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“Learn how many high quality eggs you have remaining and your chances of getting pregnant now and in the future,” beckons Egg-Q, one of the handful of new startups offering fertility testing to women concerned about their reproductive potential. The desire to know “how long you have left to conceive,” as offered by LetsGetChecked, or, more simply, “powerful information about your fertility,” courtesy of Modern Fertility, is understandable. Women are having children later than ever, a shift that has proved professionally and personally beneficial, but reproductively challenging. When offered a fertility magic eight ball, many can’t help but take a peek, hoping to discover something, anything, about their baby-making future.
If only that was possible.
These fertility blood tests provide women with an assortment of figures and graphs charting their ovarian reserve, along with a few other measures that will present themselves as authoritative, fate-determining even. But in reality, they offer little more than a fiction of control, and ultimately reveal little about any individual woman’s odds of getting pregnant beyond what her age tells her.
Many in the reproductive medicine field have long suspected this, aware of the fact that there was no evidence proving a connection between one’s egg count and fecundity. Then last month, a new and well-regarded study published in the Journal of the American Medical Association confirmed this hunch. Researchers compared anti-Müllerian hormone (AMH) levels, which is the hormone used to determine ovarian reserve in blood tests, to pregnancy rates and found that those with higher levels were no more likely to get pregnant than those with lower levels.
This isn’t the first time marketing has outpaced the science among fertility startups, who have a habit of rendering the line between solution and profit-driver rather muddy. There’s a lot of money to be made in reproductive medicine—the industry is growing at a rapid pace and expected to generate $6.6 billion revenue by 2020—and Silicon Valley’s knows this. Unfortunately, these companies are too often willing to build products first, and worry about evidence later. Or never.
Take, for example, fertility tracking apps. A study published last year found that the majority of them are ineffective in preventing pregnancy. (No one has studied how much they help in achieving pregnancy, but considering that it’s far more difficult to pinpoint the day when pregnancy is most likely to happen compared to the few days when it is possible, chances are they aren’t helping much.) Then there’s the rising crop of egg-freezing startups, which have come under scrutiny by doctors who worry that the message of future-preparedness they promote is belied by the fact that the odds of having a baby with frozen eggs aren’t great.
Now, it’s become clear that women should be suspect about purchasing fertility tests as well, which provide little in the way of useful information and can easily create false panic, or, more commonly, false hope, among those who take them.
Thirty-three and single, Sarah decided it was time to consider egg-freezing. When she went in for her consultation the doctor ran a test on her ovarian reserve. This step is necessary for egg-freezing, because the outcome gives doctors information on how much they should stimulate a woman’s ovaries. It also tells them whether or not a woman might need to do more than one round of treatment in order to yield the ten-plus eggs doctors recommend banking in order to achieve a single pregnancy. Sarah’s score was low and she was “devastated.” She said she was okay with the possibility of having to do more than one round of egg retrieval; it was the notion that her ovaries were “drying up” and she had might never be able to get pregnant on her own that bothered her.
“I was really depressed. My friends and I talk about this all the time and, from what I knew, what I hear everywhere, is that finding out how many eggs you have left only indicates your fertility. I thought [egg count and fertility] were the same thing,” she said, explaining that she thought her low AMH score meant her chances of one day having a baby were very small. When she returned to the doctor a few weeks later she got good news. He told her that despite what she’s been hearing, her chances of getting pregnant naturally weren’t necessarily any higher or lower than someone with a higher ovarian reserve count. “To get pregnant you only need one egg,” he told her. Immediately she felt better.
When Michelle was 37, her doctor recommended she get her AMH levels tested and she learned her ovarian reserve was at the far low end of the spectrum. “It was awful, I felt like an old lady. We began trying to get pregnant immediately and every time I had my period I thought: well, there are more eggs gone,” she said. To her surprise, she got pregnant three months after she received her test results. That pregnancy miscarried, but a year later she got pregnant again and now she has a 15-month-old. “I felt so thankful.”
Emma* had the opposite experience. At 32, she went to get her fertility tested, worried that her “time was running out.” She learned that she had a relatively high ovarian reserve, or what she presumed were good results, and felt at peace. Three years later she took the test again, and received what she perceived as equally promising news. “I definitely thought, ‘Oh, I am fine. I can afford to not freak out about this,’” she said. Fast forward a couple of years and she was diagnosed with unexplained infertility and had to do in-vitro fertilization in order to get pregnant.
These are just three of the many stories shared with Glamour of women who felt misled by fertility testing. Some of them got low scores and then had no trouble conceiving, while others got high scores and couldn’t get pregnant. Many saw their AMH scores fluctuate either over time, or from lab to lab, and questioned the utility of the whole enterprise.
Fertility testing became popular shortly after the American Society for Reproductive Medicine took the “experimental” label off of egg-freezing in 2012. Suddenly, there was a huge market of women who were considering freezing their eggs, and wanted help figuring out whether or not they should. Clinics, soon followed by startups, began to offer fertility testing, even if the evidence was lacking.
The are two big issues at play with the fertility business, explained Dr. Nanette Santoro, a reproductive endocrinologist and professor of obstetrics and gynecology at the University of Colorado School of Medicine who wrote the accompanying editorial to the new study. One is that while there has been a lot of research on infertile women and how to treat them, there have been very few studies on fertility in the general population. Doctors know very little about the mechanisms of fertility, and why getting pregnant is so easy for some and hard for others.
