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Opinion

Fertility testing shouldn’t be scary – here’s everything you need to know

By Tess Cosad, CEO and co-founder at Béa Fertility

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Tess Cosad

For many experiencing problems conceiving, fertility testing can offer valuable health insights. Here Tess Cosad, CEO and co-founder at Béa Fertility, explains everything you need to know.

Around one in seven couples will have difficulties conceiving. Fertility problems can be caused by a number of factors, including health conditions like endometriosis and fibroids, having a low sperm or egg count, or lifestyle factors such as smoking.

For one in four couples, a specific cause cannot be identified. Nevertheless, the best place to start if you’ve been struggling to conceive for over a year is to undergo fertility testing.

What is fertility testing?

Fertility tests are investigations designed to help determine if there’s an underlying cause as to why you’re not getting pregnant.

You can undergo fertility testing via your GP, or you can order tests online using companies such as Hertility (female hormone and fertility testing) and ExSeed (sperm testing).

Based on the results of your tests, your GP should be able to advise on next steps to help you conceive.

There are different tests available to determine male factor infertility, female factor infertility or unexplained infertility.

What to expect when undergoing fertility testing?

The fertility testing process will differ slightly depending on whether you order tests online, or seek testing through your GP.

If you are going through your GP, they will usually ask questions about your menstrual cycle, your medical history, if you take any medications, how long you’ve been trying to conceive for and when and how often you have sex. These questions will help your doctor work out what investigations to perform.

Most commonly, these investigations will often involve blood tests to establish if you’re ovulating, an ultrasound to assess your uterus, fallopian tubes and ovaries and a semen analysis which will show the quantity and quality of semen and sperm.

It’s important to be honest and transparent when answering your GPs questions. Although the questions may feel personal, responding honestly will help them make well-informed decisions on best next steps.

What are the different types of fertility tests?

When you first approach your GP for fertility testing, they will perform some initial investigations using blood tests.

If you order a fertility testing kit online, you will usually be asked a series of questions to help the company determine which tests to send you.

The exact tests you undergo will depend on your specific circumstances, but will typically involve tests to assess menstrual cycle hormones, thyroid hormones and indicators of ovarian reserve.

  • AMH (anti-müllerian hormone) test – AMH is produced by the follicles in your ovaries, little sacs. Just as women’s egg count decreases with age, so do our AMH levels. An AMH test can give a good indication of egg quantity, and can also help signal some reproductive health conditions like polycystic ovaries.

  • P21 or progesterone test – This is a blood test that is performed in the middle of the luteal phase, which is after ovulation and before your period begins. The test is scheduled for seven days before your period begins, so the timing is based on the length of your cycle. In a 28 day cycle, this test would commonly be performed on day 21. The test measures progesterone levels to assess if ovulation has taken place.

  • FSH (follicle stimulating hormone) test – FSH stimulates the growth and production of eggs in the first part of the menstrual cycle. This blood test may be used to give an indication of the ovarian reserve – how many eggs you have in your ovaries.

  • LH (luteinising hormone) test – LH should reach a peak before ovulation: a rise in the hormone signals to the ovaries to release an egg. If LH levels are overly high, this can have an abnormal effect on the ovaries. The LH test is used to assess LH levels and their impact on egg release.

  • E2 (oestradiol) test – High levels of oestradiol may suppress other reproductive hormones that are responsible for ovulation, so an elevated E2 could mean that you’re not ovulating each month. The E2 test assesses E2 levels to understand whether this hormone is impacting ovulation.

Depending on your circumstances, your GP may also arrange the following tests:

  • Prolactin test – Elevated levels of prolactin may suppress ovulation, so prolactin may be checked if periods are absent.

  • TSH (thyroid stimulating hormone) – Both an overactive and an underactive thyroid gland can have an impact on ovulation. Measuring TSH levels would give an indication as to whether this is the cause of any fertility issues.

  • Testosterone – Raised levels of testosterone in women can disrupt the menstrual cycle and may lead to irregular cycles. In men, low levels of testosterone can impact sperm production.

An ultrasound may also be performed to examine the uterus, fallopian tubes and ovaries and identify abnormalities.

