As a woman approaching 30, I鈥檓 well aware that my biological clock is ticking. Still, there are many reasons why I continue to delay trying for a family. I know it鈥檚 a risk, but what I鈥檇 really like to find out is how much of a risk I鈥檓 taking. It would appear I鈥檓 not alone. Anecdotally at least, increasing numbers of people curious about their ability to conceive are taking fertility tests. In the UK, couples are offered them free on the NHS if they have been trying to get pregnant unsuccessfully for a year or more, but anyone can opt for one of several tests carried out by private clinics. Are they any good?
鈥淚f I were a woman, I would do it,鈥� says , a gynaecologist at the University of Nottingham, UK. Perhaps that鈥檚 to be expected, given that he, like many academic embryologists, has a clinic offering these tests. Nevertheless, I decided to give it a go.
After a bit of online research, I found what I was looking for: a 鈥渇emale and male comprehensive initial consultation鈥�. Otherwise known as a 鈥渇ertility MOT鈥�, this would entail a semen analysis for my boyfriend, counting his sperm and observing how healthy they look. And I would have standard fertility tests promising to reveal my ovarian reserve 鈥� essentially how many eggs I have left. Then there would be a half-hour consultation to discuss our results. The package cost 拢450. I signed us up.
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Deformed is normal
Around a week after booking, I went to the clinic to give a blood sample to be tested for anti-Mullerian hormone (AMH), which is produced by egg cells. My boyfriend then provided a semen sample. The first surprise came a couple of hours later, when he was emailed his results. One thing stood out: 鈥�97 per cent head defect鈥�. Did this mean he is infertile? After a couple of very anxious days we discovered it didn鈥檛. It turns out that it鈥檚 normal for the vast majority of a man鈥檚 sperm to be deformed. I couldn鈥檛 help wishing the clinic had told us this beforehand.
A week or so later, on the day of the consultation, I had the second part of my test. Timed to coincide with ovulation, it consisted of an ultrasound scan to count the number of egg follicles in each of my ovaries. It鈥檚 an internal scan, so a little uncomfortable. But I was distracted when I looked at the screen 鈥� I could see my own eggs! The doctor told me the count was pretty normal. My AMH level was in the normal range too, albeit at the low end. Now what?
My boyfriend reasons that, with no serious problems, we can afford to wait a few years. But can we? 鈥淭hese tests could be dangerous if they give you a false sense of security,鈥� says , an embryologist at Guy鈥檚 and St Thomas鈥� hospitals in London. In fact, they aren鈥檛 designed to measure female fertility at all 鈥� they are meant to inform doctors how many eggs a woman might produce for IVF when she is given hormones to induce ovulation. At best, they only provide a snapshot of a woman鈥檚 egg reserve, and my results could look totally different in a matter of months.
Huge healthy range
What鈥檚 more, AMH results are open to interpretation. They do indicate how many eggs you have left, but it鈥檚 not a precise measure as levels of the hormone can fluctuate by around 13 per cent in an individual. In addition, results vary substantially between clinics, depending on the measurement technique they use. And . The doctor told me my score, 15.2, was normal, but when he said that the normal range for my age was between 13 and 60, it suddenly sounded like a bad result. I鈥檝e since learned that high AMH scores aren鈥檛 necessarily good either, because they can indicate polycystic ovaries. 鈥淢easuring AMH used to be seen as wonderful, but it鈥檚 going out of fashion,鈥� says Bolton.
The follicle count is even more problematic. During ovulation, several eggs grow and expand 500 times in size to create follicles between 2 and 10 millimetres wide. Only one will eventually be primed for fertilisation 鈥� we still don鈥檛 know how the selection is made. These follicles are visible on the ultrasound scan, and doctors count them by eye, which leaves room for human error. But it鈥檚 worse than that: we don鈥檛 know whether the number of follicles a woman produces correlates with fertility at all. And numbers tell us nothing about egg quality. 鈥淭he real crux of fertility is: can egg and sperm meet, fertilise and produce a quality embryo?鈥� says Raine-Fenning. 鈥淭he only way to test that is to try for a family.鈥�
So where does that leave fertility tests? They may help pinpoint a problem if a couple is having difficulty getting pregnant 鈥� although, many causes of infertility are unknown, and around a third of couples never learn why they cannot conceive. But for people like me, wondering if they can put off parenthood, fertility tests simply can鈥檛 provide concrete answers. As , chair of the British Fertility Society, puts it: 鈥淭hese tests don鈥檛 tell you anything about the future. They are appealing, but they don鈥檛 tell the full story.鈥�
Read more: Fertility facts: How late can you leave it to have a baby?
You want kids, just not yet. So here鈥檚 how to work out when to start trying
