from that source. A secondary Ontario source, a private lab-test ordering service, lists it as 'Not listed in OHIP SOB. Coverage depends on clinical context' [6], consistent with its absence from the Schedule but not a definitive government statement. ND-ordered testing is patient-paid regardless [8]. Coverage update (reconciliation pass): LifeLabs' Non-OHIP Billable Test List (2025, republished by an Ontario hospital lab) lists this test as patient-paid in community labs. This is secondary evidence, not a ministry statement.

CONO orderable

Yes — CONO list #19

CONO list item 19, blood: 'Anti-Mullerian Hormone (AMH).' No saliva or urine variant is listed.

Linked conditions

• pcos ↗

Counselling script

“AMH is a real, useful test at a fertility clinic, and it can also help diagnose PCOS. On its own, though, it's not a good way to predict your natural fertility. A large study found that women with low AMH conceived just as often as women with normal levels. If fertility is a real concern, I'd rather refer you for proper assessment than order this test in isolation.”

Revisit if

• —Patient begins actively pursuing fertility treatment (refer to fertility specialist)
• —PCOS is being formally assessed using the current diagnostic criteria

References

1. [1]JAMA (2017). Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. linkWomen with low AMH values did not have a significantly different probability of conceiving than women with normal values; findings do not support using AMH to assess natural fertility
2. [2]American College of Obstetricians and Gynecologists (2019). Committee Opinion No. 773: The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care. linkUsing AMH for fertility counselling in women without a diagnosis of infertility is not currently supported by data from high-quality sources
3. [3]NICE (2026). Menopause: identification and management (NG23) (published 2015, last updated 15 April 2026). linkDo not routinely use anti-Mullerian hormone testing to diagnose premature ovarian insufficiency
4. [4]International PCOS network (ESHRE/ASRM-led, Teede et al.) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. linkThe 2023 international PCOS guideline added AMH as an alternative to ultrasound within the PCOS diagnostic algorithm, in adults only
5. [5]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkDirect review of the full 2026 Schedule text found no line item named AMH or anti-Mullerian hormone
6. [6]TeleTest (private lab-test ordering service, Ontario) (2026). AMH (Ovarian Reserve) Cost in Canada. linkSecondary Ontario lab-pricing source: AMH not listed in the OHIP Schedule of Benefits, coverage depends on clinical context
7. [7]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
8. [8]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
9. [9]LifeLabs (republished by Norfolk General Hospital laboratory) (2025). LifeLabs Non-OHIP Billable Test List (republished by Norfolk General Hospital laboratory, effective 2025). linkListed as a non-OHIP (patient-paid) test at LifeLabs Ontario, 2025