Answer:
This new test, called Plan Ahead, is designed to measure a woman’s ovarian reserve – the number of eggs she has available for fertilization. The company is touting the $350 test as a way for women to check their childbearing potential, but experts are expressing mixed opinions about its value.
Some news articles have mistakenly reported that the test measures not only the quantity, but the quality of a woman’s eggs, ie, her "good eggs." The test, according to its manufacturer Repromedix, only measures the number of eggs a women has, not their quality. It also cannot determine if a woman is fertile or whether she has other problems that might affect fertility.
Women are born with their lifetime supply of eggs, which they shed during ovulation and through other biological processes. Along with the quantity, the quality of women’s eggs diminishes with age, and high quality eggs are most likely to result in fertilization. Both the number and quality of eggs a woman has are among the major factors that affect fertility.
Women’s prime childbearing years occur in their 20s and early 30s. After age 35, egg quality and quantity begin to decline more rapidly and a woman’s chance of becoming pregnant each month drops dramatically. Every woman has unique biology, however, and in some, egg quality and quantity start to diminish earlier than in others.
Some women in their 20s may have comparatively few high-quality eggs while some in their late 30s or early 40s may have an adequate supply. Such cases are uncommon, though, and for most women ovarian reserve is strongly linked to chronological age. Yet at any time in her reproductive years a woman may have egg quantity and quality that is average for her age, better than average, or worse than average.
The Plan Ahead test, which is only available through a physician, measures three different hormones that are closely linked to the number of eggs in a women’s ovaries. These are: follicular stimulating hormone (FSH), which promotes egg development; anti-Müllerian hormone (AMH), which affects egg follicle function; and inhibin B, a protein produced by egg follicles.
These hormone tests have been used for some time; the new component of the Plan Ahead test is a mathmatical formula that analyzes the results of three hormone measures in combination with other factors, such as age and estrogen levels. The result is an estimate of ovarian reserve that can be compared with the normal range expected for women of the same age. It’s important to understand that this test only measures the function of several hormones - it can’t determine the quality of a woman’s eggs or whether she is fertile.
Experts have expressed concern about this and several other aspects of the Plan Ahead test. Women may have structural problems with their reproductive system – a fallopian tube blocked by scarring from pelvic inflammatory disease, for example – or other problems this test cannot detect. Some experts worry that a woman may receive a good score on the test, delay childbearing, and find out down the road that she has other issues that make conception difficult.
In addition, fertility specialists are uncertain about the value of AMH level as a predicator of ovarian reserve. Repromedix has conducted a clinical trial of 200 women that will help clarify this point, but the company has not yet published the results. The Food and Drug Administration has not approved the AMH test for commercial distribution, and only a few fertility centers around that nation are testing AMH levels.
"The AMH measure has not been tested in large populations, which is necessary for experts to understand what AMH levels fall into the normal range," says reproductive endocrinologist Cynthia Sites, MD, director of UAB’s Division of Reproductive Endocrinology and Infertility. "AMH is not yet ready for prime time, and women should consider waiting for the results of large well-conducted clinical trials before jumping on this expensive bandwagon."