When to Test Your Fertility

I was 28 when I first started trying to conceive. I vividly remember taking my last birth control pill, throwing out my pack, and texting my friend to tell her we were no longer “not trying,” excited but nervous. Sounds pretty standard, right? Unfortunately, what I didn’t know at the time was that I was about to embark on a two-and-a-half-year journey to get pregnant with my son. This included several pregnancy losses, a few rounds of IVF, and lots of questions, including, “should I have tested my fertility sooner?”. 

I don’t share this to scare anyone. But my story is not all that uncommon. In fact, 1 in 6 individuals experience some form of fertility challenge. 

I was woefully unprepared. And because of this lack of preparedness by Sex Ed as well as limited time with my OBGYN, it probably took a good six months before I started to understand what actually goes into conceiving a healthy pregnancy: timing, lifestyle, genetics, and more. So much of my time, stress, and probably money could have been saved by proactive fertility testing.

In this article, we’ll discuss when to test your fertility, the importance of early fertility awareness, and proactive measures you can take to understand it. If you take one thing away from this article, though — the best time to test your fertility is right now. Let’s talk about why. 

So what is fertility testing, anyway?

Before we dive into when to test your fertility, it’s important to understand what fertility testing even is. 

Ovarian reserve testing

A fundamental concept of assessing one’s fertility is to understand their ovarian reserve. This involves evaluating the quantity of a woman's remaining egg supply (oocytes) in her ovaries. One of the most widely used tests for ovarian reserve (though not without its limitations — more on that below) is the measurement of Anti-Mullerian Hormone (AMH) levels, which can be done with a simple blood test. 

Understanding AMH

AMH is a protein produced by cells in the ovarian follicles, with levels of AMH in your blood providing an indication of the number of eggs remaining in your ovaries. If you’re considering egg freezing, AMH testing is especially valuable, as it helps assess your starting point and may indicate a timeline of how urgently you may want to move forward with freezing your eggs. 

Your AMH may also give a sense of how your ovaries might respond to the actual egg freezing process. Lower AMH levels typically suggest a diminished ovarian reserve, which may impact fertility potential. In general, an AMH between 1.0 - 3.5 ng/mL is considered a “normal” range. 

Individuals with a higher AMH level — which varies by lab, but could be anywhere over 3.0 ng/ml — usually have a better response to ovarian stimulation, leading to a higher number of eggs likely to be retrieved during the procedure. That said, a higher AMH also carries a greater risk of ovarian hyperstimulation syndrome (OHSS), so your doctor will need to be careful with your medication protocol and monitoring.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Face time: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. And this study indicated that, as we get older, our chances increase of needing to do multiple egg freezing cycles in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are. 

Consider your egg freezing plans

Because the ASRM doesn’t recommend egg freezing for people older than 38 (although this is not a hard and fast rule), it’s a good idea to test your fertility earlier on if possible. That way, should you decide to move forward with egg freezing, you’ll have the time and space to come up with a plan and hopefully see some successful results.

If and when you decide to move forward with egg freezing, you can freeze your eggs more affordably (even for free!) with Cofertility. Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Should I test my fertility in my 20s?

Testing your fertility in your 20s gives you the most flexibility. Whether your testing looks great and you want to freeze your eggs now, or you uncover potential fertility risks to address, the more time you have, the better. 

Your doctor may even recommend fertility testing if you have past or current reproductive health issues, including sexually transmitted infections (STIs), endometriosis, or PCOS, all of which can contribute to fertility challenges. Even if you’re not yet sure if you want to start a family in the future, testing your fertility in your 20s may help you make informed decisions about family planning options down the line. 

Best at-home fertility tests

If you’re curious to learn more about your ovarian reserve, talk to your doctor about fertility testing. If your doctor won’t order the tests…you might want to find a new one who listens to your concerns and takes them seriously. But in the meantime, there are many great at-home fertility testing options out there. 

LetsGetChecked Ovarian Reserve Test

Cost: $139 

Hormones measured: AMH

Why we like it: While it only tests one hormone, the test is simple and fast. It’s also the least expensive of the three, plus you can get 25% off with code COFERTILITY25.

