Tips on Getting the Most from At-Home Fertility Tests

I see patients who inquire about or are already using at-home fertility tests that are available over-the-counter. There are several options, but the primary three include ovulation predictor kits, follicle stimulating hormone (FSH) tests and at-home semen analysis.

The variety of these tests range greatly on price and accuracy, and there is no “one size fits all” at-home fertility test. It’s important to remember that these are screening tests, not diagnostic tests. While they can be very helpful for couples trying to conceive, women who have been trying unsuccessfully to become pregnant for a year or longer should speak with a specialist for a full analysis and more detailed, accurate results.

Many of my patients who have tried unsuccessfully for a year to get pregnant and are using these tests rely too much on them without following up with me for a full analysis and more detailed, more accurate, results. While assessing ovulation, the reproductive potential for sperm and ovarian reserve, which these tests evaluate, is important, counseling by an experienced fertility provider is critical to help interpret what the results mean.

To help you make an informed decision on these at-home kits, I’ve included information about each, and my tips on choosing the right one.

Ovulation Predictor Kits

Generally, women use ovulation predictor kits, since ovulation (release of eggs from the ovaries) is the most fertile time in a woman’s menstrual cycle. The test detects the amount of luteinizing hormone (LH) in a woman’s urine. While some LH is always present in a woman’s urine, it surges 24 to 48 hours before ovulation.

Women begin taking ovulation predictor tests around day 9 or 10 of their menstrual cycle and repeat the tests every 12 to 24 hours for the next seven or eight days. If a woman does not detect ovulation by the end of this time period, we recommend that she see a fertility specialist and we can check her serum (blood) LH levels.

I personally believe that the ovulation predictor kits have a role in the world of fertility and can be very useful for specific individuals. But women who have polycystic ovary syndrome (PCOS) are not good candidates for these tests, as they are more likely to have constantly elevated levels of LH throughout their entire cycle, giving them a false positive result. This same group may also have long anovulatory cycles, in which they do not ovulate for 30 to 45 days or longer. In this case, it’s difficult to detect ovulation, not to mention it can get expensive to keep buying the kits without getting a positive result.

My Tips:

• Take the ovulation predictor tests early in the morning when urine is more concentrated for the most accurate test results.
• These kits can cost from $1 – 500, but most people should opt for the $1 option, as the higher-end electronic tests work exactly the same way, and you’re paying for bells and whistles. You can also get these tests online, which makes them even cheaper than buying them in your local pharmacy.
• Watch out for false negatives or false positives, which can be caused by diluted urine and miscalculating the days of a menstrual cycle.
• Test early in order to time intercourse, because it typically takes about 36 hours after initial positive ovulation results for the egg to be released for possible fertilization.
• Ovulation tracking apps can be helpful for women who have a regular cycle by roughly calculating the timing of their cycles. Unfortunately, only about 15 percent of women have truly regular cycles, and most women’s cycles vary from month to month.

FSH Test

Follicle stimulating hormone (FSH) is secreted by the pituitary gland. This hormone helps us to detect the level of a woman’s reproductive maturity. For example, when FSH levels are very high it’s usually because a woman is going into menopause and is running out of healthy eggs in her ovaries.

The FSH test will give a woman an idea of what her ovarian reserve looks like. FSH is best tested on day 3 of a woman’s menstrual cycle, but could be done between days 2 and 4. At-home FSH tests use a woman’s urine (at the doctor’s office, we analyze FSH levels in her blood) and provide the range of FSH, either normal or elevated. If the test is elevated, fertility is most likely decreased.

My Tips:

• This test can sometimes be meaningless, because it doesn’t take into consideration the levels of the hormone estradiol or the anti Müllerian hormone, which is generally a better indicator of ovarian reserve than FSH. These levels can be checked by a fertility specialist.
• At-home FSH tests have a high level of variability and are very cycle-dependent, meaning a patient may have one cycle with a normal result and another cycle that is elevated. So it’s important to double check.
• My message for patients is if you see an elevated response don’t be alarmed. Contact your fertility specialist and confirm the results with a blood test.
• Patients on oral birth control pills or psychotropic drugs that affect their levels of natural hormone should not take FSH tests.
  
  

At-Home Semen Analysis Test

This is the latest development in at-home fertility tests, in which the male deposits sperm through masturbation in a cup to detect sperm protein. The results will indicate the range of sperm count, normal or low, based on the amount of protein identified.

Most at-home semen analysis tests require that the semen sample be collected between two to seven days after the male’s last ejaculation. Generally, semen analysis tests are more expensive than the other at-home fertility tests, ranging from $30 – 60 a test.

The semen analysis is difficult to endorse, because sperm count is not the only aspect of male fertility, and this test does not consider sperm motility (movement) and morphology (shape and makeup).

My Tips:

• If the male is checking his sperm the same day or the day after he has ejaculated and not enough time has passed for it to re-accumulate, the test results could be low.
• At-home semen analysis tests can give you a rough estimate of an appropriate amount of sperm, but unless it’s checked under a microscope by an andrologist, the results could be questionable.
  
  

Don’t rely on your at-home test or your app as the final word on your fertility data. Use these with caution, follow the instructions carefully, and always refer to a fertility specialist to confirm.