fbpx How At-Home Hormone Tests Are Changing the Fertility Conversation
A row of test tubes form the walls of a house.
A row of test tubes form the walls of a house.

How At-Home Hormone Tests Are Changing the Fertility Conversation

You no longer have to make an appointment to discover valuable health information.
Britany Robinson
Written by

Britany Robinson

Katherine was 34 when she started to seriously consider her desire to have children. She was also single and in the middle of a career transition.

With a family history of miscarriages and thyroid issues, Katherine wondered if she'd even be able to conceive. So she took an at-home fertility test. Through a simple blood sample taken at home and mailed to the clinic's testing facility, Katherine's results showed hormone levels indicative of a healthy ovarian reserve. There is no guarantee until she tries to get pregnant, but the information reassured her that she needn't rush.

"It was a huge weight off my shoulders, knowing that I have some time to consider my options," Katherine said.

I was also 34 when I first had a fertility health assessment. But I didn't know about the at-home option, so I visited a Kindbody clinic in San Francisco, where I had an antral follicle count done via ultrasound, along with hormone testing. My results told a different story. My anti-mullerian hormone (AMH) levels were extremely low, indicating a high likelihood of premature ovarian aging and early menopause.

In both instances, hormone testing shed light on our future options for having children. My doctor's recommendation was to either start trying to get pregnant ASAP or consider freezing my eggs. I was also told if I were to need in vitro fertilization (IVF) in the future, my success rate for retrieving eggs would likely be low. Katherine was reassured that it was probably fine to wait a few years before trying to have kids.

In both instances, we were given helpful information for family planning that we hadn't known was available until recently. "I had no idea about AMH until a friend mentioned at-home hormone testing," Katherine said.

At-home fertility tests are now growing in popularity. Kindbody, the clinic I visited in San Francisco, just released Kind at Home for both men and women. These are now among a collection of at-home options, including Modern Fertility, Everlywell, Carrot and LetsGetChecked.

(We'll note here that testing is available—and equally important—for both men and women, but we'll be focusing on women's fertility testing here.)

Earlier in this series, we discussed the importance of understanding your fertility health, which can help you evaluate your options for a future family. It can also help you to better understand your overall health. Now at-home fertility tests are helping to expand and normalize a conversation once reserved for couples who are actively trying to conceive.

What do at-home fertility tests actually measure?

At-home fertility tests typically measure a variety of hormones that impact ovulation. Each test is slightly different, but most measure some combination of AMH, considered the most accurate predictor of ovarian reserve; estradiol (E2), one of the primary hormones responsible for ovulation; prolactin (PRL), which can cause infertility when elevated; luteinizing hormone (LH), what spikes just before ovulation; follicle-stimulating hormone (FSH), responsible for stimulating the follicles which eventually release an egg; and thyroid-stimulating hormone (TSH), which stimulates the thyroid to perform many bodily functions including metabolism; and others.

Women are born with all of the eggs they'll ever have, and that number decreases as they age until eventually they reach menopause, and their body is no longer ovulating. (Actually, fun fact: A female has the most eggs when she is still in her mother's womb, and that number starts going down before she's born.)

Every woman, no matter her family history or current health, will have fewer and fewer eggs as she ages, with fertility peaking in her late-teens to late-20s. After 30, fertility typically declines faster. The results of these hormone tests can offer markers on how quickly your fertility is declining, relative to what is typical for your age.

Kristin Bendickson, M.D., a reproductive endocrinologist, said results should be taken into account along with overall health, family history and how you feel about having children, including if, when and how many.

"Hormone tests are just one piece of the puzzle," she said. "These tests provide insight on what's going on now, and what potentially could be coming down the road. So let's talk about your medical history, your family history, and what you want. How do we put this all together?"

One thing Bendikson emphasizes with her patients is that hormone tests do not provide definitive information about your ability to conceive right now. Instead, they are reflective of your ability to conceive down the road, in one or five or 10 years. They can't offer a specific timeline on fertility decline, but they can indicate if your quantity and quality of eggs are declining faster than most.

While they can't tell you about your ability to conceive today, there are instances where hormone tests can identify an existing problem that can be addressed. One example is thyroid health, which some fertility hormone tests address by measuring TSH.

"Your thyroid controls metabolism, and that impacts everything in your body—your gastrointestinal system, your skin, your hair," Bendikson said. "Learning that you have a thyroid issue is something that you can fix now and has great implications for your overall health and how you feel."

Why and when should you take an at-home fertility test?

When I asked my OB-GYN about hormone testing, I was told I should wait until I was 35. (I was 34 at the time.) But all of the fertility experts I've spoken to since, for myself and these articles, agree it's never too early to learn more about your body, your hormones and your ability to have children if and when you decide to do that.

"It's important to think about these things in the context of your career, if you want to take time to travel, how many kids you want," Bendikson said. "And you don't have to act on anything right away."

In my case, hormone testing and a fertility assessment prompted action.

The results inspired me to have a very frank conversation with my partner about what we both wanted and when. I decided waiting just wasn't worth the risk. I hadn't expected to be trying to conceive last year, but once I understood my fertility was likely declining faster than expected, my desire for children became very clear. My partner and I are now thrilled to be expecting in August.

But, as Bendikson noted, you don't have to act on anything. If you have no idea whether or not you want kids yet, understanding your fertility health might give you a new perspective on the issue. Or it might just give you some information to keep in the back of your mind as you continue to focus on other things in life.

Either way, the knowledge is empowering, because you decide what to do with that information and when.

Changing the conversation with our doctors

"Medicine is continuously changing," said Asima Ahmad, M.D., an OB-GYN, and co-founder of Carrot Fertility. "And right now we're seeing a shift. Patients really want this information."

Ahmad said some doctors might be caught off guard by this shift, as more and more people are taking at-home hormone tests, and then bringing the information to their provider with questions. But as that happens more and more, doctors are becoming accustomed to this new level of access—and it's prompting many of them to better understand the need for more access to fertility health information.

So why hasn't fertility health been a standard conversation with our OB-GYNs in the past? Sadly, it seems to often be a matter of doctors being stretched too thin.

"Providers have very limited time with patients," Bendikson said. "When you're only going in maybe once a year, they really focus on what has always been considered the priority: breast cancer screening and cervical cancer screening. Fertility just hasn't been a priority."

It's also a matter of medicine catching up with current trends in family planning.

Bendikson said that in the past, discussing fertility health was less of an issue, because couples were more likely to start trying to conceive when women were at peak fertility. "But now that couples are delaying having a baby for the first time, talking about fertility is critical."

Whether they're bringing it up or not, our doctors play an important role in helping us fully understand our fertility health, even when we have access to information about our hormones through at-home testing.

Hormone testing results should always be discussed with a doctor before making any major decisions about how to move forward. If your general practitioner or OB-GYN doesn't seem willing or able to advise you on that front, then you can always turn to a fertility clinic or the support provided by many of these at-home testing companies, which might include a phone consultation with a nurse or an in-person visit to a clinic.

At-home fertility tests are changing the conversation both inside and outside of our doctor's appointments. From our home where we might take a test, to a walk with a friend who we might talk to about taking the test, to the OB-GYN's office where we might ask for more information about hormone testing and results—the availability of education on fertility health is increasing awareness across the board.

More and more women are taking the initiative to understand how this information impacts their health and their future.

"I think these at-home tests are showing that patients really want this information," Bendikson concluded.