What time is it? …or Help a friend: Ovarian Reserve Testing

By Drew V. Moffitt, MD

My heart sank as I sat down and looked at the young couple across the table. She was only 27 and I knew how hard this was going to be for her to hear. I know that doctors from other specialties have more difficult news to give to patients, but this news is so hard to give. I had to tell her that she had the ovaries of a woman about to go through menopause. In other words, the chance that she would be able to have a baby using her own eggs is almost zero.

She had been trying for 6 years and had been seeing doctors for at least 4 years – and now I’m giving her this news. It did not go well. How should it have gone? What do you do when you get that kind of news? You don’t believe it. There are questions. There are options. But in the end she just looked empty.

This is a scenario I have lived through too many times in the 19 years I have been treating patients with infertility. It was one of the more difficult ones, but they are always difficult – every one of them. It is because of this that for the past several years I have been putting together a program to try and deal with this. What would have happened if I had seen this patient at age 23 instead of 27? What if I had, “not so great news” but not really, really bad news? What if I could have helped her to have the family she had been dreaming of just by starting a little bit earlier with treatment? How could that have happened? By checking her biological clock as soon as possible.

The term “biological clock” refers to how long women have until they can’t get pregnant. A woman is born with all of the eggs she will ever have, which are around 1 to 2 million. By the time she has her first period, her egg count has decreased to around 300,000. Every month she loses more. Some lose eggs faster than others. The most fertile eggs are lost first. When the number or quality of the eggs gets low enough, your chance of getting pregnant goes down.

There is a wide range of variability in when a woman will begin “running out of eggs,” Some women are born with fewer eggs than others. Some lose eggs faster than normal.

What time is it?

The big question about your biological clock is: “What time is it?”

Several tests have been developed to diagnosis a problem called “Diminished Ovarian Reserve”.

These tests can give infertile couples critical information about where they stand so that they can make informed decisions about pursuing an infertility evaluation, treatment, and what kind of treatment. Most of the tests involve a simple blood draw and possibly an ultrasound. The blood is most typically sent for an FSH hormone level. Newer hormones like Inhibin and AMH are also sometimes used, but the cut off levels for what is normal is still controversial. We have partnered with a company called ReproSourse that has developed a scientifically validated index called the Ovarian Assessment Report that uses all of these hormone tests combined. The cumulative cost of these tests can be in excess of $900. Through an exclusive arrangement, Arizona Reproductive Medicine Specialists (ARMS) is able to offer this test to our patients for only $99. Patients who have not yet had a new patient visit at ARMS are currently offered a package including the blood test plus two consultation visits and an ultrasound for the same price – only $99. This program is available only at ARMS. For women who are just starting to try and get pregnant, we also have an IRB approved, fully funded study where these women can bet tested for free. You can get more information at CHECKMYBIOLOGICALCLOCK.COM.

The idea is simple. There are many women out there who either don’t realize that this is an issue, or do, but are putting it off because they are not ready for “INFERTILITY TREATMENT” or they feel they just can’t afford it. Our current economy is making the problem of delay even greater than before. If we can better inform patients about this issue and reduce the barriers to getting tested, hopefully more women will choose to be tested earlier – before it is too late.

The problem is how to spread the word. It is hard for women to believe that they need to do something about this. Tabloids showing > 40 year old stars having babies right and left does not help. Plus, some women just don’t want to know. You can help. If you are reading this, send it to somebody. Post it on your facebook. Help a friend avoid the visit my recent patient just had. They will forever thank you….and so will I.

Drew V. Moffitt, M.D., FACOG, is the co-medical director of the Arizona Reproductive Medicine Specialists (ARMS), the director of the Division of Reproductive Endocrinology and Infertility at Good Samaritan Regional Medical Center and an assistant professor at the University of Arizona. He is now president of ARMS and director of the Division of Reproductive Medicine and infertility for the residency program at Good Samaritan Regional Medical Center. Dr. Moffitt has significant clinical experience in assisted reproductive technologies and reproductive surgery.