In this blog Katy Lindemann talks about her experience with “Fertility MOT” testing. Katy is a digital product and experience strategist currently writing a book that shares real women’s stories about the emotional experience of infertility and pregnancy loss.
Before we jump into Katy’s story around female hormones and fertility testing let’s address some common questions that you may have concerning a fertility hormone test.
What is a fertility MOT and how much does it cost?
Many women worry about their future chances of conceiving. However for a lot of women, it is not until they start trying to get pregnant that they will know how easy or difficult it will be. If problems arise you may wish you had started trying for a baby earlier. These issues and concerns may lead women to have what is known as a fertility MOT.
These constitute initial hormonal investigations and scans that help you better understand your fertility and ability to conceive.
The test can cost up to £500 in London private clinics particularly as you need to pay for a consultation to get the test and have it interpreted.
Can I get a fertility test on the NHS?
You can get some of the fertility hormone tests with the NHS but this typically means that you may need to be trying for at least a year. If you are 35 or older you may qualify for the test after six months of trying and unsuccessfully getting pregnant. You will also likely need to get a referral from a GP to a fertility specialist who will then prescribe the test for you which may take some time.
What does the fertility MOT test check for?
Usually this test includes a consultation with a fertility specialist, a pelvic ultrasound scan and a blood test. The blood test will look at hormones like AMH, FSH, LH, Prolactin, TSH, T4 amongst others which are useful marker to check your reproductive health. A pelvic ultrasound scan will also check for any fibroids, cysts, polyps or other symptoms that may affect your fertility as well as evaluate the Antral Follicle Count to assess your ovarian reserve.
Without Further Ado, here’s Katy sharing her experience with fertility MOT Testing
When I was 28, I read about a clinic which offered a ‘Fertility MOT’, an ovarian reserve (or egg counting) test that would look at how many eggs I had left: i.e. how fast my biological clock was ticking. This was in 2010 when ‘social’ egg freezing was relatively nascent, so I don’t think it was widely offered, and I didn’t know too much about the pros and cons. But it got me thinking. I vaguely understood that fertility declined as you got older, and had in my head that 35 was a magic number, and it seemed like a sensible idea at the time to find out what the stock levels were like in my ovaries.
I was in a stable and good relationship with my partner, and we weren’t planning to try to conceive for a few years — but I vaguely remembered that whenever I’d not been on the pill (which I’d been on and off for pretty much the last decade) I’d never really had proper menstrual cycles. I could easily go several months without a period, and although I’d thought that was a big plus at the time (wahey! no cramps and bleeding!), now that I was starting to think ahead about my fertility, the thought that this might not be quite such a plus nagged in my mind.
The clinic said I had to come off the pill, then wait for another cycle, because the test might not be so reliable immediately after stopping hormonal contraception, and then I should give them a ring on day 2 of my cycle to come in for some blood tests and a scan of my ovaries. OK, simple enough.
So I came off the pill, and waited. And waited. And waited. At the 6 month mark with no period, I went to see my GP because I was getting impatient, and by this point I thought there might be a medical issue that might need investigating, over and above getting my eggs counted. The GP told me that it’s not uncommon for it to take a few months for cycles to return after coming off hormonal contraception, but that after 6 months it would be sensible to run some blood tests.
Given that I was on day a hundred and something of my cycle, I don’t know quite what the hormonal profile should have looked like, but she told me that it might suggest polycystic ovaries, and she was going to send me for a pelvic ultrasound to have a look at my ovaries. OK, cool. The letter in the post told me to expect both an abdominal and a transvaginal scan. Fine. Except that on the day the sonographer waved the ultrasound doodah over my tummy and told me that what he saw on the screen didn’t indicate PCO (polycystic ovaries) and that we didn’t need to do the internal scan. Hmm. If I didn’t have polycystic ovaries, then why didn’t I have periods?
What I should have done: gone back to my GP to discuss further
What I actually did: consult Dr Google and harrumph.
(Dr Google is not a qualified Dr. Do not consult Dr Google for healthcare advice.)
Dr Google suggested that abdominal scans weren’t very effective at visualising the ovaries, and that a diagnosis wasn’t reliable without an internal scan.
Again, I should have gone back to my GP to discuss.
Instead, I just huffed and puffed and called the private clinic to explain. The person who answered the phone told me that it simply wasn’t possible to do the tests except on day 2–4 of my cycle: “But I don’t have a cycle!” I wailed. “That’s the reason I’m trying to come and do the test in the first place!”
So I waited.
