For the past two decades, several effective and convenient over-the-counter tests have been developed to assist patients who are trying to get pregnant or to confirm that they are pregnant. Aside from the iconic home urine pregnancy test, there are many urine and electronic kits which can help a woman detect ovulation (release an egg) and to time intercourse during the most fertile time of the month.
There are many women and couples who are not trying to get pregnant currently, but want to learn more about their fertility. Many hope to use the information from a fertility assessment to guide when they should start trying to get pregnant and to build their family. In the last several years, there has been a significant amount of publicity with the recent release of over-the-counter fertility tests. Since these at-home testing options are relatively new, many patients are asking: Are over-the-counter fertility test kits an accurate and reliable substitute for going to a fertility specialist?
What Testing is Necessary to Assess Fertility?
Fertility assessment aims to evaluate a woman’s ovarian reserve. Ovarian reserve refers to the quality and quantity of a woman’s eggs. During a fertility assessment with a fertility specialist, a vaginal ultrasound Antral Follicle Assessment is performed to evaluate the uterus and the number of “resting eggs” (also called antral follicles). Blood tests are also performed to check reproductive hormone levels, which can also indirectly evaluate the quality and number of eggs in the ovaries. Specific hormone tests include:
- Anti-Mullerian hormone (AMH) (blood test): AMH is a hormone produced in the ovaries by tiny early-stage follicles as they grow to a stage where they can potentially produce eggs for ovulation. AMH levels can provide an estimate of whether or not there is still a significant number of growing follicles. It is the most sensitive marker for ovarian reserve and does not fluctuate significantly during or between menstrual cycles. However, AMH levels can vary significantly when testing in different facilities that may use different AMH assays (test types).
- Follicle-stimulating hormone (FSH) (blood test): FSH is one of the most important hormones involved in a woman’s menstrual cycle. Its job is to stimulate the growth and development of follicles so that an egg is produced and released during ovulation. FSH production continues until you ovulate. If you don’t ovulate, the FSH levels will continue to rise. An FSH level can indicate how much effort your body is exerting to help you ovulate. High levels are a sign of diminishing ovarian reserve (reduced egg numbers and lower egg quality). However, this hormone can vary greatly between cycles and can be misleading sometimes since woman with reduced ovarian reserve can have a normal FSH level. As a result, it is not very useful in evaluating ovarian reserve and fertility potential in many women.
- Estradiol (blood test): Secreted by maturing follicles, estradiol is a form of estrogen, the major female reproductive hormone. High levels of estradiol of the third day of the menstrual cycle can be another sign that your body is having to work especially hard to produce eggs, and can mean your ovarian reserve is getting low. As is the case of FSH, this hormone can vary greatly between cycles and can have a normal value in woman with reduced ovarian reserve.
How Do Home Fertility Tests Work?
The most widely marketed home fertility kits test for the hormone levels, FSH and/or AMH. They will require you to perform a small “pin prick” of your finger to obtain a very small amount of blood in a similar way that diabetic patients check their blood glucose (sugar) levels daily. These kits use cut-off levels to determine if the result is normal level (reassuring) or abnormal levels (non-reassuring or concerning).
The Strengths and Weaknesses of Home Fertility Tests
It is obviously more convenient to purchase a kit at your nearest drug store or online site. Performing any testing at home is also much easier than going to an office to have tests drawn. Unfortunately, home kits are much less accurate than standard blood tests at the physician’s office to reliably measure reproductive hormone levels. Also, it is difficult to test your ovarian reserve and potential fertility with a home test that only provides a normal (reassuring result) or abnormal result. These kits do not account for the natural fluctuations of hormone levels from month-to-month and during different parts of the menstrual cycle. Most importantly, these kits do not account for the expected levels based upon a woman’s age, recent hormone treatments, and prior gynecologic and medical history.
Home Fertility Tests Versus Fertility Assessment With A Fertility Physician: Which is the Best Option?
The best option to assess fertility potential and ovarian reserve is during an evaluation with a fertility physician. The home kits may be useful if there is an abnormal result, since it can guide a woman to see a fertility physician more quickly to have a fertility assessment. This may be most useful for a woman who is single and in her 30s and contemplating fertility preservation with egg freezing or wants to get pregnant in the future or a couple who plans to try to build their family in the near future. However, home fertility testing can’t sufficiently interpret results based upon your individual personal and medical profile as can be done routinely during a fertility physician evaluation.
The most useful part of the fertility assessment is the antral follicle assessment that is performed during a routine vaginal ultrasound with a fertility physician. This is the most sensitive and accurate way to estimate ovarian reserve, for counting the number of antral follicles(“resting eggs”) and to also evaluate other conditions in the uterus such as fibroids (non-cancerous tumors) and polyps that can also affect the likelihood of pregnancy. Since antral follicles produce AMH, a fertility physician can correlate AMH levels with the number of antral follicles to provide the best means for ovarian reserve and fertility assessment.
If you would like to understand more about your fertility potential, or you would like to learn more about your options for fertility preservation with egg freezing or embryos banking, or you would like more guidance about when may be best to start trying to get pregnant, CCRM physicians and their team are available to perform a comprehensive fertility assessment and to provide an individualized evaluation for you.
Aaron K. Styer, M.D. is cofounding partner and co-medical director of CCRM Boston. He is a board certified reproductive endocrinologist and is an Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.