Trends in Anti-Müllerian Hormone (AMH) Testing for Fertility Assessment in Australian General Practice, 2011-2021: A Retrospective Open Cohort Study

BACKGROUND: Anti-Müllerian hormone (AMH) tests are often promoted as a measure of fertility; however, AMH adds limited predictive value beyond age alone for estimating the likelihood of live birth in couples trying to conceive. AIMS: This study aimed to examine longitudinal trends in the rate of AMH testing for fertility in the Australian general practice setting. MATERIALS AND METHODS: Retrospective open cohort study of 1,393,931 females aged 20-44 years attending Australian general practices between 2011 and 2021 using the national general practice database, MedicineInsight. Free text 'test reason' fields were examined to identify AMH tests ordered by General Practitioners for fertility assessment. We calculated age-standardised annual prevalence rates for AMH tests overall, as well as stratified by age group and concession card status. To examine between-practice variation, the intraclass correlation coefficient (ICC) was estimated using a two-level logistic regression model. RESULTS: The annual age-standardised prevalence of AMH test requests increased from 0.32 per 1000 females in 2011 to 4.33 per 1000 females in 2021. AMH testing was more common among those residing in a major city and of higher socioeconomic status, but less common among concession card holders. Following adjustment for patient case-mix, 21% (95% CI 18%-24%) of observed variation in AMH testing was attributable to differences between practices, with 45/423 (10.6%) of general practices having no patients with an AMH test. CONCLUSIONS: The noted substantial increase in clinical and consumer demand for AMH testing does not appear to be evidence-based, with substantial patient- and practice-level variation in testing evident.