You likely know a woman who has been impacted by infertility – 1 in 8 couples trying to get pregnant struggle with infertility and most women don’t have insights into their unique fertility markers unless they’re trying to get pregnant. The hard truth is that women have a limited fertility window and fertility issues are not uncommon.
The good news is it’s easier than ever to gain insights into personal fertility markers, even if you’re not trying to get pregnant, empowering you to make more informed family planning decisions.
Let’s start with a general overview of fertility.
While men generate new sperm throughout their life, women are born with all their eggs. Each month, your body summons a cohort of eggs into your follicles, 10-20 eggs is normal. It only takes one egg to get pregnant, so your body will choose the best egg and the rest will die before you ovulate. Over time, egg reserves decline, and the remaining eggs become more fragile.
So, the average woman should have a fairly easy time getting pregnant until she’s 35. After that, pregnancy rates decrease and miscarriage rates increase. 40 is generally considered a critical milestone – at this point, a woman’s chances of getting pregnant is down to 5% each month.
Your unique age will be the most powerful number to reference when you’re assessing your fertility, and if you’re 35+ it may be time to take your fertility more seriously.
At-home fertility testing
It’s easier than ever to understand your unique fertility thanks to at-home tests like Modern Fertility, Everlywell, and LetsGetChecked.
Tests typically cost about $150. When your kit arrives, you’ll prick your finger and mail back a blood sample. Within 2-5 days, you’ll receive your results.
Modern Fertility is exclusively designed to test fertility and has fantastic online resources. They also have a partnership with Quest Diagnostics, so you can get professional help drawing your blood if you want it.
Everlywell and LetsGetChecked offer fertility testing in addition to many other at-home tests.
Testing at your doctor’s office
While affordable at-home fertility tests are being used more frequently, they all have one major limitation: the results aren’t interpreted and explained by a doctor.
Doctors can also run tests that look at your body’s anatomy (which at-home tests cannot offer). For example, they can use an ultrasound to manually count your follicles, which can help diagnose premature ovarian failure. They can also use an ultrasound to observe if you have uterine fibroids. They may perform a HSG test to ensure there’s no blockages in your fallopian tubes.
Reproductive endocrinologists can perform these tests and insurance will often cover these costs. If you’re charged out of pocket, expect to pay $250-$1,000.
What does a low AMH mean?
Let’s take a moment to explore AMH, one of the most popular fertility metrics. You want your AMH to be over 1 ng/mL. If it’s below 1 ng/mL, it indicates declining egg quantity. There’s no test that assesses your egg quality, so age serves as the best quality indicator.
As you recall, each cycle the average women summons 10-20 eggs from her reserve into her follicles, but only one will be released during ovulation. If you’re attempting egg freezing or IVF, your doctor will use hormones to attempt to retrieve all the eggs summoned that month, not just the ovulated one. Generally, doctors recommend retrieving 10-15 eggs per desired live birth.
If your AMH is low, your body may be summoning fewer eggs each month, perhaps 5 instead of 10. So, if you are attempting egg freezing or IVF, a low AMH may mean that you won’t retrieve as many eggs as you’d like in one month’s cycle and may require multiple cycles of stimulation.
However, if you are attempting to get pregnant naturally, you only need one good egg, not 10. So, even if your AMH declined and fewer eggs are being summoned, you still may have wonderful luck conceiving naturally.
Low AMH indicates that you may need more aggressive fertility treatment and/or that you may be nearing the end of your reproductive years, so you may decide to get serious about natural conception. Low AMH does not mean that you are inherently infertile.
As you can see, this is confusing, and this is only one of the factors a fertility test measures. While at-home fertility tests are easy and can give you interesting data, you may panic and make ill-informed decisions if you don’t understand that data’s context. Working directly with a doctor ensures that you’ll access expert advice when interpreting your results.
Making sense of your fertility results
While it’s often extremely empowering to learn about your fertility, the results may reveal information that feels stressful or scary.
Perhaps your results may cause you to expedite your family planning. This will likely be painful to discover. First, take time to process and grieve before rushing into next steps.
Why did you test your fertility? Are you actively trying to have kids right now? Or were you testing because you’re just generally curious?
If you’re actively trying for kids
If you’re under 35 and have been trying to conceive for 1 year or you’re over 35 and you’ve been trying to conceive for six months without any success, it’s time to talk to a reproductive endocrinologist. Your test results may offer clues revealing why you haven’t been able to have the baby you desire.
If you’re testing for general curiosity
If you’re younger than 35, it’s likely that your test won’t raise any red flags. However, fertility issues are common for young women too, so your results could cause concern.
There are ample options for you and testing can help guide your decisions. If you’re not ready to have kids, but hope to one day, here are options you can explore in the meantime:
- Freeze your eggs (if you haven’t found your family planning partner)
- Freeze embryos (if you know who you want to form your family with)
- Undergo treatments to reverse anatomical barriers (ex. remove large fibroids)
- Begin researching alternate family-planning options
- Using donor eggs/donor sperm/donor embryos/surrogate carriers
- Begin saving for your family planning goals
Unfortunately, getting insights into your own fertility will not be voluntarily offered to you during general doctor appointments, you must seek this information out.
You need to be your own advocate when it comes to your health and family planning goals. Fertility testing isn’t necessary for every woman, but every woman should have the right to testing if she wants it. Allow your results to empower and guide you as you course your future.