Why I chose a "fertility test" | Life and style

I I am in a resolutely neutral room on Harley Street, my feet in the stirrups, my dignity almost preserved by a fragile cloth. On the monitor in front of me is my belly, empty of baby but nevertheless recited with energy by Professor Nick Macklon. He reports that my contraceptive device, my uterine lining, is preparing for evacuation in about a fortnight, the visible void left by my egg that has just drained – Macklon describes it all as a pivotal scene in a film that has just been released. ;action. The stakes, of course, are high.

I am in the middle of my "fertility test": yes, as for a vehicle, but for my ovaries. The two-step process – offered by the London Women's Clinic (LWC) and other similar fertility clinics for a few hundred pounds – consists of a blood test followed two weeks later by a "not too invasive" pelvic ultrasound . Along with a consultation about your medical history and lifestyle, the results help you understand your own fertility status and your likely ability to conceive now and in the future. "I must say that I really hate this term," MOT, "LWC medical director Macklon had earlier pointed out at his office," Women are not cars. "We are not cars – but there are has a lot of difficult parts, which we mostly ignore until they do not work.

If you asked me half an hour ago – while I was sitting in the majestic clinic waiting room, a little baby cry was heard from afar – I would have understood that my fertility was slightly above average. I knew, for example, that I was born with a finite number of eggs and that at age 28, I was approaching the age at which I should start to take it seriously. But with the reality of children still totally, ridiculously at odds with my daily life, I felt happy to leave the picture blurry.

I was not even sure I wanted them after all. From my early childhood to my twenty five years, I had firmly stated that I would never have children. In recent years, my roommate had ambaded a collection of photographs of me holding babies, his face veiled by terror, which, as a whole, seemed to be overwhelming evidence of my lack of maternal instinct.

But as I arrived in the late twenties, something began to change, with a tedious time. Choices such as changing countries, changing jobs, or emptying or not emptying a boyfriend have started to look good. Friends of my age have begun to admit their concerns about lack of time; Older friends who had witnessed too many heart-wrenching struggles to conceive, urged me to take them seriously. And the reality of being a woman means that the luxury of ambivalence is only offered to you for a very long time.

The MOT service, offered by LWC for two years, was born out of two things, says Macklon: greater clarity about the impact of time on fertility and the general ignorance of it. A 2018 meta-study concluded that "there is insufficient knowledge, especially to determine when female fertility declines markedly", despite the tendency to delay children until later in life. In 2016, the average age of women at first birth was 28.8 years, compared with 27.3 years in 2006. "It is clear that women misunderstand that their fertility essentially ends about 10 years before the first birth. menopause, rather than when they have their menopause, "says Macklon. "It's the huge lack of information."

Even if they have their period, many women do not even begin to ovulate reliably every month before they turn 20 years old. Fecundity peaks shortly thereafter and then begins to decline, although "not catastrophically," says Macklon. "It's probably a steady progression to 27 or 28." My age, then. I begin to feel a little panicked. The fertile window goes from the mid-twenties to the mid-thirties – not quite languid, even with a physiology on your side, and this can vary considerably.

I was right to say that women are born with all the eggs that they will ever have, about 1 m, but that number has usually halved at puberty – and I am shocked to learn that we lose about 30 to 40 eggs each month. Macklon enthusiastically explains before each period: "A whole group of eggs will have decided:" This is our time now. We have been waiting for twenty years; it's gone, here we go. & # 39; & # 39; Hooked on hormones, they begin to grow.

Two weeks before ovulation, between five and 20 eggs – a brood, if you will – will be candidates. "Out of these 20 people, one of them may be a little more mature, a little more sensitive to hormones" – and this favorite will start to produce another hormone to thwart its competitors. "It's a very interesting behavior of brothers and sisters," says Macklon almost tenderly. (And just as ferocious as the race to sperm fertilization, I note – without any mythology.)

Over time, not only do women lose their eggs, but their quality runs out. "The consequences are that, if women leave the childbearing years until their late 30s, their chances of producing an egg of sufficient quality to allow a healthy baby to fall," says Macklon. The Fertility WORD can indicate "where an individual is on their biological clock" and the fact that their request reflects a more proactive approach to family planning.

