Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.
The new research, published in the Journal of the American Medical Association, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.
Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.
“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.
That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.”
“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.
But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.
Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.
In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.
“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.
The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.
Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.
“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.
Megan Thielking has written a brilliant article on the role of AMH blood test in predicting ovarian reserve as well as pregnancy outcome. Individuals seeking fertility treatment should not over-interpret the blood test results. AMH test might predict the ovarian reserve in 50-60% of the cases especially when egg numbers are high (positively correlated with high AMH). Correlation of AMH with low egg reserve is very poor and therefore unpredictable. Regarding pregnancy outcome, AMH is a very poor predictor. Interestingly, there is no single blood test for predicting pregnancy outcome available in the current market. We have developed and clinically validated a blood test (LHCGR test based on LH/hCG receptor) that can predict the fertility treatment oucomes (see the weblink http://www.originbiomarkers.co.uk/)
Why is there no link or citation for the study?
Apologies for the oversight. We have added a link to the study, which you can find here: https://jamanetwork.com/journals/jama/article-abstract/2656811
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