Testing for male factor infertility

During early fertility investigations, a semen analysis is often performed to check if there are any issues with the sperm, such as a low sperm count or low motility (movement of the sperm). They will test for the following factors:

  • Semen volume

  • Sperm concentration (concentration of sperm per millilitre of semen)

  • Sperm count (total number of sperm number)

  • Sperm motility

  • Sperm morphology (whether majority of sperm are ‘normal’ or abnormal forms)

If the result comes back abnormal, a semen analysis would usually be performed again in three months’ time.

The term infertility can sound scary, but it doesn’t mean you’ll never become a parent.

Fertility testing is the first step to help doctors identify the potential root of the problem, and they will use this information to recommend treatments and next steps.

Even if you are diagnosed with ‘unexplained infertility’, there are lots of brilliant fertility treatment options out there to help you on your journey to starting a family.

If you choose to seek fertility testing using a private company, rather than going through your GP, do your research to ensure you’re ordering your tests from a reputable source with a track record of accurate and actionable results.

Opinion

The continued struggle for female representation in drug trials  

Dr Janet Choi, chief medical officer at Progyny

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Dr Janet Choi, chief medical officer at Progyny

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

In 2002, the Women’s Health Initiative (WHI) was forced to pause its study on hormone therapy’s effect on menopause symptoms due to results showing it increased the risk for breast cancer, stroke and heart disease, and thrombotic events like pulmonary emboli.

Over 20 years later, in May of this year, JAMA published a review of this study and determined that, given current available hormone therapy formulations as well as risk/benefit analysis, younger menopausal women may actually derive significant benefits from menopausal symptom relief with appropriately prescribed hormone therapies.

The initial study had looked at women who were older and typically years post-menopause – the average age of the study participants was 63.3 years – and the age-related changing of blood vessels, among other things, may be the key to shifting from greater risk to greater benefit with hormone therapy.

I wish this more measured summary of the study’s findings and recommendations had been headlined back in 2002 – and I imagine thousands of my OB/GYN colleagues and billions of menopausal women over the years feel the same.

Yet, due to these 2002 over-generalised published findings, doctors and patients shied away from hormone therapy, which led to unnecessary suffering for many symptomatic menopausal women.

The irony of the WHI study is that after decades of women being excluded from clinical research, Congress finally passed an act in 1993 requiring that the National Institute of Health (NIH) enrol women and persons of colour in clinical trials.

On the heels of this landmark decision, the intentions of the WHI study were excellent – a first of its kind for women – but may have unintentionally set back women’s health innovation.

The reality

If you’re wondering why we are just now reevaluating and reinterpreting findings made in a 2002 women’s health study you may (or may not) be shocked to learn that while there is growing inclusion of women into research trials, they are still underrepresented in key therapeutic research areas, such as cancer and cardiovascular disease.

Excluding women from drug trials can have several harmful consequences. First, it can lead to a lack of understanding about how medications affect women differently than men, as their physiological responses may vary due to hormonal and metabolic differences, among other factors.

This can result in ineffective or potentially harmful treatments for women. It can also hinder progress in medical research by preventing the development of sex-specific treatment approaches.

Additionally, while the amount of research conducted on the behalf of women has grown in the past two decades, research involving pregnant women has been restricted.

This leads to a limited understanding of how best to medically care for pregnant women: for example, less than 10 per cent  of prescription medications have been studied enough to understand the impact in pregnancy on both the woman and her foetus.

While the NIH and American College of Obstetricians and Gynecologists (ACOG) both acknowledge pregnancy as a “medically complex” state that can alter metabolism of medications, and the course of various diseases, increased pregnancy-specific data needs to be collected to optimise the care of women in pregnancy.

Another recent, glaring case study: initial COVID vaccination trials did not include pregnant women, which led to restrictions on the availability of the vaccines as well as restrictions of the use in pregnant women with dire consequences – as unvaccinated pregnant women are more likely to develop severe COVID infections requiring ICU admissions and are more likely to develop other pregnancy-related complications like preeclampsia and preterm birth.

How do we move forward?

