Why Women Are Getting Fertility MOTs In Their 30s

Photo: Anna Jay
"Everyone's obsessed with fertility," says Jo Bates, 35. "But most of my friends don’t have children because they're ex-party animals.” Up until recently, Jo hadn't considered having a family anytime soon, either. "Life's so busy and other things are so important but now it's like, shit, have I run out of time? I'm not sure if I'm in the right place this year to have one but I want to know realistically how long I have left."
Jo is one of many women getting an anti-Müllerian hormone (AMH) or antral follicle count (AFC) test (aka fertility MOT) to assess her chances of getting pregnant. With prices beginning at around £100, which includes a test and an explanation, doctors say they are increasingly common, especially for women in their mid-to-late 30s. But how reliable are they? And are they offering false hope?
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Experts say the answer is… complex. Professor William Ledger from the School of Women’s and Children’s Health at the University of New South Wales says these types of assessment are a good idea, provided people understand what it is they’re going to learn. “I think knowledge is empowerment and the more you know about how your own body works, the better that is in terms of making plans,” he says. “But the tests don’t do what many people think. They’re measuring your egg number and you might be someone who is blessed and has more eggs than average for your age or you might be someone who‘s been unlucky and maybe has less eggs than average for your age, but they do not measure egg quality so the problem is people get false reassurances.”
As a result, Ledger thinks doing the test in your mid-to-late 30s, getting okay results, then putting off having a family for a few years is not a wise thing to do. “The only thing we know that relates to egg quality is a woman’s age and as she gets older that quality goes down, and AMH is not a good way of predicting that,” he says.
Professor Adam Balen, chairperson of the British Fertility Society, agrees. He thinks that while most people won't need to take this type of test, it is really important to understand our fertility. “Education for young people on fertility is severely lacking. What we're seeing now is a generation of millennials who are delaying starting a family and therefore more likely to have difficulty conceiving because fertility declines as we get older.”
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Despite expert advice such as this, people in Jo’s situation are optimistic that the tests can buy them more time to map out their lives. She is currently in a relationship and says her partner, John, who she doesn't live with, is a long way off agreeing to start trying for a baby. “John is so far off having children, he can hardly even manage his own life,” she says. But when she goes for the test later this summer, if the results aren’t what she’s hoping for, she says she’ll have to rethink her plans of delaying it. “I'd do anything. I really would,” she says.
Generally speaking, there are two categories of people taking these tests. The first is women who are in a long-term relationship who can see themselves parenting with their man but who, for reasons such as stability in life and careers, don't want to be pregnant yet. The second – which constitutes the majority of the market – is single women in their 30s who are anxious because they’re hearing the clock tick and they don’t have a partner. In both circumstances, experts say the tests are useful, but women – and men too – need to be aware that the results won’t always provide reassurance.
Although it can be lovely when people get a successful result, it’s a double-edged sword – 50% of people will be below average and some are well below. “I see a lot of these people in my practice and I say think of Pandora’s box – once you undo the ribbon and let the genies out you can’t put them back in, so you have to be prepared for a result which is not optimum,” says Ledger. He thinks you need to be sure you want to know because it can be quite psychologically stressful and harmful to women who believe themselves to be healthy to find out they’ve got a low egg reserve. "That’s quite a traumatic thing for someone to deal with, particularly if they’re not in a position or in a relationship where they can have a child quickly.”
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Leah Smith, 35, is worried about this happening to her. She had considered booking a test but says she is too afraid of what she might find out. “I haven't gone for the test. I'm in denial. All I want is reassurance that everything's going to be fine. I want someone to say ‘Yes, your ovaries are that of a 20-year-old!’ but part of the reason I don't want to pursue it is I don't want to know. I’m leaving it until my next birthday.”
Others, however, took the risk and have no regrets. At 36, Laura Martinez was told that her egg count was slowing down and so she immediately started trying to have a baby and is now a mum of two. “Luckily, I went ahead and did it,” she says.
Although these tests are useful, other indicators need to be taken into account. Factors such as a family history of early menopause, polycystic ovaries and endometriosis can also affect fertility and doctors often recommend women having assessments if it took their mother more than a year to get pregnant.
As well as this, men need to take more responsibility for a couple’s chances of conceiving, particularly as they get older. “Men have a longer fertile lifespan on average but if your male partner is over 40, his sperm quality is likely to decline," says Ledger. "It’s very easy for a man to get a sperm test and DNA test and that, equally, can give reassurance and is a good package to look at together because it obviously takes two to make a baby.”
Whatever women decide to do, the general consensus is that these tests can be a positive thing. Just be sure that you are ready to accept the results, whatever they may be.
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