Taking a closer look at fertility testing in 2021

This blog was co-written by two in-house Registered Nurses at Everlywell who specialize in women’s health and fertility.

Shelley Gautam is a Registered Nurse and Consumer Science Liaison at Everlywell. With nearly a decade of experience, Shelley uses her expertise in fertility and hormone health to help educate and empower people to make informed healthcare decisions.

Charlotte Purdy is one of the Everlywell in-house Registered Nurses. Charlotte’s experience is broad, ranging from Women’s health care to fertility, as well as endocrinology and internal medicine. Charlotte is passionate about helping others to be advocates for their health and understanding how to improve their overall health and well-being

Conversations around fertility don’t look the same as they did ten years ago. In fact, access to fertility testing has changed dramatically in the past few years alone. For example, you can now take an at-home lab test that measures many of the same hormones you would measure at a fertility clinic or doctor’s office but at a fraction of the cost.

Whether you are trying to conceive or interested in fertility preservation, you may be wondering what options are out there that can help you better understand your fertility status. Below, we break down what you need to know about some of the most prominent and convenient fertility testing methods, as well as options for people who changed or paused their fertility planning decisions due to the COVID-19 pandemic.

What is fertility testing?

To better understand what fertility testing is used for, let’s first break down what fertility and infertility mean.

Fertility is defined as the natural capacity to conceive a child. Infertility is typically defined, in heterosexual couples, as the inability to conceive after 12 months of regular, unprotected intercourse for those under the age of 35 and that shortens to six months for those 35 and older. This difference is important to note for anyone who is in the first few months of trying to conceive, since a reproductive endocrinologist may not recommend any treatment at first if this is the case for you, especially if there are no abnormalities in your diagnostic testing.

Because normal ovarian function can be influenced by hormone levels, which can impact your fertility, lab testing can be a critical first step in understanding your reproductive health. If you are ready to start trying to conceive, measuring key hormones related to ovarian function can be a good starting point to understanding your fertility.

What fertility testing options are out there?

There are several options for evaluating your fertility status, some of which include visiting a fertility clinic or your healthcare provider. Others allow you to learn about your hormone levels with a mail-in fertility test that allows you to collect your sample at home.

Traditional fertility clinic If you are having trouble conceiving or are wanting to understand your fertility status better, your OB/GYN or reproductive endocrinologist will likely perform multiple tests to help you find out if any natural fertility processes (like hormone levels or ovulation) are impaired.

Some of these in-clinic fertility test options may include:

• Ovulation testing. Estimating the onset of ovulation may include a blood test and/or using an at-home ovulation predictor kit. Confirmation of ovulation may be done by vaginal ultrasound and/or a blood test.
• Hysterosalpingogram. This procedure evaluates for structural abnormalities of the uterus and fallopian tubes. It can also look for blockages in the fallopian tubes.
• Ovarian reserve testing. Although there is no way to know exactly how many eggs you have left, ovarian reserve testing can help you and your healthcare provider understand if your hormone levels are appropriate for your age.
• Hormone testing. These tests check your hormone levels that influence critical reproductive processes.
• Imaging tests. These tests may include a vaginal ultrasound, saline sonogram, or a hysterosalpingogram. Imaging may help detect various disease states as well as structural abnormalities that may be preventing you from conceiving or carrying a pregnancy.

Mail-in fertility testing options You can also learn more about your fertility status with a mail-in fertility test like the Everlywell Women’s Fertility Test, which allows you to collect your sample at home, mail it to the lab for testing, and receive digital results online. The at-home lab test only costs $149 and may help you understand if there are any hormonal abnormalities that may be influencing your ovarian function and potentially affecting your ability to conceive. Learn more about the key hormones measured with this at-home lab test here.

Additionally, our Ovarian Reserve Test can provide information about your FSH levels, the hormone that stimulates your ovaries to release an egg.

How has the pandemic affected fertility planning?

After a year of stay-at-home, work-from-home, and do-everything-from-home, so many people missed out on different opportunities as it relates to their health and wellness. This “lost year” especially affected those planning to become parents, including women and childbearing individuals on a fertility journey. For example, we know that 40% of women in the U.S. paused or changed fertility planning decisions during the pandemic.

