Infertility is defined the inability to get pregnant after one year (or longer) of unprotected intercourse. According to the CDC, 12% of women in the US, 15-44 years of age, have difficulty getting pregnant or staying pregnant and both male and female factors can impact infertility.

There are multiple potential causes for female infertility including: hormonal imbalance, structural issues, and diminished ovarian reserve.  Furthermore, female fertility is known to decrease with age.  Measurement of serum hormones is an important part of the investigation for causes of infertility.

Recently, there has been an increase in the number of direct-to-consumer (DTC) companies marketing home fertility testing (Type “Home Fertility Tests” into Google). Advertising for these companies promote that they are convenient, private, and cost effective. They also make statements such as “Learn about your fertility earlier so you can plan ahead” and “If you are starting a family, or are thinking about pregnancy down the line, (this) test is for you.” 

To understand the utility of these DTC fertility tests, I talked to Emily Jungheim, M.D., a board certified Reproductive Endocrinologist at Washington University School of Medicine.

– Do you think there is any value in ordering this type of testing on-line for women who or not infertile and are not yet trying to get pregnant?

Some of these tests can be of value, but it is important to understand what to do with the information that they provide.  When I evaluate a person for fertility, there are three pieces of information that I need as follows:

  • Are there eggs/is ovulation occurring?
  • Is there sperm?
  • Are the fallopian tubes patent and is the uterine cavity normal?

Direct to consumer tests can provide some information regarding ovulation and sperm, but there are no direct to consumer tests available to check #3.  Issues impacting the fallopian tubes and uterine cavity to the extent that fertility is impaired are not uncommon and need to be evaluated appropriately when fertility is a concern.

For women trying to conceive, there can be a lot of value in using DTC for #1—checking ovulation prediction kits to determine if and when one is mounting a luteinizing hormone (LH) surge.  This surge typically occurs 14 days prior to onset of menses.  For women with irregular cycles this testing is often not reliable, but for women trying to conceive, this testing can be helpful in timing intercourse or an insemination.  I typically recommend women try to ensure they have intercourse or an insemination to coincide on the day of the surge, and the day afterwards.

-Do you think this type of home fertility testing is useful for women who are experiencing infertility?

For women with infertility, it is imperative to rule out issues impacting the fallopian tubes and uterine cavity.  These issues cannot be evaluated with direct to consumer testing. 

Direct to consumer testing for sperm is qualitative, not quantitative, and in the case of infertility, it cannot be determined if sperm concentrations and motility are adequate for natural conception.  A formal assessment is important for women experiencing infertility.

-If a women had testing performed by one of these companies and brought you the results would you have the testing repeated, and why?

LH surge testing is quite helpful in the setting of regular menstrual cycles.  Any other testing is not quantitative and would likely need to be repeated.

-Could this testing be misleading?

While helpful, LH testing is not confirmatory for ovulation.  A woman should have a serum progesterone level drawn approximately 7 days after an LH surge to confirm ovulation.  On the flipside, a woman might not detect LH on an ovulation prediction kit may have a false negative.  She may still be ovulating, but the test may not be accurate to tell when she is ovulating.  Again, an appropriately timed progesterone would be helpful.

-What advice do you have for women who are trying to assess their ability to get pregnant?

An assessment with an experienced health care provider is recommended for women who want reliable information about fertility, timing of intercourse and fertility treatment options if they are struggling to conceive.

-Is there any value for direct to consumer AMH measurements in women who are not infertile & not trying to get pregnant?

AMH is helpful in determining how many oocytes one might get from an IVF procedure, or how to stimulate the ovaries with gonadotropins.  There is no cutoff that helps us distinguish between fertile versus infertility/sub-fertile women–even when AMH is run in a clinical laboratory setting.  Therefore, there is not much help for a layperson without interpretation by a physician. A great paper that outlines this data can be found here.

Originally published by The Pregnancy Lab

About The Author

Professor of Pathology & Immunology, and Obstetrics & Gynecology, Washington University School of Medicine

Dr. Gronowski is a Professor of Pathology & Immunology, and Obstetrics & Gynecology at Washington University School of Medicine (St. Louis Missouri). She is Associate Medical Director of the Clinical Chemistry and Serology & Immunology laboratories at Barnes-Jewish Hospital. Dr. Gronowski received her Ph.D. in Endocrinology- Reproductive Physiology from University of Wisconsin, and is a diplomate of the American Board of Clinical Chemistry. Dr. Gronowski is past president of the American Board of Clinical Chemistry and the American Association for Clinical Chemistry. Her research focuses primarily on the laboratory diagnostics of endocrinology and reproductive physiology with a particular emphasis on maternal fetal medicine. She edited the book entitled “Handbook of Clinical Laboratory Testing During Pregnancy”.