Do at-home fertility tests really work?

Young woman reading the information booklet that accomanied her ovulation prediction kit in order to determine her most fertile days after release of mature ova (AGLPhotoproductions)

Between fertility apps that track menstrual periods and at-home kits that tell a woman if she’s ovulating and a man if he has a low sperm count, there are more options than ever before that seem to give couples hope.

One in 8 couples in the U.S. struggles to get pregnant and, by 2020, the fertility testing devices market is expected to be worth $216.8 million dollars, according to a report by Markets and Markets.

“Patients ask what can they do at home to be more engaged in their fertility treatment plan,” said Dr. Brian Levine, a board-certified OB-GYN and fertility specialist, and the New York practice director for the Colorado Center for Reproductive Medicine in New York City. “By offering people the ability to use at-home testing, it affords them the opportunity to be empowered.”

Optimize ovulation

Ovulation predictor kits can help women who have regular cycles optimize their timing to have sex. Although they can give a woman valuable data about her ovulation timing, some experts caution women should only use the kits under a doctor’s care.

“Ovulation predictor kits are useful if you have already established if the patient is ovulating normally,” said Dr. Thomas Price, president of the Society for Reproductive Endocrinology and Infertility.

Kits can sometimes give a false positive reading. For example, for women with PCOS, their luteinizing hormone (LH) level may always be elevated, causing the reading to show a surge without optimal ovulation, Price said.

Another challenge is that women may not read or follow the directions correctly. Plus, since they’re sensitive tests, if women use the kits at the wrong time or the wrong part of their cycles, they can be inaccurate.

“Once a patient comes in the door, I have many more effective techniques to offer them as compared to ovulation predictor kits,” said Dr. Marie Werner, a board-certified OB-GYN and high-complexity clinical laboratory director at Reproductive Medicine Associates of New Jersey in Eatontown.

There’s an app for that
“Almost every one of my patients is using some sort of a fertility app, whether it’s tracking their menstrual calendars or trying to predict the fertile window with them,” Werner said.

Fertility apps can also help women give their doctors a history and information about their cycles when they seek out treatment, but they too, have flaws.  

For starters, these apps assume that women have regular cycles, so in a woman who does not, her fertile window could be inaccurate.

In fact, only 4 out of 53 website and app-based fertility calculators were accurately able to predict a hypothetical woman's precise fertile window, according to research from New York-Presbyterian Hospital/Weill Cornell Medical College in New York City

“If you want to know the best app for tracking your period, it’s the calendar feature on your phone,” Levine said.

At-home hormone tests
There are also at-home tests that measure follicle-stimulating hormone (FSH), the hormone that increases to stimulate the ovaries to produce eggs.

Although test results will tell a woman if her FSH level is elevated, they cannot give her information about the amount of the FSH level.

In fact, a quarter of women who used an FSH test were labeled infertile, but didn’t have more trouble getting pregnant than other women, according to a study out fromthe University of North Carolina at Chapel Hill.

“They’re not replacements for going to the clinic, they’re almost adjuncts to the clinic,” Levine said.

Semen analysis in the privacy of your home
Although infertility is often seen as a woman’s problem, for approximately 40 percent of couples, the male partner is the only or a contributing cause of infertility.

To address this need, there are a handful of companies who offer at-home sperm tests to check sperm count.

“There’s a clear role for these as a reliable screening method for low sperm counts,” said Dr. Landon W. Trost, head of male infertility and andrology at the Mayo Clinic in Rochester, Minnesota. “Once identified though, I think you should still be seen by a specialist in the area.”

Although these tests check for sperm count, a semen analysis, which is ordered by a physician, looks at the volume, PH and viscosity of semen, the presence of infection, the motility or the ability of sperm to swim, as well as the morphology or shape— all things that can affect a couple’s chance to conceive.

Since men with infertility also have higher rates of testicular, colorectal, melanoma and prostate cancers and a two-fold higher risk for death if they have several abnormal findings on a semen analysis, these tests may help to diagnose more men who are usually less likely to see their doctors for screening, Trost said.

There are also other at-home sperm tests such as Episona’s SEED and one by SCSA Diagnostics to see if there are problems at the DNA level that could impact fertility.

The challenge, however, is unless there’s a physical problem or a lifestyle factor, the treatment for male infertility is intrauterine insemination (IUI), in-vitro fertilization (IVF), ICSI (pronounced ik-see) or intracytoplasmic sperm injection, where one sperm is injected into an egg.

“I think right now the technology is not yet there to tell us how it can or will change outcomes. I think a little more research needs to be done in that area before it becomes more mainstream,” Werner said.

Although at-home fertility tests can arm couples with information, experts agree if they still cannot get pregnant, the next stop should always be the doctor’s office.

“I’m all for screening. Cast a wide net. Identify people who have problems,” Levine said. “But I think the expectation for the patient should be level set that these are not the holy grail of unlocking someone’s fertility challenges.”