Basic fertility tests your GP can do, when they need to be done and what the results can tell you – RSVP Live

Posted: May 15, 2020 at 1:45 am

According to latest figures, it is estimated that 1 in 6 Irish couples trying to conceive will now have difficulty becoming pregnant.

However, natural Fertility Specialist, Jessica Bourke wants women to be more informed so they can take back the power when it comes to their fertility and avoid unnecessary issues that could cause heartache and stress down the line.

One aspect of this, is knowing the basic tests you and your partner can do to get a snapshot into your fertility and at what point you need to seek further assistance.

While it is personal preference, Jessica admits that ideally couples should consider basic tests before trying to concieve. I would say get your full bloods done, check youre both in good health, that there is no secondary health conditions.

The blood tests are about 30 in your GP, thats nothing in comparison to fertility treatment down the line. So I would be of the belief that it's better to be safe than sorry.

So what tests should you have done? Women who have a regular cycle should get the day 3 and 21 blood tests to assess their hormonal balance (i.e. FSH, LH and oestradiol on day 3, progesterone on day 21), Jessica advises.

However, she notes that for those with a history of PCOS or an irregular cycle, it would be best to proceed with the day 3 bloods, with the addition of prolactin and testosterone, to see if those hormones are raised, as this could impact your ability to ovulate.

Both men and women should also request a standard full blood count, with the addition of vitamin D. While men should also request a semen analysis combined with sperm DNA fragmentation testing.

The AMH test, which has long been a popular tool in assessing a womans fertility, has become increasingly controversial, and Jessica thinks the value of this test has been greatly overstated.

I get messages from women all the time panicking about AMH results. Its so important women understand that AMH is just one teeny tiny part of the puzzle she explains.

The AMH result can go up, as well as down, contrary to what you may have been told.

It only provides you with a vague approximation of egg quantity, it tells you nothing about the quality of your eggs, which is what really matters when trying to conceive.

I had a woman last year whose AMH was 6, which was low, but in six months after minding her diet and doing acupuncture it went up to 12.5 and that is far from an isolated case Ive seen that a number of times over my career.

Ive had so many women in front of me in tears, thinking they need to get donor eggs, or that they need to freeze their eggs.

"This is often times, unfounded, so its important to get a full picture of your fertility potential. The AMH is just a snapshot.

Follicle tracking scans can be as much, if not more useful than the AMH test says Jessica, as it shows you how many antral follicles are developing on given cycle, as well as whether the lining is thickening as it should be and being able to see if you actually ovulated.

The AMH test is variable, which means that the same woman could see different AMH levels, within the same menstrual cycle.

"A low AMH reading can cause pronounced anxiety for many women and it is not on that women are being unnecessarily scaremongered about their fertility when I have not seen that to be the case" she says.

"The biggest misconception is that women think that it means their eggs are bad, that is not true. This is a test that is of huge profit and gain to the fertility industry and thats what it is about, you have young women being left terrified so they go in and freeze their eggs."

"If they go for IVF and they have low AMH they might be told to go for donor eggs, thats more money for the clinics.

"I'm sorry to be cynical about it but its absolutely madness that any clinic should be encouraging women to freeze their eggs based on one test."

"If your AMH result is particularly good for your age, then it would be important to rule out any tendency towards PCOS, as this is a gynaecological condition that if evident, could hamper your fertility potential."

Jessica is keen to stress that AMH is just one hormone. There are many others to consider, which would have a bearing not just on your ability to conceive, but also on whether you could be at an increased risk for miscarriage. For example, thyroid markers, prolactin, testosterone, cortisol, DHEA, melatonin, FSH, LH, oestradiol, progesterone etc.

"I had a case about two years ago with a couple, where the women at 33 years old had been told she needed to go for donor eggs" Jessica reveals.

"And I asked the partner about his sperm tests and he had been told his DNA fragmentation was high but the clinic said they would work with it. When I saw the results, his results were 42%, anything over 30% is considered severe."

"I said no sorry guys the problem guys here is the sperm. And he immediately said he had brought up a bad kick he got years earlier playing football and a whole litany of health issues he had over the years."

"That is the level of diservice that is being done to women. So women really need to get that message that the AMH is just one part of the picture. Im not saying it is useless but it is very unwise to make a big decision about your fertility based on just one marker."

The standard advice is to seek help if youve been trying to conceive for a year and are under 35, or if youve been trying for 6 months and are over 35 says Jessica.

However, she advises that it really depends on the invididual couple.

"If you have a history of gynaecological issues, whether it be chronic UTIs, PCOS, endometriosis, or indeed, any other chronic health issue e.g. auto-immune conditions, hypothyroidism, known blood clotting issues etc. then I would recommend seeking help at the 3-6 month mark, regardless of your age" she says.

"Over 80% of couples are typically pregnant within 1 year of trying, so there is usually only cause for concern once it goes over that time-frame."

"Im not saying it is useless but it is very unwise to make a big decision about your fertility based on just one marker" says Jessica.

"Never panic when it comes to anything to fertility In my line of work, it has been the case that there is always something that can be done. In 15 years Ive only had one case where the male and the female both had extremely complicated genetic issues."

"If a man gets a DNA fragmentation test and its bad dont panic.However, the clinics will say theres nothing they can do about the sperm but its fine because they can do ICSI or screen the embryos."

"However that is nonsense, you have to find out the reason why. All the background health issues, any medication they are on, past injuries, if there is any infection in the body, if there is inflammation in the area. There are multitudes of things that can be ruled out. But men have more control when they realise there is a lot they can do about it, and big improvements can be made with diet and lifestyle too."

"With fertility we are always looking for that smoking gun", Jessica admits. "'Oh it's the sperm or its the AMH level', but its very rare that I see just one factor. In 90 per cent the cases I deal with it is a combination of smaller factors."

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Basic fertility tests your GP can do, when they need to be done and what the results can tell you - RSVP Live

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