August 14, 2019
By Leigh Wingus
n 2019, you have quite a bit of information about your health at your fingertips—and that includes your fertility. It’s empowering to know that, even in your early 20s, you can get insight into your reproductive future and plan accordingly, whether that means deciding to freeze your eggs or simply resting assured that you have years to focus on your career before you need to think about starting a family.
At the same time, there can be drawbacks to having so much knowledge at your fingertips, particularly if the fertility news is bad. Is it a good idea to get your fertility checked long before wanting kids, or should you wait until you really “need” to know?
What does fertility testing include?
If you’re trying to decide if it’s worth it to get your fertility tested before wanting kids, there are a few ways to get started: A conversation with your ob-gyn is always a good idea and mobile fertility clinics have even started popping up in some cities. But if you’re planning to go all-in, what is the process of getting your fertility tested? Here, some common fertility testing services:
Hysterosalpingogram: “First, a doctor will do an anatomy check to confirm you have a normal shape and size uterus, as well as open fallopian tubes,” says Sheeva Talebian, M.D., a fertility specialist at CCRM New York. To evaluate all three, you’ll usually get a hysterosalpingogram (HSG), which is a radiology test that basically takes an X-ray of your uterus. Ideally, your uterus is an adequate size (about 3-4 inches by 2.5 inches) and normal shape (resembles an upside-down pear), both fallopian tubes are open and allow fluid to travel through them.
Ovarian Reserve Test: Next, you’ll get an ovarian reserve test done via ultrasound. “This assesses the size of the ovaries and a follicle count,” explains Dr. Talebian.
Hormone Tests: Then, on day two or three of your menstrual cycle, you’ll do blood tests to check your levels of anti-Mullerian hormone (or AMH, which indicates egg count), follicle-stimulating hormone (or FSH, which stimulates an egg follicle to grow each month), and estrogen. “Combined, these blood tests and the ultrasound give some insight to egg quality and quantity,” she says. Your AMH level should between 1.0 and 4.0ng/ml; if it’s too high, it could indicate something like polycystic ovarian syndrome (PCOS), and if it’s too low, it could mean you’re going through an accelerated aging process or may have a low egg count. Your FSH level should be below 13 or 15 IU/ml. An FSH level that’s too high can indicate a low ovarian reserve. (Related: What Ob-Gyns Wish Women Knew About Their Fertility)
“You may be given additional blood tests, too, which will look at your thyroid and other general health parameters, like blood counts and vitamin D levels,” says Dr. Talebian. If your thyroid is over- or under-active, it can impact ovulation and miscarriage rates, she says. And if you’re severely anemic or very low in vitamin D, that can also negatively impact implantation rates.
Wondering about cost? Talebian says it varies, as some insurance policies will partially or fully cover it, while others don’t—so it’s a good idea to check with your insurance and medical provider to get an estimate ahead of time. If you pay out of pocket, each test can cost a few hundred dollars, with the exception of the HSG radiology test, which can range from $800 to $3,000, according to the Advanced Fertility Center of Chicago. (Related: Is the Extreme Cost of IVF for Women In America Really Necessary?)
What are the benefits of getting your fertility tested right now?
Now that you know exactly what goes into getting your fertility tested (a lot!) is it really worth it if you’re a long ways away from trying to have kids? Getting your fertility tested before wanting kids can be really helpful from a mental health standpoint, says Kimberly Mangla, M.D., assistant director of education for the Columbia Women’s Program.
“One of the benefits of having information about your fertility prior to the desire to conceive is the ability to plan, which can give you a sense of control,” she explains. And from a physical standpoint, it may help detect a condition that can affect fertility (such as Polycystic Ovarian Syndrome or endometriosis), which is extremely advantageous because it gives you the information you need to take action now.
Age is the number one factor in whether or not you need to take action with your fertility, says Dr. Talebian. You’re most fertile around age 25 and, by age 38, that has decreased by about half, leaving you with about a 15-percent chance of getting pregnant naturally every month, according to Eldon Schriock, M.D., a board-certified obstetrician, gynecologist, and reproductive endocrinologist from Prelude Fertility, as we previously reported.
If some of your results come back abnormal, this can help inform next steps: “For example, if you’re 29 years old with an AMH that’s too high, statistically, you have time before you need to consider fertility preservation options,” says Dr. Talebian. “If you are 39 with an AMH that’s too high, based on your age, we would encourage you to do something quickly.”
Having information about your fertility can make you feel empowered, whether that means making a decision for your reproductive future (such as egg freezing) sooner rather than later, or feeling comfortable in the timeline you’ve set for yourself.
Are there any downsides to getting your fertility checked too early?
One important thing to consider in deciding whether or not you should get your fertility tested is this: Alone, results aren’t 100-percent indicative of your current or future fertility. They’re more indirect markers that should be considered with other lifestyle factors as well, especially your age.
“There’s no blood test that says, ‘you’re fertile and can wait,'” says Dr. Talebian. “These results are just various data points that are combined with information about your health history, such as whether or not you’ve been trying to conceive or if there are there other fertility risk factors at play (like a family history of early menopause or endometriosis).” It’s also important to note that this information cannot predict your fertility 10 to 15 years down the line. Rather, it’s an at-the-moment snapshot of your fertility, and tests should be repeated every 12 months in order to be kept up to date on your current fertility.
Plus, as with most forms of testing, there is a margin of error, and you could uncover abnormalities that have no real significance for your fertility but may lead to unnecessary feelings of stress and anxiety, says Dr. Talebian. For example, if your results show that you have an AMH that’s too low, it could be an issue down the line, or it might not be. (A low AMH can indicate a low egg count, but it doesn’t give insight into the health of those eggs. That’s one reason people are questioning the role of ovarian reserve tests in fertility testing.)
“For that reason, when women or couples come in to get tested before they’ve really tried to conceive, I have a thorough conversation explaining that abnormal results may not actually be a problem,” she explains. “I also always discuss what the action plan will be if they do receive abnormal results.”
Ultimately, the decision to get your fertility tested (or not) before wanting kids is a personal one. And should you choose to undergo fertility testing, you may walk away feeling empowered, but you may also find out that getting pregnant could be difficult for you down the road, which can lead to feelings of grief, anxiety, depression, anger, and shock. In this case, Dr. Mangla suggests talking about it openly with other women who have gone through this.
“Oftentimes people feel shame, like their bodies have failed them,” she says. “What they don’t realize is how many people suffer from infertility in silence. Today, there are over 9 million women in the U.S. alone who have used or are currently undergoing infertility treatment. There’s support and hope for this group. I would not underestimate the potential struggle, but believe in your ability to cope through difficult times.”