Tiffany T. got married a few months shy of her 35th birthday. She and her husband want to have kids, but they weren’t quite ready to start trying right away. Tiffany knows that it’s harder to get pregnant after 35, so at her next ob-gyn appointment, she asked her doctor about getting a fertility test.
“I thought that if I had a general sense of how plentiful my eggs were, it would help me feel better about our decision to wait,” she says. “Conversely, I decided that if the results showed I had a lower than average egg count for my age, then it would spur us to start trying earlier than we’d originally planned.”
The results showed that Tiffany’s hormone levels were normal for her age, which “reaffirmed my decision to wait a little longer before trying to start a family,” she says.
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While Tiffany went the traditional route—getting tested in a doctor’s office—fertility testing is now available in other forms, as well. Today, women can order an at-home test to measure their hormone levels; this past summer, some even opted for complimentary testing from mobile “pop-up” labs in New York City and the Hamptons. (The company behind the pop-ups, KindBody, also offers egg-freezing and IVF services.)
But even if fertility testing is more easily available than ever, does that mean all women of child-bearing age should take advantage? Some doctors say no—and if a woman does choose to be tested, they say, here are some things she should keep in mind.
There are several different types of fertility tests
When a woman has questions about her fertility, the first test doctors usually start with is a blood test to determine her levels of anti-Mullerian hormone (AMH). This hormone is released by a woman’s eggs, and these levels go down as her egg count declines with age. An AMH test can provide a good idea of how many eggs a woman has left, and how she compares with other women the same age, says Jennifer Eaton, MD, a fertility specialist and assistant professor of obstetrics and gynecology at Duke University Medical Center.
Women can get their AMH levels tested in their doctor’s office or at a lab facility, or they can order an at-home kit from a company like Modern Fertility or Let’s Get Checked. In either case, the results take a few days to be analyzed.
Blood tests for fertility can also measure levels of follicle-stimulating hormone (FSH). This number actually goes up as a woman’s egg count goes down, so it can be another indication as to whether her “ovarian reserve,” or the number of eggs she has left, is normal for her age.
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For couples who have been trying to get pregnant and haven’t succeeded, doctors will likely recommend other tests, as well. These may include other blood and urine tests, along with a hysterosalpingography—an x-ray of the uterus and fallopian tubes to check for any abnormalities or blockages. Men might also be asked to provide a semen sample, to test the quantity and quality of their sperm.
The process isn’t always easy or cheap
Unfortunately, getting all of these tests isn’t always easy. Marissa M., 35, from Kingston, New York, recently underwent fertility testing because she and her husband have been trying to conceive for nearly a year.
Her initial blood test was done in her ob-gyn’s office, but she was referred elsewhere for a hysterosalpingography, and then to an endocrinologist for her husband's semen analysis. “My issue with the whole process was that three different medical offices were needed to perform these tests," she says, "and I don’t feel we ever got a clear picture of our fertility outlook by putting all the tests together.”
On top of that, many insurance companies won’t cover fertility testing for women under 35 unless they’ve been trying to conceive for a full year. For women 35 and over, tests are generally covered after couples have been trying for six months.
If a woman is simply looking to find out her AMH levels, she can ask her doctor or insurance company whether this test would be covered. At-home kits fall in the $100 to $200 range, while costs in the doctor’s office or at a fertility clinic can vary. Some companies, like KindBody, will credit a woman’s testing costs toward the price of egg freezing or IVF, if she decides to pursue either option.
Some research suggests that AMH levels don’t mean much
A study published last year in JAMA found that ovarian reserve numbers are not necessarily an indication of fertility. Researchers gave blood and urine tests to 750 women who had been trying to get pregnant for three months or less, ages 30 to 44, and then followed them for the next six to 12 months. Almost 500 of those women conceived naturally during that time, and the women’s levels of AMH and FSH had no significant effect on who got pregnant and who didn’t.
Lead author Anne Z. Steiner, MD, professor of obstetrics and gynecology at the University of North Carolina, was surprised. “These tests have worked their way into generalist’s offices and more mainstream uses, and we were really hoping to find that they are a good test for women who want more information about their fertility,” she told Health last year. “Ultimately, that’s not what we found.”
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Dr. Steiner says these findings should discourage women in their 30s and 40s from reading too much into these tests, if they haven’t already been trying to get pregnant for several months. Dr. Eaton agrees and says she doesn’t recommend them to women who are simply just curious about their numbers. (The test may be helpful, she says, for women who are considering freezing their eggs or undergoing IVF.)
“These tests are really to test the quantity of the eggs, but the more important thing is the quality of eggs,” says Dr. Eaton. “We don’t have any good tests for egg quality, so we actually don’t have any good test for somebody to know if they’re truly fertile or not.”
Lifestyle factors can affect fertility, too
Even if a couple’s fertility tests all come back normal, there can be other factors that could get in the way of a healthy conception and pregnancy. For example, body mass index (BMI) could play a role—both for women and for their male partners. A 2017 study published in Human Reproduction found that couples in which both partners are obese take longer to get pregnant compared to those in the healthy weight range.
Other lifestyle factors that can affect fertility include stress, smoking, diet, and physical activity. (Moderate exercise seems to boost fertility, while too much vigorous exercise may affect a woman’s cycle and make it harder for her to get pregnant.) Even a woman’s work schedule and job responsibilities may affect her ability to get pregnant, research shows.
A “good” result doesn’t mean you should wait to get pregnant
“There is a misconception that if you have a normal AMH level, you’re fine and you can delay trying to get pregnant,” says Dr. Eaton. “And I wouldn’t want anyone to hold off just because of these results.” For Tiffany, waiting to have kids wasn’t about her ovarian reserve—but her test results did make her feel better about her decision. She says her doctor was supportive of her getting tested, “although she did say that the test is for giving you a sense of how your eggs are at a specific point in time,” Tiffany says. (If women have below-average AMH levels for their age, her doctor explained, she encourages them to start trying sooner, especially if they want several children.)
But plenty of couples still struggle to get pregnant, even with normal AMH tests. Marissa and her husband are one of these couples: Her tests came back average for her age and detected no serious fertility issues. But eventually, her endocrinologist “concluded that we won’t likely be able to conceive on our own, and that we will need to do IUI,” she says. “He said our ages were the biggest factor.”
And a “bad” one doesn’t mean you can’t have kids
“A lot of people also think that if you have a low AMH level, you’re not going to be able to have a baby—and that’s not true either,” Dr. Eaton says. (It’s also no reason to be lax with birth control if you’re currently not trying to get pregnant.)
Ultimately, fertility tests—especially those not done in a doctor’s office—should only be considered one piece of the puzzle, says Dr. Eaton. And they shouldn’t take the place of advice from a doctor, or give couples preconceived notions about what is and isn’t possible for them.
“The real bottom line is that the most important thing that affects your fertility is your age,” says Dr. Eaton. The younger you are when you choose to start trying, the better your chances of getting pregnant without difficulty, she says. “But I always tell my patients that the best time to start a family is when you’re ready to start a family—not based on what a test tells you, or what you feel pressured to do.”
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