Beyond awareness: Why we need a top-down approach to fertility education

As a medical director at a leading fertility clinic, I have met individuals and couples at almost every stage of their fertility journey.

Many are trying to start their family. Some are looking to add to it. And a growing number of women are taking pre-emptive action to gain a better understanding of their fertility, even if they do not plan to have a baby in the near future.

This is an overall positive trend and reflects a promising increase in awareness not only around fertility, but also around the fertility preservation options available for men and women who may wish to start a family later in life. Despite this, crucial gaps in understanding remain, both among patients and even medical professionals. Better education is still needed to ensure that those embarking on the path to parenthood can make informed and empowered choices about their own fertility.

For women considering freezing their eggs, a fertility assessment is often a natural proactive first step, either independently or with a partner. While these assessments can offer valuable insight into personal fertility and support with long-term family planning, they are not without their pitfalls. For instance, women with good Anti-Müllerian hormone (AMH) levels may be led to believe this means they can delay freezing their eggs. In reality, AMH levels only provide a snapshot of ovarian reserve at a given point in time, and delaying egg freezing beyond the ideal window of the mid-20s to early-30s can have an impact on fertility and future chances of conception.

This potential scenario is one example of why the advice that accompanies these tests is just as important, if not more important, than the tests themselves. For instance, if a patient isn't ready to freeze their eggs, it may be more appropriate to advise them to monitor their AMH levels over time rather than to allow them to leave believing that no further action is needed.

At the other end of the spectrum, a patient relying on an at-home test kit may see that their AMH levels are low and misinterpret this as meaning they are infertile, causing unnecessary psychological distress. In reality, a result of this kind does not necessarily mean a woman cannot become pregnant, as a consultation with a qualified expert may reveal. With the modern femtech market booming, the potential of these home tools to empower women must be balanced against their potential to misinform.

Getting specialist advice early on can help avoid the risks of both self-diagnosis and over-testing. The latter is most common when GPs carry out tests that will inevitably need to be repeated by a fertility specialist later down the line. The Renewed Women's Health Strategy (see BioNews 1152 and 1247) aims to ensure women are directed to the right professional first time through a single referral point; it will be interesting to see whether its implementation helps shorten the journey from GP to specialist for women seeking fertility treatment, alongside support for gynaecological conditions like endometriosis and polyendocrine metabolic ovarian syndrome (PMOS).

PMOS, recently renamed from polycystic ovarian syndrome (see BioNews 1339), represents an especially relevant example of why there is still room for evolution and improvement in how we understand and treat reproductive conditions. The new name aims to communicate that the condition is not defined by the presence of cysts or limited to the ovaries. These previous misconceptions contributed to misdiagnoses and delayed treatment for some women, while also fuelling fears around how the condition may affect fertility. In reality, with the right support, many women with PMOS may be able conceive naturally or through treatment.

At present, we need to avoid the mindset that improving access to and awareness of fertility preservation and support alone is enough. This increased visibility needs to be matched by active efforts to deepen understanding, both by providing better education from school level and by ensuring fertility experts, GPs and medical professionals offer more complete, evidence-based and timely advice for patients at every stage of their journey. This kind of top-down accountability will be needed if we want all women and couples to receive the personalised and effective care they deserve.