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.