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Moving fertility science forward at the 2021 ASRM conference

Moving fertility science forward at the 2021 ASRM conference

7 min read

Every year, the American Society for Reproductive Medicine (ASRM) hosts fertility healthcare providers and researchers alike for the field's biggest conference. So, for us at Modern Fertility, it’s one of the *most* exciting times of the year.

At this year’s ASRM conference in Baltimore, we spent three days fully immersed in the latest science on fertility and reproduction. And, in addition to learning from leading researchers and clinicians in the field, we were invited to give four research talks of our own after submitting our latest research initiatives. (For context, talks are all individually selected by a committee who decides that a submitted research topic is of particular interest — so not all submissions get chosen to be talks.)

Below, we're aiming to provide a pretty thorough breakdown of what we learned from our research and presented at ASRM 2021. Here's a TL;DR of the biggest takeaways:

  • Using data from 18,000+ Modern Fertility customers who consented to research, we found that the prevalence of very low anti-Mullerian hormone (AMH) over age 35 was over 1%. More specifically, 2 in every 100 38-year-olds, and about 3 in every 100 39-year-olds had very low AMH.
  • We used data from over 25,000 people on different hormonal contraceptives, as well as some people not on hormonal contraceptives, to develop the first-of-its-kind set of reference ranges, specific to both age and hormonal contraceptive use. These numbers can be used to provide better interpretation and recommendations.
  • The Modern Fertility platform and customized results experience can be an effective tool for improving fertility knowledge. Accessing personalized information about reproductive health and fertility in general can increase positive and decrease negative emotions. It can also support the decision to take further action when those steps might be helpful when trying to conceive.

Before we dive into what we presented and what our findings mean for the field of reproductive medicine, we have to highlight just how indispensable the participation of Modern Fertility customers who consent to research is. Thanks to everyone who's helped us push fertility science forward for all people with ovaries by opting in to research. Interested in participating? Scroll to the bottom for step-by-step directions.

(If you want a replay of our virtual event with the researchers behind our new findings, create your free Modern Community account here!)

How common is very low AMH, and can we use data to identify people who are most likely to have it?

Anti-Mullerian hormone (AMH) is a hormone with important implications for understanding things like ovarian reserve, responses to egg freezing and in vitro fertilization (IVF) procedures, and menopausal timing. Very low AMH also may be indicative of primary ovarian insufficiency (POI), which comes along with a lower likelihood of conception (both with and without IVF), and some health concerns (like decreases in bone mineral density) that can be treated if the condition is detected.

Despite the importance of identifying very low AMH, doctors don't routinely screen for it. But AMH can be valuable to *proactively* test, too: it can help you understand your overall reproductive timeline, and unlike other hormones used to assess ovarian reserve (we’re looking at you, follicle-stimulating hormone), it can be tested at any point in the cycle — even when someone's on birth control. Understanding how many people of reproductive age in the general population have very low AMH through routine screening can help us get a sense of true prevalence — and help us explore other factors that might be associated with very low AMH.

Using data from 18,000+ Modern Fertility customers who consented to research, we first determined the frequency with which we observed very low AMH (defined here as less than 0.08 ng/mL, aka levels that are too low to be precisely measured by our hormone assay). We found that the prevalence of very low AMH over age 35 was over 1%. More specifically, 2 in every 100 38-year-olds, and about 3 in every 100 39-year-olds had very low AMH.

Our next step was to figure out if there were specific factors that were more common in people who had very low AMH. We found that people who had high FSH, long cycles, recent changes in their menstrual cycles, and who reported either never or just sometimes getting a period were more likely to have undetectable AMH.

Knowing what factors are associated with very low AMH and how prevalent it is at different ages means we could potentially use this info to target screening efforts for people with very low AMH — and help them get the treatments and resources they need to reach their reproductive and health goals more quickly.

We created age- and contraceptive-specific reference ranges to help doctors better interpret AMH values

Some previous work (including work done by us here at Modern Fertility) has shown links between hormonal contraceptive use and AMH. Having a clear understanding of the relationship between current hormonal contraceptive use and AMH is super important: More and more people are seeking proactive info about their fertility, many of whom are on hormonal contraceptives when they test.

But knowing how much contraceptives may impact AMH is just one piece of the puzzle. What we also need are ways to interpret whether a result is considered "low," "normal," or "high" in the context of their specific contraceptive. The data and values used to assign an AMH value to one of those categories is often called a “reference range,” and to be able to most accurately interpret someone’s AMH, we need reference ranges that take their exact age and their contraceptive use into account.