The good news is that doctor’s offices and fertility clinics are widely back in business with increased safety protocols. This means you are now able to resume your fertility journeys by accessing the necessary health and fertility appointments needed to plan for pregnancy. However, you may find that your new patient visit and/or injection training appointments will be virtual. Additionally, keep in mind that your partner may not be able to accompany you to your appointments.

Is fertility testing covered by insurance?

Unfortunately, many insurance companies do not cover fertility treatments. However, there are varying levels of mandated fertility insurance coverage laws in 19 states, including:

• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Illinois
• Louisiana
• Maryland
• Massachusetts
• Montana
• New Hampshire
• New Jersey
• New York
• Ohio
• Rhode Island
• Texas
• Utah
• West Virginia

As fertility insurance coverage becomes increasingly available in the U.S., it’s important to understand the stipulations of your insurance coverage, including any possible age restrictions or treatment restrictions related to age. Also, note that certain medications may not be covered, or you may be required to use a pharmacy that’s contracted with your policy in order for medications to be eligible for coverage. Some policies also dictate which clinics you can work with. Always confirm your eligibility and discuss fertility coverage with your benefits provider to ensure you know exactly what may be covered by insurance and what is not.

Generally speaking, you can use your HSA/FSA account to pay for an at-home health test, as many FSA/HSA benefits coordinators consider Everlywell tests to be qualified medical expenses (as defined by the IRS). Some FSA/HSA benefits coordinators, however, might deny reimbursement – so consider checking with your benefits coordinator to see if your FSA/HSA covers Everlywell tests before purchasing. Learn more about FSA/HSA eligibility here.

I recently took a mail-in fertility test. Now what?

If you took an at-home lab test related to fertility testing, like the Women’s Fertility Test from Everlywelll, you may be wondering what actions you can take next to continue on your fertility journey. Here are some tips for anyone trying to conceive:

1. Share your mail-in fertility test results with your healthcare provider. If you took our Women’s Fertility Test and received your digital results through our secure, digital results portal, you are able to print or directly send your healthcare provider a copy of your results. This way, you can set up an appointment to discuss your results and let your doctor know that you are ready to start trying.

2. Track your cycles. Tracking your menstrual cycles (for example, with a menstrual tracking app) can help you better understand the length and regularity of your cycle as well as when you may be ovulating, which is the timeframe when you are most likely to conceive. Talk to your OB/GYN or reproductive endocrinologist about their recommendations for tracking and understanding your menstrual cycle.

3. Ask your provider for a recommendation for a prenatal vitamin* to prepare your body for pregnancy. A balanced diet is a great way to get the vitamins and minerals you need, but you may be falling short on key nutrients. If you're pregnant or trying to conceive, prenatal vitamins can help fill many gaps that are important to fetal development, such as folic acid and iron.

4. If you’re trying to conceive in a heterosexual relationship, ask your provider about male fertility testing options. According to the National Institutes of Health (NIH), in about one-third of infertile couples, the problem can't be identified or is with both the man and woman. This is why fertility testing can be important for both partners involved when trying to conceive. Talk with your healthcare provider about male fertility testing options, including a semen analysis.

5. After taking an Everlywell test, attend a live webinar If you have taken an Everlywell test, and more specifically a Women’s Health Test or Women’s Fertility Test, consider attending one of our live group webinars to learn in more detail about each of the biomarkers tested. The webinars are led by a healthcare professional and include a Q&A portion.

Whether you are resuming your fertility plans after the year-long pandemic or you are just starting your journey, fertility testing can be an exciting first step in understanding if the hormones that influence ovarian function and that are needed for pregnancy are balanced. If you’re looking to learn more about your fertility status, shop our Women’s Fertility Test. To help you take another step in your fertility journey, we also offer an Ovarian Reserve Test that can help you better understand your FSH level which is the hormone that stimulates your ovaries to release eggs. Learn more about all our Women’s Health tests here.

*Disclaimer: Always consult with your healthcare provider before starting any new medications or supplements.