The price of the service is about £ 200 for a consultation without pelvic ultrasound, up to £ 450 for a male and female package (and £ 640 for two women), the service is not good market and about half of the 800 women undergo annual consultation with the LWC is a first step toward the beginning of fertility treatment, "rather than to rebadure or help with future planning," says Macklon.

It is also advisable for women whose results tests return problematic results to take into account the freezing of eggs, which gives rise to fears that the tests will guide them on an uncertain and costly trajectory.

the The British Fertility Society (BFS) says that it is important to remember that these tests were developed to inform the treatment of IVF, not natural fertility, and are therefore open to interpretation: "There is no doubt that tests showing good ovarian reserve are rebaduring but in no way guarantee a baby; Similarly, a poor or impaired ovarian reserve does not mean that you are going to have a hard time needing a fertility treatment.

Raj Mathur, secretary of the BFS, explains that his point of view on egg freezing is "cautiously favorable … but like everything, we risk saying too much about it and not accurately reflecting the problems".

Similarly, he said, although MOT can help some women and couples in their family planning, it should not be confused with a complete diagnosis of individual fertility. "They do not look at other aspects of female fertility – whether they ovulate or not, that their fallopian tubes are clogged – and they often do not look at the man. It is a kind of incomplete snapshot of an aspect of a couple's conceiving ability, which can easily give false badurance.

The MOT blood test measures the levels of anti-Müllerian hormone (AMH) released by growing follicles, indicating the number of eggs that you have left – but a study conducted by # 39; last year revealed that a decrease in ovarian reserve was not badociated with infertility. "If you're just starting to have a baby, a low or high AMH will not affect your chances of conceiving," says Mathur. Macklon admits that only one measure of AMH speaks little, but adds that, in the context of the MOT, and discussed in the broader context of the person's medical, personal and lifestyle background, it is useful to estimate the duration of the patient's reproductive period.

Macklon explains that early in his career, he was usually faced with infertility problems: "You know," I have been trying to make kids for three years. It did not work; can you help me? 'Now it's completely different.' Over the last ten years, and especially the last five years, he has been more often approached by single women and new couples wanting to know if they should go to school. before. The growing interest in the MOT testifies to the "growing awareness": "It may be a good thing to plan these things."

Yet many women – even those who are convinced of wanting a child one day – leave any further questioning on the idea until it is a practical reality or that there is room for s & # 39; worry. "One of the most difficult aspects of our job is to announce bad news to women who think they do not have a problem," said LWC spokesperson Ben Cordle when I called him there. a few weeks. make an appointment. It was possible for a healthy and fit woman, aged thirty years, for no reason to doubt her fertility, to record a low AMH rate. only 2, on a healthy range between 4.1 and 58.

In fact, the idea came to my mind this morning only: that this appointment I made without greater impulse than a mere curiosity could not change the course of my life. On my way to the clinic, the issues that I had been comfortable with until now were brought to mind, where they jostled for importance.

The big one, of course: what if I'm sterile? Then nuance nuances: if I'm sterile, could I still write a story about it? And if I'm certified so fertile, I can safely push motherhood to more than 40 years – will I leave it as late as possible or will I follow the pace of my peers? Can I afford to freeze my eggs? Do I even want a baby? And the most frightening thought of all: if the test says I must have one now or never?

In this tastefully tended clinic, which returns to Macklon's office after my ultrasound, I'm about to find out.

With regard to his somewhat fanciful visit of my belly, Macklon is at the center of his concerns because he reviews my results and my medical history. I have a normal uterus. Normal endometrial thickness. My right ovary looked normal, with 10 follicles – also normal – and the "left ovary was similar". My AMH level was "within the normal range for a woman of your age" even though it was in the lower end of the mean value, which means I would not have -be not want to leave a baby before the end of my thirties – but I supposed it.

According to Macklon, the worst thing I can do about my fertility right now is to start smoking or contracting chlamydia.

All this seems somewhat of a kind of anti-climatic. But then, I realize I'm lucky to have this result, lucky to know that I still have a few years to go. The MOT, explains Macklon, presents "some options that we did not have in the past, if it is not to say" move "or" you can relax. " he casually stays me long after the appointment. "If you think about it, women have to organize almost all the events of their lives over a period of about 15 years: career, having children." It's not long, but I have time – and the discovery process has focused my mind on how I want to spend it.