An increasing number of companies are hijacking feminist discourse to promote so-called 'fertility tests' not backed by evidence. The use of feminist 'empowerment' language in their marketing attempts to convey these companies as socially progressive and champions of female health.
In the 60s and 70s second-wave feminism started to question the control doctors held over women's bodies, as women campaigned for greater reproductive rights, less medicalisation of pregnancy and greater knowledge of their own bodies. The seminal book, Our Bodies, Ourselves encouraged women to empower themselves through better knowledge of their bodies to allow them to play an active role in meeting their own health needs.
This rhetoric has been employed and evolved over the decades, and can now be seen in the promotion of fertility tests to women of reproductive age. However, what if the tests they're selling have no evidence of benefit, and strong potential to harm?
What is the anti-Mullerian hormone (AMH) test?
Anti-Mullerian hormone (AMH) is produced by small follicles in the ovaries, which contain immature eggs, and can be measured using a blood test. As the number of follicles, and therefore eggs, drops with increasing age, the level of AMH also decreases. The AMH test, also known as the egg-timer test, can give an indication of the number of eggs in the ovaries, but not of egg quality.
While the test is helpful during IVF as it roughly suggests the number of eggs that may be retrieved during a stimulated treatment cycle, the test cannot reliably predict the likelihood of pregnancy, how long it will take to get pregnant, or specific menopause timing. For example, studies show that women with low or high AMH levels have the same chance of conceiving. This led the American College of Obstetricians and Gynaecologists to state that the test 'should not be ordered or used to counsel women who are not experiencing infertility about their reproductive status and future fertility potential'.
'Empowerment' marketing
Despite clear evidence that the test is not predictive of fertility, companies increasingly market the test as an empowering way to give women insights into their fertility and reproductive timeline, even if they are not trying to get pregnant.
Examples of the persuasive feminist rhetoric on upmarket, fancy websites and in social media advertising include:
- 'Whether you're years away from having children or have already started trying, you deserve to know your reproductive potential'.
- 'You're not ovary-acting. Understand your hormones and fertility, be the boss of your symptoms and get the expert care you deserve—every step of the way.'
- 'Some of the information you can get from this test is vital to making plans for your future.'
We examined the websites of 27 companies across seven different countries selling the AMH test direct-to-consumers. Concerningly, the majority of websites made claims about the AMH test that are not supported by evidence. We found that 74 percent claimed the test indicated a woman's likelihood of conceiving and menopause timing, and 41 percent stated the test could help with family planning or indicate whether women needed to adjust their reproductive timeline. Over one quarter of websites used language promoting empowerment and control over one's body. Although some companies included caveats or mentioned the test's limitations, these were overshadowed or contradicted by the messages of empowerment encouraging women to take charge of their health.
Inaccurate information about the AMH test has also been identified on other websites including fertility clinic websites, which we explored in more detail in our paper in the BMJ Open, often with similar empowerment messages, such as 'Information is power and lets you take charge of your fertility'.
Rising in popularity but little data on usage
Given the apparent false and misleading information surrounding AMH testing, there is rising concern about inappropriate testing in women without infertility. We conducted the first population-level survey to ask how many women in Australia have had AMH testing and for what reasons. We reported in Human Reproduction approximately seven percent of women aged 18-55 years in Australia had had an AMH test, and concerningly, 30 percent of these women got it for reasons not supported by the evidence (eg were considering getting pregnant soon and wanted to understand their chances, were curious about their fertility, were considering delaying pregnancy).
What are the harms of inappropriate testing?
Aside from the unnecessary financial cost, women who are misled to believe the test can estimate their fertility or inform their reproductive timeline are at risk of inappropriate medicalisation, overdiagnosis and overtreatment.
For example, women may be worried or reassured by the test result without basis. As a result, they may change their reproductive plans and behaviour. For example, women who receive a lower-than-expected result may experience unwarranted anxiety about their ability to conceive. This may pressure them to conceive earlier than desired or undergo costly and potentially unnecessary fertility procedures.
The decision to have an AMH test may appear to be empowering, however this rests on the false assumption that the test is an accurate predictor of fertility status. We believe that the marketing of useless health products using feminist well-being messages ultimately undermines empowerment and women's ability to make an informed decision.
Ways forward
While we fully support stronger patient autonomy, marketing and campaigning for interventions to women in the general population without evidence of benefit and/or without stating the limitations risks causing more harm than good. Companies should not be allowed to market the AMH test to women given the lack of proven benefits outside of IVF and risk of harm. To weigh up all possible benefits and harms and make informed decisions about AMH testing, women need evidence-based information free from vested interests.
We urge women to be wary of simplistic health messages that any knowledge is power, particularly if the person or company promoting the test gains profit from an increase in test sales. Knowledge is power, but half-truths are lies.
This article is based on a recently published BMJ Analysis article by the authors.
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