Direct-to-Consumer Fertility Testing: A Viable Alternative or Confusing and Misleading?

A study investigating direct-to-consumer (DTC) fertility testing has revealed that consumers view it as a viable alternative to traditional medical testing. However, it was also found to be confusing and misleading, highlighting the need for education surrounding the purpose and accuracy of DTC tests. The paper is published in Social Science & Medicine.

Fertility testing outside of the clinic

Although their accuracy and reliability are the subject of much debate, DTC medical tests are on the rise; low costs, widespread availability and a population increasingly concerned about their health have seen people turning to DTC testing for information they may not so easily be able to receive from a healthcare professional.

This has extended to “fertility testing” for women; several companies now provide tests for anti-Müllerian hormone (AMH).

AMH levels in the blood are often used to provide an estimate of the “ovarian reserve” i.e. the remaining egg supply. This is primarily used as a diagnostic tool before ovarian stimulation, as part of the in vitro fertilization or egg freezing process. However, it can also potentially be used as an indicator of fertility.

People’s desire to find out more about their fertility is understandable – around 6.1 million women in the US have difficulty becoming or staying pregnant, according to the CDC. With other factors like a lack of insurance coverage potentially playing a role, DTC fertility testing could provide an accessible, alternative means of understanding individual fertility.

But do these tests provide genuine benefits to people looking into their fertility? Or are they misleading, taking advantage of health-concerned consumers?

“They’re attractive, but they don’t deliver on their promise”

To discover more about people’s experiences with DTC fertility testing, author Moira Kyweluk, Ph.D., followed 21 individuals who were interested in pursuing DTC ovarian reserve testing.

In an effort to ensure diversity, Kyweluk used ethnographic methods; participants stemmed from a range of groups, including those of different ethnicities, socioeconomic status and sexual orientation.

The study found that there were some positive views surrounding DTC testing. Particularly for LGBTQ+ individuals and single women, DTC ovarian reserve testing was viewed as an alternative method for family planning. Participants also stated that receiving testing outside of a traditional medical context felt “empowering”.

However, it was not all positive; some participants were uncertain about the accuracy of the test results. Others were unsure of what the next steps were supposed to be in order to confirm fertility status, or how to preserve it.

“Consumers continue to desire these tests, and they’re attractive, but they don’t deliver on their promise.” said Kyweluk in a recent press release. “Though there may be some benefits to consumers using DTC fertility testing, across the board participants were left with incorrect assumptions about the power of hormone testing to predict fertility.”

Education, education, education

“I view DTC testing as an entry point into what I term the ‘new (in)fertility pipeline’ for women today,” said Kyweluk. “Because it is low cost and widely available, it’s reaching a larger demographic, people of diverse identities and backgrounds, and raising awareness of more advanced procedures and technologies like egg freezing.”

However, Kyweluk emphasizes the need to improve consumers’ education around this kind of test, to make it clear what they are getting for their money, reduce confusion around result interpretation, and to increase understanding of fertility treatments in general.

“No test or medical procedure guarantees future fertility—including egg freezing—and these startups directly target women who are concerned about their reproductive futures,” concluded Kyweluk.

Reference

Kyweluk. (2020) Quantifying fertility? Direct-to-consumer ovarian reserve testing and the new (in)fertility pipeline. Social Science & Medicine. DOI: https://doi.org/10.1016/j.socscimed.2019.112697