My feet in stirrups, I stared at the eerie black-and-white images projected on the screen in front of me, as Hailee Steinfeld’s “Love Myself” bumped energetically in the background. My ovaries, the squishy bean-shaped blobs on the screen, bounced in and out of shadows as my gynecologist shifted the ultrasound probe, searching for the follicles that produce eggs.
This was not your typical ob-gyn exam, to say the least. I’m not trying to get pregnant—quite the opposite, actually—but I paid a visit to Trellis, a new “fertility studio” and egg-freezing clinic in New York City, to learn just how fertile I am now, and will be in the years to come. With an in-house juice bar and a quote from Michelle Obama (“It’s up to each of us to invent our own future”) displayed prominently in the well-lit lounge, Trellis is one of several new startups launched in the past two years garnering attention and investor dollars for adding fertility to the list of health stats you can easily track.
The idea behind making fertility testing cheap, convenient, and trendy, stems in part from data: Women are increasingly putting off having children—for the first time, women in their thirties are now having more babies than women in their twenties, according to the CDC. But because fertility naturally starts to decline in your 30s, these companies assert information is power. “We help you understand what’s going on in your own body so you can use that information to make the decisions that are right for you,” says Afton Vechery, co-founder of Modern Fertility, an at-home fertility testing service launched in summer of 2017. Armed with your fertility stats, the idea is that you can eliminate (or at least reduce) anxiety about putting off baby-making, adjust your timeline if your proactive tests reveal any red flags, or make a more informed decision about egg freezing.
But after my procedure, I was skeptical. Is this just millennial marketing—complete with an Instagram-worthy reception area, socially-conscious brand mantras (“empowered egg freezing”), pink take-home brochures, and sleek apps—at its best?
If you’re having trouble getting pregnant, a trip to any traditional fertility clinic will generally follow a few key steps: a look at your medical history, an ultrasound to examine your ovaries, a blood test to measure key hormones tied to egg production. No one test can tell you with 100 percent certainty if or when you’ll be able to get pregnant, but for now, the combined results of these tests are the closest you can get to a crystal ball.
The problem these startups—all led by women—have with that approach? It comes too late. Many ob-gyns or specialists won’t run these tests unless a woman is already having issues, which means the game may already be decided, or the options for action limited.
Piraye Yurttas Beim, who has a Ph.D. in molecular biology, first went to her doctor for a fertility assessment at 32. She was told, based on her fertility hormone tests, that her chances of getting pregnant using her own eggs was less than one percent. “I felt like, wait a minute, I did all the right things,” she says. “I went to my ob-gyn every year for my annual screens. Why wasn’t I screened for [fertility]? Why wasn’t I given a heads up that this was a possibility? Why was this sprung on me when it was effectively too late?” As a scientist and founder of Celmatix, a company that tests fertility-related genetic markers to help predict a woman’s baby-making odds, Beim knew that hormone levels don’t always tell the whole story. The proof? She went on to conceive her three kids naturally.
Still, hormone tests can be a starting point to getting insight into your fertility potential, which is why startups like Modern Fertility and Future Family analyze the same exact hormones traditional clinics do. This gives doctors an idea of your egg quantity, aka your “ovarian reserve” and can help a fertility specialist assess how many eggs you likely have in the bank. (Trellis operates more like a traditional fertility clinic that’s been given a chic makeover—they perform blood tests and ultrasounds, like the one I had, conducted by doctors specializing in reproductive medicine at their NYC clinic. From there, a “fertility coach” can walk you through the company’s egg freezing packages and “fertility wellness” plans.)
The science behind these tests isn’t new. But these founders hope streamlining the process of getting them will help women move from being reactive to proactive about fertility. Now, you can order a hormone test online (you can either prick your finger at-home, or get an order to have blood taken at a local lab) for under $200. Old school fertility testing would require jumping through hoops to find your way to a fertility specialist, where you may be socked with a hefty bill—potentially reaching into the thousands—that may not be covered by insurance.
