Direct-to-consumer fertility tests confuse and mislead consumers, study shows

At-home fertility tests are an empowering tool for some women in making decisions about their fertility, but leave others feeling lost and confused, a new US study has found.

These 'direct-to-consumer' (DTC) tests measure levels of anti-Mullerian hormone (AMH), a marker that estimates the size of a woman's remaining egg supply, or 'ovarian reserve'. 

Until now, the ovarian reserve tests have primarily been used as a clinical diagnostic tool for ovarian stimulation prior to IVF, but DTC tests are increasingly being marketed as a low-cost way to investigate fertility. 

The study highlights the importance of educating users on the accuracy and purpose of such tests, which are not predictive of natural conception.

The study was conducted by Dr Moira Kyweluk, a fellow in the department of Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania.

Referring to the DTC tests, Dr Kyweluk explained that 'consumers continue to desire these tests, and they're attractive, but they don't deliver on their promise.'

The work was published in Social Science & Medicine and is the first ethnographic study on DTC ovarian reserve testing in the US. Dr Kyweluk wanted to see how differences in relationship status, sexual orientation, socio-economic status, racial or ethnic identity, and medical insurance coverage shaped women's experiences of the testing. 

A group of 21 participants in Chicago, Illinois were followed through the entire process of ovarian reserve testing and interviewed at various points.

Through these interviews, Dr Kyweluk was able to identify four main themes across all the women, including: knowledge, empowerment, DTC fertility services as a viable alternative for family planning, and participants' varying degrees of uncertainty about their results. 

Some of the women who took part found the results empowering and described how they would help them plan for their fertility choices. However, other participants expressed confusion over their results, and what the next steps were, even after a follow-up consultation with a nurse practitioner. 

The hormone testing is achieved by taking blood from the participants, although it is not comprehensive enough to provide a formal diagnosis of infertility, which usually requires an ultrasound scan at a clinic. 

Ovarian reserve tests are also not predictive of natural spontaneous conception and are discouraged in otherwise healthy individuals. 

Looking to the future of at-home fertility testing, Dr Kyweluk said, 'I view DTC testing as an entry point into what I term the 'new (in)fertility pipeline' for women today.' 

She explained that the availability of the tests means they can reach a wider demographic and raise awareness of more advanced assisted reproductive technologies available to them.