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

It’s crucial for the government and pharmaceutical companies to put more resources and funding into women’s health so we can have a deeper understanding of how to treat diseases that impact over half of the population, for more female and diverse talent to enter the medical field – either as doctors, researchers, healthcare executives – and to incorporate how biological sex can affect medical treatment into provider education.

And, for pregnant women, the answer was proposed by ACOG back in 2015: “A more careful examination…points to the need for evidence-based consideration of pregnancy exposure in research rather than broad exclusion of all pregnant women”.

If evidence demonstrates minimal risk to the foetus as well as potential benefit to the pregnant woman, why should she be denied the right to give informed consent to enrol in a clinical trial?

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Opinion

‘Women are left in limbo’: how telemedicine can cut down NHS gynaecology waiting times

By Kat James, director of new projects at Consultant Connect

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Almost 600,000 people in England are waiting for gynaecology treatment. It is clear the current system is not fit for purpose.

The NHS, across the board, is struggling to reduce waiting lists, but gynaecology health, in particular, has been sent to the back of the queue.

Referral numbers are about 60 per cent higher than pre-pandemic, which represents one of the three highest specialties in terms of volume increase since pre-COVID.

Not only are women left feeling neglected, but longer wait times also result in them needing more complex treatment or even emergency admissions to hospital.

Then, there is also the impact on family life, work, and women’s mental health. A survey of the Royal College of Obstetricians and Gynaecologists found that four-fifths (80 per cent) of women said their mental health has worsened due to the wait and that one in four of those whose mental health had deteriorated, pain was given as a reason.

More than three-quarters (77 per cent) of women said their ability to work or participate in social activities had been negatively impacted.

One of the main stumbling blocks impacting patient waiting times is the disconnect between primary and secondary care. Often, patients who have faced long waits for their appointment are discharged after their first hospital appointment and told that their care is best taken care of by their GPs.

The good news is that new ways of working better connect primary and secondary care and ensure patients receive the right treatment first time. If applied at scale, these solutions considerably reduce waiting lists.

For example, giving GPs immediate access to speak to a consultant on the phone for specialist advice and guidance for their patient. In ordinary circumstances, a GP would have to call the hospital switchboard or send a written advice request which might take days to be answered.

Often, these queries would go unanswered or aren’t transferred to the correct department, resulting in patients being referred sometimes unnecessarily or presenting at a busy A&E department.

Technology like Consultant Connect allows GPs to directly “hunt down” a specialist consultant from a pre-defined rota for expert advice via a phone call, ensuring GPs can direct their patients to the right care first time. This service is available for gynaecology in almost 50 NHS areas across the country.

In Coventry, for example, a 54-year-old patient presented with obvious advanced gynaecological cancer. While the two-week wait referral had already been made, the GP couldn’t move the appointment sooner than 14 days later.

Meanwhile, the patient started deteriorating, and the GP considered an urgent admission. The GP used Consultant Connect and, within seconds, was connected to a gynaecologist, who then arranged for the patient to be scanned that day. The patient got the care they needed and avoided an acute admission.

In June 2023, the service expanded to cover a menopause advice and guidance line as referral data in one local area showed increased referrals relating to menopause-specific questions, many of which did not require to be seen in a hospital setting.

This meant that trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without management plans.

With the new Consultant Connect Menopause line, GPs can get through to a consultant with special interest in menopause matters within 26 seconds.

Data shows that 87 per cent of calls resulted in the GP receiving “enough” advice for their patient to benefit from an immediate treatment plan via their GP rather than waiting for a hospital appointment with a specialist unnecessarily.

Another way to tackle the wait problem is to leverage remote ways of working, which opens access to a new pool of workforce that otherwise wouldn’t exist.

Consultant Connect runs a network of NHS consultants who review gynaecology referrals remotely, with no need to travel to local hospitals and with consultants choosing their own working hours. This is often attractive to consultants who work part-time in hospital or are on parental leave, for example.

For patients, it means they get access to treatment plans faster: the remote working consultant determines the urgency of a referral and writes up a management plan, which means that treatment can start immediately.

