Back in 1970, the average age for a first-time mom was 21. Now it’s about 27, and in some areas, such as New York and San Francisco, over 30. In the past few years, women in their 30s have been having more babies than their 20-something counterparts. The trend toward starting families later means, among other things, that fertility will become a concern for more women interested in motherhood.
But the traditional way to evaluate fertility isn’t the fastest process: In many cases, doctors tell patients to spend time trying to conceive — at least one year of “regular sexual intercourse” for those under 35, and six months for 35 and up — before moving on to a fertility evaluation. That’s the official clinical guideline from the American College of Obstetricians and Gynecologists for patients without known fertility issues. These tests can be invasive and expensive, the reasoning goes, so why go through with them unless a problem is suspected?
Still, women who feel like they’re running out of time might balk at the prospect of spending up to 12 months not getting pregnant before taking other measures. Enter at-home fertility testing. For a fraction of what a clinic charges, you collect your own blood or urine sample at home or at a lab and mail it off. In a matter of weeks, you can learn what your levels of various hormones say about your reproductive health. It’s a popular choice, and getting more so: Analysts predict the global fertility services market will see 9 percent annual growth and exceed $21 billion by 2020.
“While no hormone or test can definitively tell you if you can get pregnant at a specific time, fertility hormone tests do provide a window into your broader reproductive health so you can have a baseline understanding of your fertility,” says Erin Burke, head of research and clinical operations at the startup Modern Fertility. “We believe that women deserve the right to understand what’s going on inside their bodies so they can be their own best personal health advocates.”
A lot of fertility experts, however, have reservations about at-home testing. Here’s what to know about going the DIY route.
What at-home tests actually test
Each at-home test is different. Some companies, like EverlyWell and LetsGetChecked, offer several varieties relevant to fertility and women’s health. Others, such as Modern Fertility and Proov, offer only one kit that measures hormones related to ovulation and women’s health. (Companies can be cautious in how they label these tests; Proov doesn’t actually call its kit a fertility test. Modern Fertility says it doesn’t predict fertility.)
Most of these tests use a finger prick to measure hormones in your blood. Hormonal birth control can affect some tests results. If you’re on birth control or take another medication that manipulates hormone levels, the companies will either omit certain tests or recommend that you limit your testing to anti-Mullerian hormone (AMH) and/or progesterone.
Here’s what most at-home fertility tests measure:
Ovarian reserve: This tells you how many eggs you currently have. Women are born with a certain number of eggs that declines with age. By measuring AMH, follicle-stimulating hormone (FSH) and/or estradiol (E2), you can get a sense of your ovarian reserve and whether it’s normal, high or low for your age. Additionally, says Jennifer Kawwass, medical director and associate professor at the Emory Reproductive Center, “AMH, FSH and E2 likely correlate with time of menopause and are also reflective of response to fertility treatment such as IVF or egg freezing.”
Progesterone: This hormone prepares the uterine wall to receive a fertilized egg and nourish an embryo. It indicates if you’re ovulating normally. “Imbalances in progesterone can lead to suboptimal implantation, which can contribute to unsuccessful conception or miscarriage,” explains Amy Beckley, a pharmacologist and founder and CEO of Proov. While Proov analyzes progesterone in urine, most companies rely on blood testing.
Other hormones: You can also order tests that measure a combination of hormones, including FSH, luteinizing hormone (LH), testosterone and thyroid-stimulating hormone, to detect hormonal imbalances such as hypothyroidism or polycystic ovarian syndrome. “A body of research shows how thyroid dysfunction can impact fertility and pregnancy, and can result in pregnancy loss and preterm birth,” says Marra Francis, an ob-gyn and executive medical director for EverlyWell. “Our test also identifies hormone imbalances commonly associated with PCOS,” which is one of the most common causes of infertility.
What the experts say
One major criticism of at-home tests is that they don’t provide a full picture of fertility.
First off, you don’t need to measure progesterone to know you’re ovulating. “More often than not, someone who is having regular, predictable cycles at a standard interval (between 24 to 34 days from the start of one cycle to start of the next) is almost certainly ovulating,” Kawwass says. “Additionally, progesterone levels can fluctuate depending on the time of day, so measures of ‘adequate progesterone levels’ are often not helpful.”
As for ovarian reserve, the science is mixed on how well it predicts your ability to get pregnant. In a 2017 JAMA study, researchers analyzed levels of AMH and FSH in the urine and blood of 750 women aged 30 to 44. Women who had abnormal levels of these hormones were not significantly less likely to become pregnant than women with normal hormone levels. Study authors concluded that their findings “did not support the use of urinary or blood FSH tests or AMH levels to assess natural fertility for women” without a history of infertility who have been trying to conceive for three months or less.
“Knowing your AMH might give you a sense of whether the number of eggs you have is high or low for your age. But it tells you nothing about the quality of those eggs,” says Molly Quinn, an ob-gyn and professor at the University of California, Los Angeles. “And the majority of the time, if a couple is struggling to conceive, it’s not the ovarian reserve; it’s myriad issues.”
Women who feel like they’re running out of time might balk at the prospect of spending up to 12 months not getting pregnant before taking other measures.
These can include fallopian tube obstruction, anatomical abnormalities in the uterus, abnormal sperm function and poor oocyte quality. A fertility specialist can perform additional tests, such as a transvaginal ultrasound, to get a more robust picture of your fertility.
Another criticism concerns the interpretation of at-home test results. Although many testing companies provide access to professionals or encourage consumers to consult healthcare providers, experts say that it’s best to talk to a provider in person when you receive your results.
“The interpretation of these tests is nuanced, and quite a bit of counseling is needed to help individuals understand implications,” Quinn says. “My average initial visit with a patient is 60 minutes long. It involves discussion of clinical history, patient-centered counseling and an examination.”
Fertility is complicated
At-home fertility tests can provide an estimate of your ovarian reserve, which might be helpful for women who know they’re infertile or are considering freezing their eggs. They’re also typically less expensive than going to a doctor for essentially the same tests. But they can’t predict how fertile you’ll be in the future. “It is possible to have diminished ovarian reserve and then have no trouble conceiving,” Kawwass says.
Quinn says the tests could lead to a false sense of security: “If the test says your ovarian reserve is good, it doesn’t mean it’s safe to wait five years to get pregnant. Additionally, a low AMH level or high FSH level doesn’t mean an individual is infertile or likely to have issues with conception. The overwhelming predictor of a successful pregnancy is the age of the female.”
Still, age isn’t the only factor in fertility. Experts recommend that a woman who is concerned about her ability to have kids see an ob-gyn or reproductive endocrinologist.
“I’m very much in favor of women getting more info about their own bodies. I think that’s empowering. But I can’t say there’s a ton of benefit to doing this on your own,” Quinn says. “A fertility or infertility evaluation is multifaceted, and often there is much we don’t know until an individual actually attempts to conceive. As a result, I think it can be dangerous to use the results of ovarian reserve testing alone to make decisions about reproductive planning. A blood test is only going to tell you so much.”
The companies acknowledge this. Both Modern Fertility’s Burke and EverlyWell’s Francis say that no one test can predict future fertility. “Some tests still need to be conducted by a medical professional to get the whole picture,” says Francis. Still, these tests could offer a starting point for further conversations with a healthcare team. It’s understandable that a 39-year-old woman who’s anxious about her fertility would want to know as much as possible to better understand her reproductive health. An at-home test might be one way to begin working toward an answer.