I am a woman in my thirties. Unfortunately, because I joined Facebook an incredibly long time ago, Facebook knows that about me. There are plenty of things that Facebook knows, or thinks it knows, about me that with hindsight I might not have told it. But here I am, a woman in my thirties, an open target for companies to advertise to when they’re looking to advertise to women in their thirties.
In the last few weeks, the company I’m getting the absolute most advertising from (at least one advert every. single. time. I open the app) is a company called “Hertility”.
The adverts take a different tact each time. Some focus on the risk of hormone-related ill health. Often, they focus on case studies of women who are in my age bracket who decided to take fertility tests “just in case” to see “how much time” they have left to make babies, and made life-changing decisions based on those tests.
I am not the target audience for these sorts of stories. I don’t want children. I love children, I enjoy spending time with my niece and if any of my friends have babies, I will offer to babysit any time because babies are adorbs and cool little scientists who take data from their surroundings and analyse and learn from it before our very eyes. But I know that I definitely don’t want my own.
As a woman in my thirties, I could be considered some kind of weirdo by many in our society. I’m supposed to want children. By the age of 32 I should be starting to panic about the fact that my body is getting decrepit, and I won’t be able to perform as a baby making machine for very much longer.
There are a bunch of really awful messages that women are inundated with: that they can only be fulfilled if they make their own babies and birth them in the correct way; that they must have the perfect monogamous relationship in which to have those babies;, that they must sacrifice their lives, bodies and careers in the name of these adorable little helpless parasites; and if they leave it too late then they just might miss out on the opportunity to be a True WomanTM.
It’s no wonder that many women want children. Many even want them truly independently of this bullshit messaging. And of course, many men and non-binary people also want children, but it is women who are most subject to these external pressures and particularly time pressures. Regardless of why people choose to have children, there is an awful lot of pressure to have them, to have them the right way and at the right time and in the right situation. If you can’t conceive, carry or birth a baby in “the correct way” then you are defective in some way.
As a woman in my thirties, I’m starting to see this pressure in people who are important to me. I’m having conversations with other women in their thirties who are panicking about their relationship status or their housing stability, or their career trajectory or their anatomy because they really do want children and if they don’t figure out how to go about that in the next X years, they’ll miss out on something truly very important to them. And those conversations break my heart because I know that parenthood is very fulfilling for a lot of people and it’s something they truly want, but also because I know that many of those feelings are tied up in fulfilling a societal expectation.
I’ve taken the easy way out – I’ve refused to play the game and I’m considered outside of womanhood as a result. But for many other women – those who do want children but might have to figure out how to have them outside of normal expectation; through surrogacy or adoption or IVF, or with non-conventional relationship set ups; in queer or polyamorous situations, or as disabled or trans people who might need different pregnancy or birthing support if they are able to conceive- for all of those women and others, having children might look different to societal expectation, or may truly be outside of their reach.
Within all this context, comes Hertility.
Hertility tests
The first advert I saw on Facebook was a sponsored post:
Getting my fertility and hormones tested changed the course of my life. If I didn’t do that second test, I would be in a completely different place; if I had waited, Annie might not be here
The post attached a link to a Metro article with the headline “I took a fertility test to see how much time I had to have children – I found out it was now or never.”. The article had a header photo of the Hertility test kit in a letterbox sized box on a table next to a potted house plant. They know their target audience: busy millennials who like pot plants and the convenience of postable home test kits.
The key goal of Hertility is to offer something individualised, so their selling point is that you do a questionnaire before even committing to buy anything, about your lifestyle and what you’re looking for. I took the questionnaire answering honestly: Why do I want to know about my fertility? I answered, “just curious”. They went on to ask about my contraceptive choices, whether I have periods, my body weight and whether I’m diagnosed with any gynaecological conditions like PCOS.
While the website says they will test up to ten different markers, they suggested sending out a test for three, based on my survey: AMH, TSH and FT4 for £149.
