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Chapter 1: What is the main topic discussed in this episode?
Today's episode was made possible by our friends over at the University of Sydney.
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Oh, now it makes sense.
Good morning and welcome to The Daily Oz. It's Sunday the 31st of May. I'm Zara Seidler. I'm Billie Fitzsimons. If you're a young woman, there's no doubt that the topic of fertility has come up in some conversation with your friends.
It feels like every day there's new information surfacing on social media about testing your fertility, how fertility changes with age, and what you as an individual are actually in control of. But as we've seen interest in this topic grow, so too has the rise in misinformation.
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Chapter 2: What is fertility testing and why is it important?
And afterwards, they learned that it was potentially not the most accurate test. And I think that they felt a little bit robbed that they had made all of these decisions based on a test that became inaccurate.
Yeah, I mean, it's an interesting concept about whether it became inaccurate or whether the way it's been marketed has just been misleading because what we're going to talk about in today's podcast is that this AMH test can test how many eggs a woman has, but it can't tell you anything about the quality of those eggs.
And the reason that I first got interested in this, it was also a number of years ago, but one of my friends was telling me that she had seen her doctor, her gynecologist who had recommended that she do this test and and it had sped up her timeline dramatically because she found out she had really low egg reserves. It turns out that wasn't correct.
She fell pregnant straight away and has had no fertility issues there. But this test and what it tells you and what it doesn't tell you it feels like is everywhere.
And so I wanted to ask Dr. Tessa, whose research is really about what this test is, what it isn't, and what the marketing of it is, so that hopefully everyone listening to this goes away getting a bit more of an understanding as to whether or not you can actually test your fertility. Without further ado, here's Dr. Tessa Kopp from the University of Sydney.
Tessa, thank you so much for joining The Daily Oz today. Thanks so much for having me, Sarah. So certainly in my friendship group, the discussion of fertility, where to find information has somehow come out of nowhere but is everywhere. And I wanted to chat to you today about understanding what you can actually do to test your fertility and also where to get, you know, credible information from.
So I guess as a starting point, can you just give a really rudimentary example explanation of how a woman's fertility actually works, because otherwise it can be a bit challenging to know what's actually right and wrong.
Yeah, no, you're absolutely right.
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Chapter 3: What are the common misconceptions about fertility testing?
And I think there is a body of researchers and clinicians who are trying to get this embedded in kind of high school curriculum and in sex education.
We learn how not to fall pregnant. I don't know that we ever learn the opposite. No, you're right.
And I think there's kind of a fine balance because when you are a teenager in your early 20s, you are incredibly fertile. So I think it's right that the emphasis is on avoiding pregnancy if you don't want to get pregnant and, you know, STIs. But, yeah, you're absolutely right. There's a complete absence of discussion about the biology of fertility. And so women are born with all their eggs.
Yeah, that's my mind. Yeah. Blows my mind.
Yeah, we have the most in utero and then at birth. And then as we get older, they decline in number. And so by the time of menstruation, you know, I think we only have a small proportion left. And so each month during our menstrual cycle, there's a small pool of follicles that are built up in the ovary and each of them contain immature eggs.
And one of those eggs will mature to dominate and then ovulate at time of ovulation. And the rest of the eggs are absorbed back into the ovary. So, you know, as we get older, the number and the quality decline.
That's why I guess it's important but not alarmist, not to be alarmist to know of the impact of age and fertility so that if women have a choice, they can plan depending on how many, you know, kids they want. family planning is important there if you have a choice, but you know, a lot of women don't.
So I guess if you're looking to figure out your fertile window, there's lots of online calculators that can help you figure that out.
Because it is a limited window. We're told so often about how easy it is to fall pregnant if you are not trying to fall pregnant. But if you are trying it, there's actually a very limited window where you can fall pregnant.
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Chapter 4: How does the AMH test work and what does it measure?
Just for anyone who's not familiar with this AMH test that you're talking about, what actually is it? Is it a blood test?