Getting Answers Without Fear
Conversations about fertility have long felt like scare tactics, pressuring women to have kids ASAP or shell out cash to freeze their eggs before time runs out. Past awareness campaigns even included an upside down baby bottle as a rapidly dwindling hourglass. The fear-mongering around fertility isn’t just uncool, evidence suggests it can be costly—only 6 percent of women who froze their eggs went on to actually use them, in one small 2017 study. (Most women in the study who were pregnant at some point, conceived naturally.)
The modern conversation, as I experienced, has gotten a major course correction. These days doctors really, really don’t want the results from these tests to cause any panic. “It’s incredibly complicated,” says Paula Brady, M.D., a fertility specialist the Columbia University Fertility Center. “We can’t take one value and say, ‘This is great, don’t worry,’ or ‘This is bad, you should be worried.’”
My blood tests (one from Modern Fertility and another from Trellis) and ultrasound revealed that, while I’m still technically within the “normal” range for a woman in her late 20s, I have a less than stellar ovarian reserve. My AMH level, perhaps the best indicator of how many eggs I have, is “lower than expected for [my] age,” Trellis found.
My first reaction: Holy shit. Do I need to freeze my eggs?
It’s surprisingly hard not to panic about these results. But as I made more calls, almost every expert I spoke with stressed that my ovaries’ meh report card was no reason to freak out. “The low edge of normal is still in the normal range,” assured Nataki Douglas, M.D., director of translational research for the department of obstetrics, gynecology and women’s health at Rutgers University and chair of the medical advisory board at Modern Fertility. A below average test result, in other words, doesn’t mean you should rush to put your eggs on ice.
The Fertility Prediction Blind Spot
Not only is the science of predicting fertility imperfect and complex, it also has a major blind spot: Even the techiest and trendiest fertility assessments look only at the quantity of eggs you have when evidence suggests the quality of your eggs is equally important. Last year a team of reproductive researchers led by the University of North Carolina Chapel Hill found women with signs of “diminished ovarian reserve” were just as successful at getting pregnant as women with a normal reserve. Basically, an underwhelming ovarian reserve result might mean something about your ability to get pregnant in five years—or it might not. (The best predictor of egg quality doctors have is your age.)
These new companies believe the services they provide could add another layer of data to your family planing calculations. Testing early, they suggest, means you can track your fertility stats over time—one AMH test might not tell you much on its own but a drastic drop in the hormone year-over-year is a more reliable red flag, Dr. Douglas says. “The key is to have the information so that you’re empowered to make decisions and have informed discussions with the right people,” she adds.
Still, experts don’t recommend all women start tracking AMH levels with the same rigor as you might track your steps or your sleep. “I always say check a value if you would do something with the result,” says Dr. Brady. If your mom went through early menopause, for example, getting your hormone levels tested could give you a little more insight about having kids earlier or freezing your eggs. Or if your period is irregular, a fertility assessment might help shed light on conditions like PCOS that could impact your baby-making plans. But if seeing ambiguous below-average hormone levels will only make you stress, Dr. Brady says it might be best to pass.
After two hormone tests, one ultrasound, and nearly a dozen interviews with reproductive experts, I still don’t know if I can confidently put off pregnancy for another five years or whether I should sign up for egg freezing at Trellis (estimated cost: $12,850 plus $600 per year in egg storage fees). I have my results, but I don’t exactly have answers. “It would be awesome if we could have a single blood test or an ultrasound that could really lay out your future,” says Alan Penzias, M.D., chair of the American Society for Reproductive Medicine’s Practice Committee. “But right now, I don’t think we’re quite there.”
I’ve wrestled a lot with how I feel about that. Unlike years ago when that baby-bottle-as-hourglass campaign got major backlash, women today know more than ever about our bodies. We track our steps, our sleep cycles, our periods right on our phones. We’re fluent in data about our bodies, ourselves. This whole panoply of information about our bodies helps us make more “empowered” decisions—so why wouldn’t the same be true about fertility data? Now, rather than remaining in the dark about what my ovaries are up to, I’m armed with baseline information that I can use to start a conversation with my gynecologist about the choices I’ll be making for my body over the next five, even ten, years.
Testing early means I don’t feel like I’m at the mercy of my biology—I feel like I’m in the driver’s seat.