“Are you sure you want to do this?” my friend asked, genuinely concerned. “What if it’s bad news?” My at-home hormone testing kit had just arrived courtesy of a Dutch company named Grip which tests the hormones which provide indicators of a woman’s fertility remotely for £139.
Grip tests the same hormones as any private fertility clinic: Anti-Mullerian Hormone (AMH) which is produced by cells from the small follicles in a woman’s ovaries and is used as a marker of egg quantity. Luteinisizing Hormone (LH) which is responsible for triggering monthly ovulation, and used in the diagnosis of Polycystic Ovary Syndrome (PCOS). Thyroid Stimulating Hormone (TSH) which helps diagnose thyroid disorders: hypothyroidism and hyperthyroidism. Total Testosterone (T) which is often thought of as a male hormone, but women also produce small quantities. An imbalance in testosterone can indicate PCOS.
Knowledge is power, or so they say. And private companies selling self-testing medical kits promising to deliver it seem to be everywhere right now. Particularly ones which, like Grip’s claim, shed some light on the mystery that is women’s fertility. Others, like Thriva, promise to help you “take control of your own health”. And some, like LiveSmart take a slightly different approach; taking aim at employers they say that their blood analysis can help “build a happier, healthier workforce”. In exchange for a sample of your blood, spit or faeces these companies, broadly, promise the same thing: to shed light on the mysterious inner workings of your body so that you can optimise it in order to know when to have a baby, be more productive, avoid disease or all of the above. But, what if you can know too much?
Grip was founded by two women in their 30s - Anne Marie Droste and Ling Ling. It was, 32-year-old Anne Marie tells me over Zoom from Portugal where she has been spending lockdown and working remotely, borne out of frustration at all we do not know about women’s bodies because of the gender medical gap whereby women have, historically, been excluded from medical trials. “We don’t even understand how women as an entire category respond to an everyday drug like paracetamol because of the lack of knowledge about women’s hormones,” she laments, “let alone how it works in individual women”.
“The scientific evidence is clear that these tests are of limited use.”
Dr Lisa Webber, consultant gynaecologist and subspecialist in reproductive medicine at St Mary’s Hospital Imperial College Healthcare NHS Trust
Like so many of us, Anne Marie tells me that she began to Google “when is the right time to have children?” when she hit her thirties because she noticed that women around her were trying and struggling to get pregnant. “It wasn’t straightforward for everyone,” she explains, “some were having to go down IVF routes. So, I went to my GP and asked if they could tell me whether I needed to hurry up. I wanted to know because, if I knew that it might be difficult, I’d be making very different choices over the next five years of my life.”
However, the data Grip can provide isn’t necessarily the knowledge you might expect. Grip, unlike most millennials who dabble in divining the future whether by “manifesting” or via horoscopes, are careful to state that they cannot give predictions. Indeed, despite misconceptions to the contrary: no doctor or fertility test can. “We can’t tell you if you’ll be able to get pregnant, and neither can any doctor. There's also no predictor of infertility, so we won't be able to tell you that you can't have kids either,” they say on their website. Instead they encourage customers to think of testing their hormones “as a risk profile”.
“If you know your risks when you’re still young, then you still have all the options to do something about them,” Grip argues.
“I’d suggest running your finger under a warm tap for a minute or so,” a kind and encouraging young woman doctor told me over WhatsApp video call while I pretended to be “totally fine and actually very relaxed” about the prospect of “milking” (as she put it) blood from the ring finger on my left hand into the plastic vile I’d been sent. What if it was “bad news”? I ruminated on the concept. As if I, a 33-year-old woman, didn't already worry about my fertility enough. As if I haven’t had more conversations about the pros and cons of egg freezing with my friends than anyone should ever have to endure. What would a result that indicated that I might be at risk of early menopause do to me? How would a result that indicated that I might have a lower than average for my age number of eggs impact my life choices?
“Ready, show me your finger,” the doctor said cheerfully. “Don’t worry I’ve helped lots of people successfully prick!”
I removed a lancet from the packet, placed it against my finger and released the needle. She was right. It was fine. My plastic vile was full in moments, packaged up and, within an hour deposited in a post box so that it could make it’s way to a London-based lab for analysis. I was told to expect to wait a few days for the results which would tell me something, albeit it somewhat hypothetical, about my fertility.
As I waited it occurred to me that while I seem to be having more conversations about fertility than ever before, what's really being discussed in all but name is infertility or, rather, the fear of it. Since time immemorial, women who can’t or don’t have children have been singled out by society. To be “barren”, through choice or not, is to be an unnatural pariah. The term comes from the Middle English word barain which can be defined by what it is not: it was used to refer to anything that wasn’t fruitful whether that be women, animals or land. To be a woman who is not or has never been pregnant has long been deemed “unnatural”. In the Renaissance, infertility was described by male writers as an evil spell. And, throughout the early modern period, by some, women who experienced it were considered witches.