‍Natalist Women’s Fertility Test 

Cost: $149

Hormones measured: estradiol, LH, FSH, TSH, and total testosterone

Why we like it: Natalist provides comprehensive insights into ovarian reserve, empowering individuals to assess their fertility potential in the comfort of their own homes. Plus, it’s a woman-owned and woman-run company. Use Cofertility20 for 20% off your entire purchase.

Remember: at-home fertility tests aren’t without limitations

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

Consider egg freezing as a proactive measure

After testing your ovarian reserve, it’s worth considering freezing your eggs if you don’t want kids soon. We’ll be the first to say that egg freezing is not a guarantee for a successful pregnancy in the future — those eggs need to be fertilized into embryos, transferred to a uterus, and then carried for 40 weeks to result in a live birth! But because our fertility declines with age, the earlier we preserve it, the more set up for success we may be in the future if we do need to use those eggs down the line. 

How does egg freezing work? 

As a primer, egg freezing allows individuals to preserve their fertility by freezing and storing their eggs for future use (fertilization). Let’s get into some of the specifics. 

Some benefits of egg freezing

There are many reasons why egg freezing can be beneficial, including: 

Delaying parenthood: Egg freezing enables individuals to postpone childbearing to pursue educational, career, or personal goals while increasing their chances of having a healthy pregnancy down the line.

Medical reasons: Some medical treatments, such as chemotherapy or radiation, can impact fertility. Egg freezing offers a proactive option for individuals facing medical conditions that may affect their reproductive health.

Preserve higher quality eggs: As we age, our ovarian reserve diminishes, and the quality of our eggs declines. By freezing eggs at a younger age, individuals can preserve their eggs when they are of higher quality.

The egg freezing process

Overall, the egg freezing process is a 10-14 day period involving ovarian stimulation, the actual egg retrieval, and storing the frozen eggs. Here’s what goes into each.

Ovarian stimulation: Before the egg retrieval, individuals typically take injectable hormone medications for about 10-14 days. This process encourages the ovaries to produce multiple mature eggs. You’ll head to the clinic for monitoring every few days (more frequently as you get closer to your retrieval) so your doctor can check on how things are progressing and make updates to your medication protocol if needed.

The egg retrieval: Once the eggs are mature, a minimally invasive procedure known as transvaginal ultrasound-guided aspiration is performed to retrieve the eggs from the ovaries. The procedure is usually well-tolerated and does not require a surgical incision.

Cryopreservation: After retrieval, the eggs are frozen using a process called vitrification. This method prevents the formation of ice crystals, which could damage the eggs during freezing. You’ll store your eggs in a special storage facility meant for just that. 

For an in-depth overview of the egg freezing process, click here.

Success rates of egg freezing

The success of egg freezing largely depends on the age at which the eggs are frozen. Generally, eggs frozen at a younger age have a higher chance of resulting in a successful pregnancy. Advanced vitrification techniques have significantly improved egg freezing success rates, with some studies reporting comparable pregnancy rates between fresh and frozen-thawed eggs.

One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

• 21 eggs for women under 35
• 17 eggs for women 35-37
• 14 eggs for women 38-40

But, in addition to egg quantity, we also need to consider egg thaw survival rate, and the rate at which these eggs become embryos and result in a live birth. According to a study in the Journal of Assisted Reproduction and Genetics, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Not only will freezing your eggs proactively give you the options of utilizing higher quality eggs in the future, it also helps alleviate the pressure of finding a reproductive partner, and can allow us to feel empowered to make family planning decisions on our own terms without any compromises. Taking a proactive approach to fertility preservation can provide the freedom to pursue opportunities without sacrificing the dream of having a family when the time is right.

Freezing your eggs with Cofertility

With Freeze by Co, you have the opportunity to apply to our Split program, where you can freeze your eggs for free when you donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, as part of our Keep program, we offer lower prices on things like consultations and storage, along with access to our community of others going through the process at the same time. ‍Plus, you’ll have direct access to our team, which is here to support you throughout the entire journey.

Summing it up

If you’re considering testing your fertility, the best age to do it is now. Whether you test yourself at home, or with a doctor at a fertility clinic, testing your fertility can provide valuable insights into what your family-building future may look like. It might also uncover the need for egg freezing in order to preserve some of your existing fertility as it stands today. But whatever you decide to do with the results, you’ll at least be armed with more information about yourself than you would have had otherwise.