From their website:
Anti-Müllerian Hormone (AMH)
TESTED FOR
Egg quantity, polycystic ovaries
WHY?
AMH is produced by your follicles—little sacs within your ovaries where your eggs are matured before they’re released during ovulation. Since the number of eggs we have decreases with age, so does AMH, which is why testing your AMH levels can give a good indication of your egg quantity at a given point in time. It can also help signal some reproductive health conditions like polycystic ovaries.
AMH does indeed indicate egg reserve. And it makes sense, in principle, that we would want to test how many eggs we have left: we all know that the number of eggs produced in the ovary is finite, and that the number diminishes as we age. We also tend to believe that this diminishing number is the reason fertility drops as we age. And it certainly is part of the reason. But it’s not the only reason – it is also the case that as we age there are more likely to be chromosomal mutations in the eggs which can prevent conception or lead to a greater chance of miscarriage, and as we age we are at greater risk of health conditions that reduce fertility.
In fact, several studies have shown that while AMH does indicate egg reserve, it is categorically not useful for predicting how long it will take for a person to become pregnant, nor how likely they are to succeed in conceiving with one review firmly stating:
In no situation does AMH reflect oocyte health or chances for conception.
The other two suggestions for testing, T4 and TSH, are related to thyroid function. And while it is true that problems with the thyroid (which cause symptoms such as fatigue – which I ticked as a symptom I have in my survey, albeit with a known cause unrelated to the thyroid) can reduce fertility, there is no evidence that subclinical (i.e. without clear observable symptoms) thyroid issues are linked with a higher prevalence of infertility, though further research is needed.
What is important for examining a patient’s fertility, is physical assessment. Doctors will use their expertise to examine a wide range of things, from examining the thyroid gland to identify if thyroid investigation is warranted, to examining the skin to identify other potential hormone issues. They might refer you for an ultrasound to see how the uterus and ovaries look and there are other tests that can be done to visualise the fallopian tubes and check for any blockages. There are a few hormonal tests that can be done, if warranted, which doctors will establish based on various pieces of information they will glean from a discussion with their patient. This is why seeing a doctor is essential.
Several of the hormones that Hertility tests for are actively dissuaded by medical experts unless there is a specific reason for including them. For example, prolactin should only be tested if a patient is not experiencing (regular) periods. It is true that Hertility are asking some of these questions in their questionnaire and perhaps they only do those tests when a person is missing their periods but it is not clear from their website that sometimes there is no reason to test for some of the hormones they recommend testing for.
On their website, Hertility claim their value is twofold:
They are quick. They say “The average wait time to see a reproductive health specialist is 12 weeks. Skip the queues and get the expert care you need, when you need it.”. They deliver the test in 72h and have your results to you 10 days later along with a private gynaecologist’s report.
They are cheap. If you go down the private healthcare route in the UK they claim it will cost you up to £1,858 whereas their test costs just £149.
But once you’ve done your test, if you want to continue using Hertility for your healthcare, you’ll need to fork out between £39 and £219 for consultation with private specialists. Plus, presumably, any private tests that would be done for free on the NHS, would cost you the extra per test. These prices are pretty much inline with regular private consultation.
What Hertility is offering is an example of mostly unnecessary medical testing targeted at people who mostly don’t need it and won’t benefit from it. They claim to be offering peace of mind by telling you things like your egg reserve, but in reality, they risk putting undue pressure on people to make big life changing decisions based on test results that aren’t proven to show what their customers think they show.
We are in the age of the health test kit – biological tests are getting cheaper and easier to produce and can be sent out easily for people to take in the convenience of their own home. This desire to know our individualised health data was jumped on by Theranos CEO Elizabeth Holmes who has fallen from Health Tech Genius to convicted fraudster over tests that didn’t even do what they claimed to. But there are many more health test kits that do actually do what they claim to do, they just aren’t all that useful to the vast majority of customers.
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Hertility’s at-home fertility testing kits are at best ill-conceived, and apply undue pressure to make life-changing reproductive decisions.
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