Today, the “evil” barren witch has transmuted into the (no less maligned) figure of a woman who has delayed having children for what some call “social” but I prefer to call economic reasons such as not having met the right person or the prioritisation of an education and career. And, make no mistake, in a country where housing is unaffordable everywhere for the average woman and there is no universal free childcare, reproductive autonomy is the backbone of women’s economic liberation.
During the pandemic, with so many of our freedoms intermittently removed, conversations about fertility or, rather, potential infertility, have proliferated. Egg freezing was on the rise anyway. Data from the Human Fertilisation & Embryology Authority (HFEA) shows that the number of egg storage cycles has increased rapidly, rising from 1,500 cycles in 2013 to just under 9,000 in 2018. This is a staggering increase of 523% which means that the number of women freezing their eggs has increased five-fold in recent years. But, over the last 18 months, it has been everywhere: featuring in as many articles and podcasts as it has in the private conversations had between women when nobody else is listening. At-home hormone tests are no different. There is not a single woman of my age I know without children who doesn’t want to take one and feel that they’ve claimed some power over their future which, by its very nature, is always going to be beyond their control.
My results arrived along with a call from a Grip doctor. It wasn’t bad news. I have a slightly elevated level of testosterone. This, they explained, could be an indicator of PCOS which could, potentially, make getting pregnant tricky. I already knew this. I was diagnosed with PCOS in my teens. However, I’d never had my hormone levels tested so it felt vindicating that these results reinforced that diagnosis and legitimised all of the symptoms - from excess body hair and painful periods - that I battle with. On the fertility front, also not bad news. My hormone levels indicated that I (potentially) have an above average level of fertility for my age.
“At-home hormone testing kits can give women useful information in certain situations but they should not be relied on for the diagnosis of conditions such as polycystic ovary syndrome (PCOS).”
Dr Raj Mathur, spokesperson for the Royal College of Obstetricians and Gynaecologists, and Chair of the British Fertility Society.
Next came an inevitable question. What to do with this information? Can I now relax? Is the pressure to make a decision about whether I want to have a child off? For a bit, anyway?
Not really, as it turns out. As with egg freezing, which experts are careful to caution women against seeing as “insurance” against infertility, there is growing concern about the increasing interest in at-home fertility tests too.
Dr Raj Mathur is a spokesperson for the Royal College of Obstetricians and Gynaecologists, and Chair of the British Fertility Society. “At-home hormone testing kits can give women useful information in certain situations; for example if a woman is trying for a baby and has regular periods, a urine ovulation test may help confirm that she is ovulating,” he told me. However, he warned “these at-home testing kits should not be relied on for the diagnosis of conditions such as polycystic ovary syndrome (PCOS)” because they “do not show the full picture and there are further factors that need to be considered including hormonal and ultrasound results, and if the woman has any other associated conditions like diabetes.”
“We understand it can be expensive purchasing these at home testing kits. That’s why we would strongly encourage women to discuss any concerns they may have about their health with a GP or fertility specialist. A doctor will be able to tailor advice and treatment to their specific needs, whether it’s for fertility, the menstrual pattern or skin problems.”
Added to that, Dr Mathur made an important point. The fertility of both men and women still declines with age and, yet, these tests are mostly marketed at women. “Home testing of hormones has a limited role because it does not provide women or couples with the full information about their fertility,” he explained, it only gives the woman a theoretical understanding of her hormone levels.
Dr Lisa Webber, consultant gynaecologist and subspecialist in reproductive medicine at St Mary’s Hospital Imperial College Healthcare NHS Trust went even further, telling me that these tests are “not in the best interests of women” because they can either give “false reassurance” or cause false alarm.
Like the private companies offering egg freezing, Dr Webber says that at-home hormone tests are “an industry”. “Women,” she said categorically, “are vulnerable and this is yet another industry profiting from that.”
Are we vulnerable? Yes, insofar as no matter how far we progress, women are still haunted by an invisible but inescapable so-called ticking biological clock which hangs over us like the sword of Damocles whenever we make a relationship or career decision. In that context, living with the weight of centuries of stigma about "going against nature", is it any wonder that young women are founding companies in an attempt to hack biology and fill in the knowledge gaps in women’s health? That they are prepared to pay to feel empowered? No.
But, data isn't necessarily knowledge. And, feeling empowered isn’t the same thing as having actual power. At-home hormone test kits may throw up more questions than they answer. And, in the end, if you fear infertility but aren't ready to have a child and find yourself wondering what to do, a doctor you've never met will not find the answer to that question at the bottom of a single vile of your blood.
“While these tests can tell you things about your body, which can be good,” Dr Webber concluded: “these hormone levels don’t actually tell you anything about your fertility - they only give clues and those clues have to be interpreted in a medical context. Things do also change. So, the scientific evidence is clear that these tests are of limited use.”