If I had gone back to my GP, I might been given a short course of medication to kick start a cycle, because going for months and months without a bleed can cause the womb lining to build up if you’re not on hormonal contraception. (If you’re on hormonal contraception the lining is kept thin and there’s nothing to shed). If I’d done this I might have been able to discuss further tests to find out what was going on. And if I’d done this I might have been able to go for my ovarian reserve testing earlier.
What did the fertility test tell me?
When eventually, after many, many months, I was able to go to the clinic and get the fertility test, within 30 seconds of beginning the pelvic ultrasound — going straight to the internal scan, skipping the tummy scan — the nurse pointed out that my ovaries had the distinctive ‘string of pearls’ appearance of polycystic ovaries. When I saw the Dr for a full consultation, he told me that lots of women have polycystic ovaries and no symptoms, but that based on my history and the results of my tests, I had 3/3 of the diagnostic criteria for polycystic ovarian syndrome (PCOS).
My blood tests were also suggestive of possible PCOS — high levels of AMH and LH. LH is the hormone that spikes before ovulation, which is what ovulation sticks test for — however these are often unreliable in women with PCOS, who can get false positive tests due to high LH levels.
In my head I’d thought that PCOS was associated with being overweight, and I had always been naturally slim. But the consultant explained that although the two did often go hand in hand (because PCOS is at its heart an endocrine disorder related to insulin production), that ‘lean’ PCOS (PCOS in women with normal BMI) was not uncommon and often wrongly diagnosed. He told me that whilst in ‘classic’ PCOS it was often possible to restore ovulation by losing weight, ‘lean’ PCOS could sometimes be trickier to manage purely from a lifestyle perspective — but that trying to balance insulin production by eating low GI could still be beneficial.
The summary was:
- my ovarian reserve was excellent for my age (28).
- I had ovulation problems due to PCOS.
- my hormone levels didn’t give any other cause for concern.
- my age was the most important factor in my fertility.
ie:
- the stock levels were good for my age.
- but the warehouse didn’t ship.
- based on my age, the the quality of the merchandise was probably decent, but would decline over time.
Watchouts
The most important thing I was told was that the term ‘Fertility MOT’ is completely misleading — as that implies that you get a once-over and signed off if everything is in good working order. Checking your hormone levels and ovarian reserve can be a valuable way of understanding more about your fertility, but it’s only one piece of the puzzle, and it doesn’t tell you whether or not you’ll have issues conceiving naturally. It doesn’t check your fallopian tubes. It doesn’t tell you about other issues that can affect fertility like endometriosis or fibroids. Most importantly, if you’re planning on conceiving with a male partner, it doesn’t tell you anything about his fertility (and male factor infertility is the no. 1 reason that couples do IVF).
Since then, a study from researchers from the University of North Carolina has found that even amongst older women, low ovarian reserve had no bearing on whether patients went on to conceive naturally. Professor Richard Anderson, from the University of Edinburgh, has said:
“The most important test is whether a woman is ovulating, i.e. whether she is releasing an egg every month, rather than how many eggs she might have in reserve.”
So on their own, ovarian reserve tests have to be used with caution. Egg quantity doesn’t affect natural fertility, but egg quality does — and the best indicator for that is your age.
My key takeaways
Coming off hormonal contraception to understand my natural menstrual cycles was invaluable. The pill was a brilliant choice for me — but it can mask lots of issues. Learning about your menstrual cycle and fertile signs can be extremely helpful in understanding your fertility, and I think there are definitely merits to coming off hormonal birth control a little while before you want to start TTC. However, you do need to weigh this up against what’s right for you —if you don’t want to get pregnant then you’ll need to use other, non hormonal, forms of contraception (like the condom or copper IUD).
My age was the most important thing that drove our decision making. I was in a relationship and so deciding when to start TTC was a mutual decision — if I’d been single, I might have wanted to think about other options, such as egg freezing. Egg freezing has lots of pros and cons, and it may not have been the right path for me — but it might have been something I’d have considered finding out more about.
I did everything right, but still couldn’t have changed the outcome — I couldn’t have foreseen the uterine issues that would be the reason I couldn’t sustain a pregnancy.
But I’m still hugely glad I did get myself checked out. I wouldn’t have known about my PCOS if I hadn’t, and forewarned is forearmed. I was able to take positive steps to deal with the things I could deal with.
Knowledge is power — including knowing the limits of that knowledge.
We would like to say a special thank you to Katy for sharing her story about the Fertility MOT testing with the Parla community.
We have built Parla to empower women with better knowledge and support as they navigate their often confusing fertility journey.
