I am a 31-year-old woman who is married and living in New York City, and I definitely want kids one day. I grew up in a large family just outside of Chicago, and almost all of my high school friends are married with children. But I have spent the past decade prioritizing my career as a magazine editor, something I’m still trying to establish before my prime midnight-oil-burning years are up. At which point, I’ll start thinking about a family—exact time to be determined.
It’s a certain type of drive that runs rampant in my cohort of working millennial women: rise up in your career first, consider the mind/body/wellness/fertile factor second (or third, as evidenced by last year’s number of births, which hit an all-time low since 1987, especially among those in their 30s). And while I can imagine the working mom scene perfectly—me, donning a cutting-edge breast pump under my Off-White suit, taking calls or making edits with my office door closed (Note to self: Must get office before I get pregnant)—the reality of how many eggs I’ll have left in my basket at that time may be a lot less glamorous.
Nevertheless, it’s a thought I felt comfortable designating for “later’—until this summer, when an email about an affordable at-home fertility test that measures your reproductive hormones and tells you things like when you can expect to go through menopause hit my inbox. A deadline? Deadlines I can do.
Called Modern Fertility, it’s a startup that, in addition to testing for nine hormones (including your anti-Mullerian hormone, follicle-stimulating hormone, and luteinizing hormone—which is also tracked in over-the-counter ovulation predictor tests), aims to arm women with knowledge surrounding their reproductive health so they can one day consider such options as egg freezing and in vitro fertilization should they need to, and before it’s too late.
“People talk about infertility all the time,” says Afton Vechery, the company’s cofounder and CEO, who spent time at 23andMe, as well as a private equity firm, where she often worked with fertility clinics and got a first look at how inopportune and costly in-office reproductive testing can be for some individuals. “But people rarely talk about fertility. That’s what we’re interested in.”
It’s an empowering thought—my fertility versus my infertility, and for a fraction of the cost—and one that doesn’t feel intimidating nor too far away. I can do this, I thought, as I opened up the all-white box filled with two finger-testing pricks on the morning of my third day of my period (an important time stamp, as hormone levels fluctuate throughout your monthly cycle). Not one for blood, I felt surprisingly at ease when poking my finger twice and sealing my test strips in the postage-marked packaging, all from the privacy of my living room couch.
And yet it’s precisely that DIY collection method, now increasingly popular among consumers seeking everything from personalized fitness recommendations via a DNA kit to HIV screening results, that worries some experts. Taken out of context, fertility results may prove particularly murky. “If anything comes back out of the average or normal parameters, it may cause unnecessary angst,” says Alexis Greene, M.D., a reproductive endocrinologist and fertility specialist at Westmed Medical Group in Westchester, New York, who sees numerous women struggling with their fertility as well as reproductive disorders, like irregular periods or polycystic ovary syndrome (PCOS). “Fertility is not just numbers; it’s a big spectrum that encompasses a lot of different things beyond lab work, such as age, prior history, if you’ve ever been pregnant before, and what your ovaries look like on an ultrasound.”
And while Modern Fertility doesn’t offer a way to see how many follicles you have in your ovarian reserve, let alone actual medical advice—though its staff of nurses will walk you through your results and help you link up with a specialist should anything come back abnormal—the company attempts to do its due diligence by asking your age, prior diagnoses, whether you’re taking birth control, and how regular your periods are before looking at you from a hormonal perspective.
Less than a week after sending in my test, I received an email with the subject line “Your Modern report is ready” and a link to my results as well as an invite to a private webinar with Jill, the company’s fertility nurse. With a huge pit in my stomach, I double clicked the provided link and opened onto a page that stated my ovarian reserve, ovulation, and general body hormone levels. A rush of heat hit my ears when I read that I was, almost across the board, average.
Average? Average to my type A mind is below average; not excellent; doomed; dried up; dusty; Jan versus Marcia Brady! I speed-read through the results: I have an average number of eggs for my age; I may hit menopause around the average age; I may collect an average amount of eggs in IVF or egg freezing; “Your Free thyroxine (fT4) is outside of the normal range. Not to worry, your doctor can help balance things out.” I shut the computer and avoided setting up a call with Jill for another two days.
“While many of us are seeking excellence in everything we do, in reproductive health, average is normal, and normal is good—that’s where you want to be,” says Jill Kerwin, R.N., B.S.N., a certified holistic nurse who struggled with infertility herself and ended up having two children with the help of IVF and a donor.
And then, just as I’m starting to feel slightly better, she adds: “That said, the sooner you have kids, from a reproductive perspective, the better, because you’re losing eggs, aging, and being exposed to more toxins every single day.” She suggested I start conversations with my ob-gyn, and perhaps ask for an additional thyroid ultrasound, as low levels of fT4, which helps the body expand energy, may get in the way of fertility down the line. (Cue the unnecessary angst . . . now.)
Take it with a grain of salt, urges Shannon Tomita, a fellow in gynecologic oncology at Mount Sinai Hospital who, while agreeing with Greene that fertility is a lot more complicated than a few blood tests, sees the positive side to a test like this, too. “Anything that makes women be more proactive and less reactive, and gets them in to see their doctor, is a good thing. Because there is really no substitute to seeing someone who can talk to you directly about all the questions you may have.”
Currently on the hunt for an ob-gyn who my husband and I see in our fertility future, so we can speak and perhaps act on my results, our exact timeline is still to be determined—but there’s at least one major change worth noting: I now officially answer that common question with, “Yes, we’re trying.” And it feels pretty empowering.