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They spend years trying not to get pregnant, but once they decide they are ready to start trying, they want to be pregnant yesterday. I am no exception. When I was a 28-year-old medical student, my husband and I decided we were ready to have a baby. I was eager to do everything I could to get pregnant as quickly as possible.
At the time, there wasn’t much I could do, beyond tracking my cycle or using ovulation predictor kits to time sex.
But now, decades later, there’s so much more on the market purporting to help you get pregnant or “optimize” your fertility, like at-home fertility tests intended to help people collect information about their bodies before they even start trying to conceive. The tests are marketed as helping you be proactive about your fertility, essentially giving you insights that you’d otherwise get from a doctor’s office.
They appeal to people (like me!) who are anxious to do everything they can to control a situation that feels frustratingly out of control at times. But are these tests worth it?
What do at-home fertility tests actually test?
Most of these tests, geared toward women, ask you to collect blood using a fingerstick. You send back your blood sample, and the lab tests a number of hormones and sends you the results. What they test differs across brands, but in most cases, the results include the same handful of hormones: antimullerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid stimulating hormone (TSH), and thyroid hormone.
Only two of those hormones directly pertain to fertility: AMH and FSH. AMH is made by immature eggs in the ovaries, and the AMH level tells you how many eggs are starting down the path to becoming a mature egg. It can give some information about the overall numbers of eggs in the ovaries — often called ovarian reserve. But it can also vary from month to month.
The FSH level indicates how much hormonal stimulation it is taking to mature the eggs in the ovaries. When we have a lot of high-quality eggs, it will take less FSH to mature an egg each month. As we approach perimenopause, the eggs that are left need more stimulation from FSH to mature.
The other hormones listed above don’t directly relate to fertility. Instead, testing them looks for possible hormonal changes that might decrease your chances of getting pregnant. Prolactin is a hormone made in the pituitary that tells the breast to make milk. It should only be high at the end of pregnancy and postpartum when the body is preparing for breastfeeding. If prolactin levels are elevated, it can prevent ovulation.
TSH and thyroid hormone indicate whether your thyroid is functioning properly. Both an overactive and underactive thyroid can affect ovulation. Thyroid hormone is important for normal embryologic and fetal development in early pregnancy.
Some companies also offer fertility testing for men, which involves collecting a semen sample and submitting it for analysis.
The problem of timing
FSH, LH, and estradiol vary over the course of the menstrual cycle. The normal range for FSH is set based on typical levels on day 3 of the menstrual cycle. FSH measured at other times during your cycle doesn’t tell us much about your fertility. LH triggers ovulation and thus should be high mid-cycle. In most cases, a day 3 LH wouldn’t tell us much. There is not one point in time when testing all three of these levels would be helpful.
While some of the tests on the market promise to interpret levels even if you are taking a birth control pill, birth control pills will typically suppress FSH, LH, and estradiol. When you get results that those hormone levels are low, all that tells you is that you are taking a birth control pill. It doesn’t yield any other information. Birth control pills also significantly lower AMH levels, again making them impossible to interpret. As a result, it is essentially useless to perform this kind of testing while you are taking a birth control pill.
So are these tests necessary?
As a physician, I ask myself the same question every time I order a test: How will the results change the plan I am developing for my patient? If you are healthy and your periods are regular and you are just starting to try to conceive, I would argue these tests aren’t likely to provide you with much actionable information.
On the other hand, if you have been trying to conceive for six months or more without success, or if your periods aren’t regular, then it is time to do some testing. However, at that point, it also makes sense to see your OB-GYN. A doctor who can ask you specific questions about your menstrual cycles, efforts to conceive, and health history will be able to order tests specific to you. Some of those tests might be ones included in an at-home kit, but your doctor might order others that aren’t included in a one-size-fits-all test kit. Plus, your doctor will then interpret those results in the context of your particular situation.
Before insurance is applied, testing these hormone levels could cost hundreds of dollars at a conventional lab. Most of the companies offering at-home testing advertise that their testing is less expensive and that you can use your flexible spending or health savings account to pay for the test. But if your doctor orders the tests through a lab and indicates why they are doing the tests, they will almost always be covered — at least partly — by your health insurance, which could significantly reduce what you pay. Depending on your insurance, they might not cost you anything. And if any of the tests need to be repeated in the future, it is always easier to compare tests performed in the same lab.
Ultimately, for most women one-size-fits-all fertility testing is unnecessary and likely won’t provide actionable information. If you have been trying to conceive for a while, or if your periods are irregular, you are likely to get more specific and helpful testing with a doctor who can talk to you, examine you, and order tests specific to your situation.
The bottom line
- Many companies offer at-home fertility testing that uses blood from a fingerstick to measure a handful of female hormones. Some also offer semen analysis for men.
- This type of testing should be done at a specific time in your cycle. However, there is not one point in the menstrual cycle when measuring all of these hormones would be helpful.
- If you are healthy and your periods are regular, these tests are unlikely to provide helpful information. If you are struggling to conceive, performing testing tailored to your specific situation (with your doctor) will be more helpful.
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