Often, the health problem can be resolved through this plan, and for those still needing to be seen, it means they come to their first appointment on a more informed basis.

At the same time, it ensures patients are on the correct pathway, and any diagnostic test needed for a diagnosis are initiated in a timely manner.

Last year, Consultant Connect’s team triaged over 5,000 gynaecology referrals across the UK, resulting in 43 per cent of referrals being safely removed from the waiting list.

Many of these patients were returned to their GP with a treatment plan devised by the consultant. By fast-tracking urgent cases, women are not put through unnecessary stress and pain while waiting to be referred to a gynaecologist. Among these referrals, one in ten cases were upgraded to the urgent and suspected cancer pathways.

By reviewing current systems to make them more joined up and to allow for efficient ways of working, we can speed up care for women and make sure that clinicians have the right tools to help the NHS deal with the mounting gynaecology backlog.

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Opinion

‘We are not allowed to talk about our bodies’: why we need to address social media censorship

By Clio Wood, women’s health advocate and founder of &Breathe

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Social media censorship is just another example of women’s issues being sidelined and women being made, yet again, to feel small.

The gender data gap is huge and, if you’ve ever read the great Caroline Criado Perez’s book, Invisible Women, you’ll know what I mean. It touches every day of a female life.

That impact includes social media too. Because while the social media platforms are notoriously secretive about their internal workings, it’s a pretty safe bet that social media algorithms, like most of the rest of life, are built on male data and trained on male behaviours.

This means that as long as women have different behaviours and priorities of what they want to see on these platforms, we’re going to find it a struggle.

Meta and Tiktok are silencing women’s health and sexual wellbeing content. Censorship harms women’s health: it increases women’s pain, and disempowers women, which in turn means the gender health gap cannot close. What annoys you when you’re on your phone scrolling has long-lasting impact for us and our children.

I’ve experienced this censorship first hand on Instagram, with my reach being restricted for simply posting a body confidence reel of me dancing in a bikini.

That in itself – one example of many – is infuriating, but what’s especially galling is that everyday men’s health topics are left uncensored, and hyper sexualised women’s bodies, unsolicited “dick pics” and fake accounts using nearly naked female profile pictures are making their way into social media feeds and inboxes unchecked. The hypocrisy of the situation is clear.

All the while charities are being forced to use male nipples instead of female ones, and female-led period brands are losing hundreds of thousands of pounds when their ad accounts get deleted.

Creators, charities, medical practitioners and brands are being censored constantly through algorithms picking up words like sex, vagina, vulva, or period. Which are all normal human functions or body parts and integral to these creators’ missions. You can’t be a period care brand without talking about periods.

CensHERship aims to alter the trajectory of the current algorithms and end the routine censorship of women’s health content online

Creators end up using written symbols and numbers to disguise these words and bleep them out in speech to try to get around this censorship.

It’s examples like this that finally led me – after many years of finding this situation ridiculous – to do something about it.

Together with Anna O’Sullivan, we’ve created CensHERship, a campaign which aims to alter the trajectory of the current algorithms and hopefully restore some balance to what is allowed on social media. Our ultimate aim is to bring the platforms to the table for discussion by this time next year.

We launched a survey in late January 2024 to try to collect as much information as we can about the incidences of muting and censorship that female creators are experiencing, whether they are educators, charities, brands or medical professionals. The results emphasised that this is a widespread issue taking in all of women’s health and sexual wellbeing.

In tandem we hosted an intimate roundtable to launch the CensHERship campaign and found, to our astonishment, that the problem goes much deeper than social media. Women’s health and sexual wellbeing brands are being refused bank accounts, insurance and being kicked off payment platforms without warning.

Social media censorship is just the tip of the iceberg. It’s just one more example of women’s issues being sidelined and women being made, yet again, to feel small.

We’re not being allowed the freedom to talk about our own bodies and health, because speaking up goes against the male-gaze archetype of the female role and body. Let’s end CensHERship once and for all.

Clio Wood is a women’s health advocate, journalist, author and Founder of &Breathe.

Anna O’Sullivan is a communications and marketing professional and writes FutureFemHealth 

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