Here’s an example: People who take combined oral contraceptives have AMH levels on average 24% lower than people who aren’t on a contraceptive. If we compared the result from someone on the pill to a reference range based only on people who were not using contraceptives, we won’t give them the best interpretation and may erroneously flag the result as being lower than expected. Having age- and contraception-specific reference ranges would help us avoid these kinds of misclassifications.

We used data from over 25,000 people on different hormonal contraceptives, as well as some people not on hormonal contraceptives, to develop the *first-of-its-kind* set of reference ranges, specific to both age and hormonal contraceptive use. These numbers can be used to provide better interpretation of AMH levels and recommendations for appropriate next steps (especially if you’re considering egg freezing or IVF).

 

Predicted median AMH
values ng/mL (95% CI)

Contraceptive
type

Age: 30

No contraceptives

3.33 
(3.24 - 3.41)

Combined oral
contraceptives

2.84 
(2.72 - 2.97)

Hormonal IUD

3.33 
(3.18 - 3.49)

Copper IUD

3.39 
(3.17- 3.62)

Implant

3.08 
(2.80 - 3.40)

Minipill

2.87 
(2.53 - 3.25)

Ring

2.81 
(2.58 - 3.06)

How does Modern Fertility’s platform impact fertility knowledge, emotions, and proactive behaviors?

Education is at the heart of so much of what we do at Modern Fertility, in part because fertility and reproductive education often starts and ends with how to prevent pregnancy. We’re strong believers that every person with ovaries should have access to reliable and accurate info about reproductive health (not just as it pertains to pregnancy prevention!). When people take the Modern Fertility Hormone Test and get back their results, they also get a customized set of reports that are chock-full of personalized information about fertility and reproductive health.

So, we surveyed 469 Modern Fertility customers before and after they received their Fertility Hormone Test results to examine three things:

  1. Study how people’s knowledge about fertility changes
  2. Understand how emotions change
  3. Determine whether people intend to make different decisions about their fertility

To answer our first question, we developed a set of 13 questions about fertility (for example, “fertility hormones can tell someone about their egg quality”), and asked people to agree or disagree with the statements.

When comparing people’s scores before and after reading their reports, we found that scores on 12 out of the 13 questions significantly increased (and overall scores increased by 55% on average!). On top of that, over 80% of people scored higher after receiving their results.

Next, we asked about emotions (five we considered more positive, and five we considered more negative). We found that all five "positive" emotions were higher after people got their results — specifically, people reported being more excited, empowered, informed, prepared, and supported after getting their results. All five "negative" emotions were lower — specifically, people reported being less alarmed, anxious, concerned, confused, and nervous after getting their results.

We also looked at whether emotional responses differed based on what AMH result someone got. Specifically, if someone received an “in range” or "normal" AMH value, how did that compare to people who received an “out of range” or "high/low" AMH value? On average, people who received out of range results reported being more alarmed, concerned, and nervous compared to people who had "normal" AMH levels. This isn’t necessarily surprising — research has been published showing that people experience more negative emotions when they receive a result that is abnormal. In this case, fertility hormones are not an exception.

This takes us to our third and final question: Do people intend to make different decisions about their fertility after getting their results? We found that people with out of range results, who on average reported higher “negative” emotions, also reported a higher intent to engage in behaviors to increase their chances of conceiving (e.g., making an appointment with a healthcare provider to follow up on their results).

We found this result very encouraging: Customers who find out that they have an out-of-range hormone result are empowered to take action on the information. Imagine if you measured your blood pressure at home and the readings came back high. While you might initially be concerned, this would prompt you to dig in further, perhaps talk to your doctor, and take action in a way that optimizes your health. This is the power of being able to access information about your own body.

Our takeaway here?

  • The Modern Fertility platform and customized results experience can be an effective tool for improving fertility knowledge.
  • Accessing personalized information about reproductive health and fertility can increase positive and decrease negative emotions.
  • It can also support the decision to take further action when those steps might be helpful when trying to conceive.

Interested in helping us push fertility science forward?

Modern Fertility is committed not just to helping people access information about their fertility and about their reproductive health, but also actively contributing to what the scientific community knows about the field. We wouldn’t be able to do this without those of you who consent to research and provide us with the data we need to help push fertility science forward.

Here’s the thing: The more people who opt in and join us in our research efforts, the faster we can make an impact in fertility science. Want to update your consent to research? Head to the Modern Fertility App, click the “Me” icon at the bottom right of your screen, and click “research consent” at the bottom of the “Account” section.

Whether you consent to our research or just want to learn about our findings, we appreciate you!

Did you like this article?

Sharon Briggs, PhD

Sharon leads Clinical Product and Research at Modern Fertility. She's a craft beer-loving, soccer-playing, cookie-baking scientist who completed her PhD in Genetics at Stanford University.

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