Yes, so it's a blood test. So the AMH test measures the level of antimalarian hormone in the blood and this AMH hormone is secreted by the small follicles in the ovary so it can give an indication of of how many eggs might be in the ovary. However, it's not predictive of fertility. So how long it will take to get pregnant, your chance of conceiving or your reproductive timeline.
And so I think it's really important for women to have a good understanding of what that test can tell them. And it's not recommended for women who aren't struggling to get pregnant. It's useful in IVF or egg freezing settings because it can give an indication of how many eggs might be retrieved in an egg-stimulated cycle.
And this is helpful for setting expectations about how many cycles you might need to get a decent number of eggs and therefore the cost. It's really important to note, though, because it gives an indication of the quantity. It tells you nothing about the quality. And so... it's not predictive of your chance of conceiving or how long it will take you to get pregnant.
And guidelines in the US and the UK are really clear about women who don't have infertility getting this test. So it's not recommended if you're simply curious or wanting to understand your reproductive timeline. If these are questions you have, your GP is a great person to talk to because they'll be able to do a preconception check, which involves, I guess, checking your blood levels.
So your vitamin levels and your iron, that sort of thing. They can also discuss with you your menstrual history and help you kind of figure out when your fertile window is.
So just to be clear, if somebody hasn't experienced infertility, but is curious and starting their journey of fertility, there is no single marker that will tell them at this point, or with the research available to us now, how their fertility will fare.
There's no single thing. Unfortunately not, no. The best test is trying to get pregnant when you're ready. And you know, the Guidelines around the world recommend women under the age of 35 to try for 12 months before getting fertility testing. But if you're over 35, maybe around six months mark to start getting tested just because, you know, we're not very efficient reproducers.
There is quite a small chance per month. And so, you know, it can take a little while to get pregnant. But the one thing with all these testing before necessary is they can flag potential issues that might not actually be a problem when you start trying or vice versa. Everything might come back fine, but then you still have trouble.
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Chapter 5: What limitations does the AMH test have regarding fertility predictions?
It sounds really appealing, this simple blood test. And when it first came out years ago, it did seem like it was going to be, you know, this test that could indicate reproductive timeline. But since then, the studies have consistently shown that it cannot predict your chances of conceiving.
And whilst it's associated with age of menopause, it's too imprecise and too variable to be useful for individual women. to kind of, you know, say exactly when you're going to go through menopause.
You referred there to research that you and your team have done. Can you run us through what that research found broadly and why that research exists in the first place?
Yeah, so we've done kind of a whole body of research around the anti-mullerian hormonal AMH test. And so we've really examined how it's being marketed and promoted to women. And so we've done studies of fertility clinic websites, but also online companies that are now popping up all around the world selling this test. direct to consumers.
So you can simply order this test online at a click of a button. And so we really analyzed the information they were presenting and the vast majority of it was false and misleading. So for the online companies selling the test direct to consumers, 74% say it can indicate your chance of conceding, which is incorrect. Very few of them kind of state the limitations of the test.
So, you know, how if you're on oral contraception, it can give you artificially low results. Particularly if you're under the age of 30, there's a recent study that's come out that's shown your AMH level is just as likely to increase as it is to decrease in the subsequent testing.
And so, you know, it's really not a reliable test to be making a really, you know, life altering decision or basing your big life decisions on a single test.
And we've also looked at what influences and content there is on social media and found, you know, overwhelmingly these posts discuss the benefits of testing using empowerment language, you know, be in control of your fertility, take control of your future, be empowered, you know, that sort of language. Very few discuss the harms of testing.
So, you know, if women are falsely believing this test can indicate their fertility and If they get like a normal or higher result, they may be falsely reassured that they can wait and delay pregnancy. Or if they receive a low result, it may cause unnecessary distress and anxiety, which may pressure them to pay thousands to freeze their eggs or even undergo IVF when it might not be needed.
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