The other is the fact that the fertility industry is not as regulated as other areas of medicine, largely because of federal restrictions on funding for fetal research. As a result, reproductive medicine depends more on profit-seeking investors than public grants to fund research, and much of the industry is still held accountable to these investors. This combination of limited regulations and limited data makes for an ideal setting in which entrepreneurs can omit, or ignore, the big picture while seeking a profit.
“Bullying might not be the right word, but it is close to what it feels like sometimes. Women are being told what to do, and we need to be making sure that what they are being told is being based on careful science,” she said about the experience many women have when seeking fertility advice or treatment. “It’s cynical, but we live in a capitalistic society, and this is something that can be sold to women.”
Gina Maranto, who teaches women and gender studies at the University of Miami and is a fellow at the Center for Genetics and Society, said that while reproductive medicine has always been difficult to navigate for patients and consumers, startup culture has made it even trickier.
“These [online] marketing campaigns can be ran in covert ways and there are these really slick websites out there. It’s beginning to look like a different beast,” Maranto said, about the online businesses promoting things like fertility testing and egg-freezing. “The challenge has become how to make sure [patients] are getting impartial information. What happens when you start Googling and get nothing but advertisements about fertility treatments?”
Among the many startups focused on fertility, only a handful who aim to educate women without the use of lab work.
Maja Zecevic, a doctor with a background in public health, said that when she was pitching Opionato, her fertility counseling service, she came across many investors who were interested in backing companies who sold blood tests. Because of the lack of evidence supporting these tests, she decided not to, and instead talks to women about their genetic history, family history, lifestyle and age—factors that tend to be more predictive than ovarian reserve count. Zecevic said that while some of these blood tests can pick-up on a health problem, like a thyroid disorder or autoimmune disease, that may later cause infertility, that doesn’t mean they predict fertility.
“Silicon Valley has a tendency to simplify healthcare problems, when they are usually much more complicated,” Zecevic said, explaining that there is a lot of profit potential in panicked women. “Empowerment and education in fertility is important. But women are confused into thinking one test can solve all the issues, and so they get the test and skip [learning about all the other factors.]”
Deborah Anderson-Bialis said one of the reasons she and her husband Jake started FertiltyIQ, a website that offers data on doctors, clinic, and treatments in the field of reproductive medicine, is because so much of the information out there is “misleading.” When she received a low AMH score in her late 20s she panicked, having read in countless magazines and discussion boards about the importance of ovarian reserve. After that she felt infuriated that all OB-gyns didn’t routinely run tests on AMH scores, and ended up going through numerous rounds of failed in-vitro fertilizations. But over time she learned that the research behind fertility testing was lacking, and her low score didn’t mean what she thought it did. This realization was underscored by the fact that she eventually got pregnant twice, without any interventions.
“The amount of this stuff that women are hearing that isn’t evidenced base in mind boggling,” Anderson-Bialis said.
Founders of two at-home fertility testing services, Modern Fertility and Future Family, told Glamour that one of the main reasons they started their businesses was because women want information about their fertility and are having a tough time getting answers from their doctors.
“Anecdotally, we hear that women are being told by their doctors that they don’t need the tests, and should go and try to get pregnant and then come back. But they aren’t trying to get pregnant, they want [to understand their fertility]. They can’t get the hormone test if the want it.” said Claire Tomkins, CEO of Future Fertility, which, like Modern Fertility, couples the test with advice from medical professionals.
However, Dr. Alan Penzias, a reproductive endocrinologist who is a professor at Harvard and chair of the American Society for Reproductive Medicine’s Practice Committee, said that there's often a good reason for this: Ob-gyns can order a test and deliver the patients a number, but there’s not much they could say about the results. “There is no guarantee with human biology.”
Both Modern Fertility and Future Family say they will continue to offer fertility testing, and plan on relaying the findings of this new study, and all other relevant research, in the counseling sessions they offer clients along with the results of their tests. They are also currently considering updating their language online.
Tomkins said that she believes that hormone tests are still useful insofar as they allow curious women to compare their ovarian function to other women their age. They also allow women to learn in advance about how they would respond to the stimulants used in egg-freezing and IVF, which might help them determine when they should do those procedures.
However, Dr. Anne Z. Steiner, the lead researcher of the new study on AMH and a professor of reproductive endocrinology and infertility at the University of North Carolina in Chapel Hill., says she doesn’t recommend women using AMH as a tool to help them figure out when to do fertility preservation, or whether to do it at all. Instead, they should consider their age, and how soon they can see themselves having kids.
“We aren't saying don’t freeze your eggs. Just don’t use [ovarian reserve] markers to decide whether or not to freeze your eggs,” Steiner said.
One of the paradoxes of reproductive medicine is that while experts can do a lot to treat infertility, they know very little about what causes it in the first place. This makes fertility a poor fit for the age of the quantified self, in which tech startups lead us to believe we are just a metric away from unlocking the biological secrets contained within us.
Perhaps the most important step a woman can take when trying to gauge her reproductive potential is to recognize this. While “Uber for future babies,” and its many variants, might be trending in Silicon Valley, we remain a long, long way away from anyone being able to guarantee that those babies will, or won’t, one day arrive.
*Names have been changed.
