Fertility potential reflects a woman’s likelihood of becoming pregnant. This is important to consider when you’re trying to become pregnant or thinking about procedures like egg freezing — but it’s a potentially confusing topic for many women.
While your OB-GYN and primary care physician can walk you through prenatal care and the basics, much of the advice around testing, cycle tracking and decisions to pursue fertility treatments such as in vitro fertilization (IVF) come straight from friends and the internet — sometimes popping into your email or social media streams without ever asking for it.
Direct-to-consumer fertility testing is meant to empower women with knowledge of their reproductive potential, to understand their own bodies and to inform them about opportunities to preserve their fertility.
As a reproductive-aged woman who delayed pregnancy while pursuing my career, I understand the appeal. Add the option to order this online, without scheduling an appointment or stepping foot in a medical office or lab — as is true for many of these direct-to-consumer testing options — and I just might click to order straight from an Instagram story.
However, as a reproductive endocrinologist who cares for women with infertility and offers fertility preservation procedures like egg freezing, I know that these tests are not without potential pitfalls.
A commonly offered fertility test measures the levels of anti-mullerian hormone (AMH). This hormone, secreted by the small resting follicles in the ovary, helps a medical team predict your response to fertility treatments. However, a woman’s AMH does not guarantee that she can get pregnant and must be interpreted in the context of additional factors to best guide care and assist in decision-making. These additional factors are things like how old the woman is, whether she has at least one open fallopian tube, and the quality of a male partner or donor’s sperm. These factors are inadequately assessed with at-home testing options.
For example, consider a 27-year-old woman who pursues a direct-to-consumer test to better understand her fertility potential and learns she has a low AMH. She will now be prompted to pursue egg freezing. If she anticipates a lower response to fertility treatments, as might be expected with a low AMH, she may complete multiple egg freezing cycles to have a “good number” of eggs frozen. It is possible that this same woman may meet her future partner tomorrow and successfully achieve her desired number of biologic children without assistance. While potentially offering peace of mind, these egg freezing procedures and the more than $10,000 she spent were, in hindsight, unnecessary.
Conversely, imagine a 40-year-old woman who is falsely reassured by her “normal AMH” and unaware of the impact of age on reproductive outcomes. She may delay further fertility evaluation and treatment. This delay may limit her options in the future and ultimately her chances of a successful pregnancy.
The goal of all health care providers and direct-to-consumer testing companies should be to empower women, to offer affordable and approachable fertility testing options, and to expedite opportunities for fertility care. But to minimize the real risk of over- or undertreatment and to offer a more complete understanding of fertility potential, fertility tests are best interpreted with a health care team trained in fertility evaluation and treatment.
