Ovarian Reserve Testing in the United States

Kyweluk, Moira Anna

doi:https://doi.org/10.21985/n2-03j0-xb42

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Ovarian Reserve Testing in the United States

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For women, age is one of the best predictors of fertility. Younger women are typically more fertile, and ability to conceive declines until a woman reaches menopause. However, the age at which an individual woman becomes less fertile varies depending on many factors unique to her individual body, including genetic makeup, diet, lifestyle, and environment. Frequently branded the “Egg Timer” or “Biological Clock Test,” anti-Müllerian hormone (AMH) screening for women is becoming widely available at low cost in the United States in clinical medical settings and through online, direct-to-consumer (DTC) testing companies. Along with other assessments, blood levels of AMH reflect the remaining egg supply or “ovarian reserve”; below average values may indicate reduced fertility, although the utility of AMH level in predicting spontaneous conception is debated. Fieldwork for this dissertation explored experiences with ovarian reserve testing in the United States among elective testers, clinical patients, physicians, and other experts. Comparative ethnographic data on clinical patients are drawn from two field sites where ovarian reserve testing is common: first, a network of private infertility clinics that offer initial fertility assessment for a small out-of-pocket cost and second, a large research hospital infertility clinic where testing is often a part of family building using assisted reproductive technology (ART) like oocyte cryopreservation (OC; i.e., egg “freezing”) and in vitro fertilization (IVF). Data on elective testers was collected from an enrolled ethnography, a new method in which a recruited sample of interested individuals was provided the opportunity to pursue DTC ovarian reserve testing including AMH level through a US-based company and closely followed throughout the testing process. Data from each phase of fieldwork included participant observation and semi-structured interviews with elective testers, patients, providers, and other experts on ovarian reserve testing from both academic medical institutions and the private infertility industry. The sample included individuals across diverse socioeconomic, medical insurance, and relationship statuses, as well as self-identified sexual orientation and race/ethnicity. Detailed ethnographic case studies drawn from clinical fieldwork and the enrolled ethnography provide narratives of how the ovarian reserve testing experience is mediated by relationship status, socioeconomic and medical insurance status, and identity. Across each of these contexts, ethnographic data highlight anxiety around ovarian reserve testing. Uncertainty among patients and elective testers about how to interpret results and make decisions about next steps in reproductive healthcare were compounded by misinformation about the utility of AMH levels in indexing fertility status. This anxiety was reiterated by clinicians who must counsel patients and sometimes make decisions about their own personal medical care without robust clinical evidence or definitive guidelines. Interviews revealed many psychosocially fraught decision-making points in navigating new reproduction options facilitated by ARTs like ovarian reserve testing and OC, as well as underlying cultural mandates around biological parenthood. This dissertation considers ethnographic cases along with research on the emerging market for ovarian reserve testing, associated clinical research, and evolving regulations as proxies to understand broader cultural shifts in how medical information is accessed and delivered, as well as gendered social expectations around reproduction and cultural anxiety about age-related fertility decline.

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