Amerley Ollennu first started worrying about her reproductive health when her periods started playing up. With fertility testing growing in popularity, here are a few things Amerley wishes she’d known before going for a fertility MOT.
Fertility testing is on the rise, with the fertility test industry projected to soar from $472 million (£348 million) in 2020 to $680 million ($500 million) by 2025 globally. But despite the popularity, it’s worth knowing that testing can be a Pandora’s box of unexpected emotions, costs, and health conditions.
“An in-clinic female fertility MOT usually consists of a blood test for the anti-mullerian hormone (AMH), and an ovarian reserve and antral follicle count,” says Dr Amin Gorgy, fertility consultant and co-founder of The Fertility & Gynaecology Academy. “All of which help to determine the estimated number of stored eggs in the ovaries.”
“Finally a tubal patency test is performed to see if the fallopian tubes are open, as this is where egg fertilisation takes place, and where the egg travels through to implant in the uterine wall in order for pregnancy to begin.”
When my periods started to go haywire a few months before my 37th birthday, I began to worry about my reproductive health for the first time (something it turns out I should have considered far sooner). So, I hotfooted it to see Dr Gorgy for a fertility MOT.
“The number of eggs stored in the ovaries and the quality of those eggs decline with age,” explains Dr Gorgy. “Women are most fertile before the age of 30, after which their fertility starts to decrease, and after 35 it declines more significantly.”
This makes fertility testing a valuable tool for those who are finding it hard to conceive, have a history of irregular periods, evidence of endometriosis and fibroids or who are contemplating egg freezing – as results can help determine when to go ahead with the procedure.
Despite being at an age where fertility testing makes perfect sense (since having children is still something that I would like), there are a few things I wish I’d been prepared for before my MOT.
You may experience pain
Testing your anti-mullerian hormone (AMH) levels can be performed at home by way of a finger prick test. While in-clinic you’ll simply get your blood drawn like any other blood test.
However, when you go for a full MOT, things get a little more intrusive. First, I had the ovarian reserve test. This one’s a pretty standard transvaginal ultrasound – where a lubed up wand-like transducer is inserted into the vagina. Legs are akimbo similar to when going for a smear test – and for most people this isn’t painful at all. But the same can’t be said for the tube patency test.
“To check whether your fallopian tubes are open or blocked, we need to put a catheter through the neck of the womb,” says Dr Gorgy, “and inflate a small balloon that’s attached to keep it inside the uterus. Then we inject fluid, which leads to the uterus contracting in response to these manipulations, which can cause discomfort that might last for a couple of hours.”
I was advised to take some ibuprofen before the appointment, but even then my contractions were so strong that I experienced nausea during the test as well as some sharp pains. Post-procedure vomiting ensued for a good hour. I also had shoulder and chest pain for hours after, making it the worst day to have planned my birthday dinner on – oops!
Not all fertility tests measure fertility
Because they can be performed at home, AMH tests are the most accessible fertility tests on the market. However, this misunderstood test is not a crystal ball to your fertility, and it can send anxiety levels soaring when results are lower than average.
“AMH levels depend on the number of the potential follicles in the ovaries,” explains Dr Gorgy. “This indicates the ovarian reserve and helps us decide on the necessary dose for ovarian stimulation for IVF.”
So while this test can help indicate how you’ll respond to fertility treatment, what it can’t do is help predict your chances of getting pregnant naturally. This is because, as studies have shown, AMH levels are not a true marker of fertility. In fact, Black women like me may naturally have lower AMH levels when they’re young, but experience less of a reduction in AMH with advancing age when compared to white women.
The test also doesn’t account for egg quality. “This is probably more important,” adds Dr Gorgy, “and depends on your age, as women under 35 have a much better chance of getting pregnant than those who are over 35 with the same ovarian reserve.”
Be psychologically prepared
I wasn’t trying to get pregnant at the time of my MOT. However, because I’ve always wanted to have children, my not-so-favourable results, which included an endometriosis diagnosis, threw me for a loop.
Despite the fact I’d had issues with my period in the months leading up to my MOT, I truly thought that since I look much younger than my age, my fertility would follow suit. I realise now that I had internalised the stereotype that Black women are uber fertile, despite there being no studies to back up this long-held belief perpetuated by medical doctors for centuries.
“The myths we believe around fertility impact the way in which we navigate our own fertility,” says Jacky Boivin, professor of health psychology at Cardiff University. “So, when faced with the facts, this can be a hard pill to swallow as it shatters our reality.’
Suddenly my future felt even more uncertain than ever and, in the weeks that followed, I experienced low mood and anxiety. To combat this, Boivin believes it’s imperative to understand that rarely will an MOT give you a definite answer as to whether you will ever get pregnant, or how long exactly you can wait before pursuing pregnancy.
“If you’re looking for certainties,” she adds, “you will be disappointed. What you do need post-MOT is a good support system, a plan, and a tool kit of tangible coping strategies that help you manage the anxiety that can ensue when life feels uncertain.”
Fertility treatments are expensive
Generally, a fertility check-up can be accessed through your GP if you’ve been trying to conceive for at least a year or if you have a medical condition that could impact your fertility. However, if that’s not the case or you’d rather not wait months for an appointment, your only other option is to go private.
A full MOT like the one I had at The Fertility & Gynaecology Academy can cost anywhere between £300-850, depending on what clinic you visit. And like me, post MOT, you may well want to try fertility treatments like artificial insemination, egg freezing or IVF – all of which cost thousands of pounds.
Have a fertility plan
As children, we’re constantly asked what we want to be when we’re older, often choosing careers before we’re even fully fledged adults. However, it’s almost unheard of for people to have a fertility plan.
“Schools are finally addressing fertility within their curriculums, which is a positive move forward,” says Boivin. “It will hopefully help younger generations have a better sense of what fertility entails, and how lifestyle choices like smoking, drug use, and a generally unhealthy lifestyle can impact fertility. It should also help them factor in their fertility timeline when making life and career plans.”
While I can’t go back in time and put money into a fertility fund, Boivin says I can make a plan now. She advises that I think about and decide whether I want to have a child as a solo parent (and at what age), or how long I’m willing to wait to see if I find a partner. If my goal is to become a mother, I also need to consider any changes to my current lifestyle that might make that more of a reality.
If you know these answers or have a plan before an MOT, it should make the next steps a little less scary.