Fertility is complicated. An egg, sperm, and streams of hormones and body systems all work together to bring life into the world. For some people it can feel like magic (ta daa! Life!). For others, it can all feel like a big mystery. But waiting and wondering isn’t the only option. There are ways to check in on fertility–even before you’re ready to have kids. Before we dig into the options, let’s rewind and break down the basics.
The background basics
Here’s the very (very) simplified version of what happens when your body becomes pregnant:
- * A healthy egg is released from an ovary
- * The egg travels down the fallopian tube, towards the uterus
- * A healthy sperm joins with and fertilizes the egg
- * The fertilized egg implants to the lining of the uterus
Every little step is essential to a healthy pregnancy. And just like an assembly line in a factory, each step depends on the one before it. If the health of the egg or sperm is in question, if ovulation doesn’t occur, or if other reproductive organs aren’t functioning properly–chances of conceiving a healthy child are affected. Fertility depends heavily on general health and age. We’ll be posting a lot more to come on fertility and age–especially as it relates to egg quality. But for now, know that studies show definitively that fertility declines with age. The thing here though, is that everyone is different. Everyone has a different fertility curve.
So how do you check in on your fertility?
There is no one “crystal ball” test that will predict the future. If you’re looking for a “go or no go” answer–it doesn’t exist. But there are key indicators that are better predictors than age alone–your hormones.
Blood tests and hormones
There are simple blood tests you can take to measure hormones that relate to fertility. Modern Fertility tests for up to 10 key fertility hormones including AMH and FSH–which can give you a sense for ovarian reserve–as well as LH and Progesterone–which help to regulate your cycle and prep your body for conception. If you know you want to have kids one day, you can check in on your levels every year. Just like you get your pap smear or your credit score, it’s data to help you take stock of where you are and where you want to be. When you're ready to have kids down the road, Reproductive Endocrinologists (say that five times fast) have a few other ways to take an inside look at your fertility:
Ultrasounds and follicles
Transvaginal ultrasounds can be used to count the number of follicles you have in your ovaries. This isn’t the “rub over the belly” ultrasound process you see in movies–a doctor inserts an ultrasound probe about three inches into your vaginal canal. From there, the probe returns images of your follicles and gives your doctor a sense for whether or not you have a normal number of follicles for your age. Studies show that follicle counts decline with age.
X-rays and fallopian tubes
An X-ray of the fallopian tubes and uterus, known as a hysterosalpingogram, or HSG, can confirm whether or not there are any structural issues with reproductive organs. For example, it can detect if a fallopian tube is blocked and therefore not allowing an egg to be released.
What can I learn from a blood test?
Many people don’t think about their fertility or seek out testing until they have trouble conceiving. Yet, more and more scientists today are talking about the benefit of testing fertility hormones for future planning–especially AMH, which is released by the follicles and maps to ovarian reserve (how many eggs you have left). Some studies have concluded that that AMH is the best marker we have to assess the decline of fertility.
In addition to giving you a sense for how many eggs you have, hormone levels can help you understand your body’s ovulation process and check in on several hormones that support pregnancy. They can, in some cases, help you and your doctor understand whether or not you have a condition like PCOS. Most of all, these blood tests can help you detect red flags and make informed decisions about choosing to become pregnant in the future.
What are the limitations of blood tests?
Hormonal blood tests are a start towards understanding the likelihood of becoming pregnant but they’re just one piece of the puzzle. Your hormone levels can’t tell you if there are structural issues within your reproductive organs and they can’t detect syndromes or conditions that may cause infertility. They’re not magical predictors. But they are an informational first step–and they can be a powerful one.
How can I get a blood test?
You can ask your doctor for blood tests. Keep in mind that insurance plans in most states don’t have fertility or infertility coverage and that coverage depends on whether or not you work for a self-insured employer. Many states that do require proof that you’ve been trying to conceive for a certain amount of time–so checking in for the future can be expensively prohibitive. When you take these tests through Modern Fertility you don’t have to worry about that. Since we’re ordering many tests, we’re able to offer them at a fraction of the price along with custom reports in a personalized dashboard.
These hormones are complex and the science around them is relatively new. Instead of fishing through forums or trying to interpret raw lab results, you can tap into Modern Fertility to understand what each hormone is, what your levels mean for your age, and how they can inform future conversations with your doctor.
We’re here for you
This is just the tip of the scientific iceberg when it comes to fertility testing. If you take anything away from this post, remember that you deserve this information! We know this is personal and complicated. So if you have any questions about fertility testing, you can reach out to us at any time at [email protected].
David B. Dunson. (2002). Changes with age in the level and duration of fertility in the menstrual cycle.
Tremellen, K., & Davulescu, J. (2014). Ovarian reserve screening: A scientific and ethical analysis . Human reproduction update, Oxford press.
Daniel A. Dumesic. (2015). (Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Fertility and Sterility.
J Scheffer et. al. (1999) Antral follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility. Fertility and Sterility.
A.J.van Rooij et al. (2005) Serum antimüllerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: A longitudinal study. Fertility and Sterility.
Dewailly, D et al. (2014) The physiology and clinical utility of anti-mullerian hormone in women
Human reproduction update, Oxford press.
F. J. Broekmans et al. (2009). Ovarian Aging: mechanisms and clinical consequences. Endocrine Reviews.