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Is there a test to determine how fertile you are?

Author: Professor Joyce Harper

4 years ago 0
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For many years, some companies and IVF clinics have been marketing a test for women that they say can determine how fertile a woman is, even though there has been no evidence that the test is reliable. Such a test might give false hope to some women that they can delay starting a family as they are still very fertile. But no matter what the results are of the test, most doctors will say the same thing – start your family as soon as possible. So why do the test?

Globally women are delaying having children for many social reasons.  The average age of first conception in the UK is 29 years.  But from our mid 30s our fertility declines and the rate it declines varies greatly between women, so we cannot simply use age as a predictor of our fertility potential.  Some women will not be able to conceive naturally from their late 30s, whilst some still have a chance up to their mid 40s.

A woman’s ovarian reserve is the capacity of her ovary to provide eggs that are capable of producing a pregnancy.  The ovarian reserve test or ‘Fertility MOT’ uses biomarkers (molecules that can be measured to determine a particular medical condition) which try to determine a woman’s fertility potential.

The ovarian reserve tests that are being marketed vary but the basic tests measures antimullerian hormone (AMH) and follicle-stimulating hormone (FSH).  Some clinics also measure serum inhibin B. 

FSH stimulates follicles (eggs) to grow.  FSH levels vary throughout the cycle as the egg is being produced and so it is normally measured during the first few days of a cycle (days 2-5) and should be around 2-8.9.  A level over 9 is an indicator of poor ovarian reserve.  As you get near the menopause, levels of FSH increase.

AMH is produced by the growing follicle which contains the eggs.   It varies less through the cycle and so can be measured at any time.   AMH varies with age but should be between 3-35.  Low levels suggest a low ovarian reserve and high levels may be indicative of polycystic ovaries.

Anne Steiner of the University of North Carolina and colleagues conducted a study to determine the extent to which these tests can measure fertility potential and their results showed a low ovarian reserve is not associated with reduced fertility. The study included women aged 30 to 44 years without a history of infertility who had been trying to conceive for three months or less.  A total of 750 women provided a blood and urine sample. They concluded that “These findings do not support the use of urinary or blood follicle-stimulating hormone tests or antimullerian hormone levels to assess natural fertility for women with these characteristics.” 

IVF clinics have been offering these tests for many years as the results help the IVF doctors decide which dose of fertility drug to give, can identify poor responders and so reduce cancellation rates, and identify excessive responders which reduces the risk of hyperstimulation. 

But as I reported last year, I have never thought these tests should be used to give women information about their fertility potential – “should women have a fertility tests before they reach 30?”  And in the British Fertility Guide called ‘what exactly is ovarian reserve?” it states “It is important to remember that these tests were developed to inform IVF treatment and not your natural fertility. Many women with low ovarian reserve will conceive without any problems whilst others with a good ovarian reserve may take time and need fertility treatment. Their increasing use as a ‘fertility MOT’ test to reassure women that their fertility is normal or that they should consider treatment sooner rather than later is open to interpretation.”

There are numerous tests on the market that claim to measure your fertility potential.  They range in price from £7.00 to £150.00 and they usually either measure AMH or FSH.

One test on Amazon is the “Womens Fertility Home Testing Kit – UK Accredited Lab Test”.  It claims “Atimullerian Hormone Test – is for women wishing to check their fertility hormone levels at home. Levels of antimullerian hormone are a useful indicator of ovarian reserve in women over 30 years of age. Higher levels correlate with higher rates of natural fertility. This is the standard first-line test for fertility in women.”  And then goes on to say this test is ‘ it is recommended for anyone who is concerned about their colesterol levels.”  Note the spelling mistakes!!  I have no idea what the reference to cholesterol is about.

Another test on Amazon is the “Babystart FertilCheck Female Fertility Test Midstream” which just measures FSH.  It claims their test “measures the sex hormone that is an indicator of a their biological fertility clock.”

So unfortunately there is currently no predictor of our fertility potential. Before we pay for any medical test, we need to think about the evidence that such a test is useful and that it is measuring the right things. And the best advice is – if you are thinking of starting a family (or are thinking of freezing your eggs), it is better to do it sooner rather than later.

Read More:

Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age, Anne Z. Steiner, MD, MPH1; David Pritchard, MS2; Frank Z. Stanczyk, PhD3; et al. JAMA. 2017;318(14):1367-1376. doi:10.1001/jama.2017.14588

Global women – Should women have a fertility check before they reach 30?

British Fertility Society – what exactly is ovarian reserve?

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