The Truth: We Can’t Actually Test Fertility
Can you really “test” your fertility? Is everything you’ve heard about fertility assessments kind of a myth?
This week I’m revealing why “fertility testing” isn’t what most people think it is and how they don’t actually define your fertility or your worth.
Topics in this episode:
AMH numbers
semen analysis
anatomy scans
holistic care and coaching tools
turning survival mode off
You’ll leave with more clarity, more hope, and the sense that you’re not as far off as you think. Listen to find out how Love and Science can help you thrive, no matter where you are on your fertility journey.
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
If you found this conversation valuable, book a consult call with me using this link:
https://calendly.com/loveandsciencefertility/discovery-call
Also, be sure to check out our website: loveandsciencefertility.com
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my loves, and welcome back to the Love and Science podcast. Today, we're going to be talking about a controversial topic, which is how I believe there's actually no fertility tests.
People come to my office all the time and they say, "Dr. Bove, please test me for infertility." And what, you know, maybe people are even forward thinking like, "What can I do to test my fertility now because I know I'm going to go to medical school and residency and all the things." You know, it's really interesting, you know, and I say this a little bit in tongue and cheek, but it's kind of true if you think about it. There are actually no fertility tests. I am a fertility specialist with no fertility tests. There are tests that we can get to look at egg reserve, but we all know those do not tell us if somebody's fertile or not. The AMH specifically, people say, "Oh my gosh, my AMH is low. My life is over. I won't be able to conceive," or, "I won't be able to have a big family." We don't have any data to show that that's true. So, you know, that actually is not a fertility test, even though people all the time confuse it. It's not even a screening test. There is a study that showed that people with abnormal AMH went on to have the same fertility outcomes as other people who did not have a low AMH. So, you know, I like to dispel those myths because I think it's really important. Even the semen analysis, you know, what is the semen analysis looking at? It's looking at the confidence intervals, right? It's looking at men from several continents who conceived without assistance over the last year, and 95% of those men met the minimum criteria that the WHO, you know, said. And so, when somebody says, "Oh, I'm going to check a semen analysis," I can review the parameters and I can sort of say, "Okay, let's look at the movement. Let's look at the shape. Let's look at the concentration. Let's look at the total modal count." But at the end of the day, that's not really a fertility test. Even a man who has a normal semen analysis may, those sperm may not functionally work, right? They probably do, but we don't know. So, I say even a screening semen analysis, although I'm always happy when I see it comes back normal, that does not tell me that a man is fertile. I want to make that clear.
There's also even the anatomy tests, right? Like the histrosalpengogram and the sonohistogram, those tests, if that's normal, fantastic. That can tell me that the channels are open and that the anatomy is there, but it also doesn't tell me, functionally speaking, are those tubes functionally working? Are they helping the sperm get to the egg on the way up? Are they helping that embryo? If there's an embryo created, are they helping that get down? Because we actually know now that the fallopian tubes play an active role in that transport. Just because a uterine cavity is normal does not mean that that uterine lining is receptive or a good environment for an embryo. And so, all these tests are useful to try and get a picture of what might be going on, but they are not by any means, in quotes, "fertility tests." And so, when people see me and they say, "Am I infertile?" I can say, "Well, if you're under the age of 35 and you've been trying for 12 months, or if you're over the age of 35 and you've been trying for six months, the ASRM defines that as infertility." And so, it's more of a historical, right? Like you tell me what you've been experiencing and I can tell you if you have infertility. But oftentimes, people also see me, like I said, maybe during medical school or maybe during residency, and they have an interest in having children in the future and they want to know if they're fertile, we can even freeze eggs.
Like I cannot tell somebody if they are fertile or not. The only way to know is to do treatments, see if they work. And when somebody has a baby at the end of the day and walks home from the hospital, they're, well, if it doesn't happen, then we have a lot of question marks. So, we are always looking for better ways to assess fertility. I think now that we're looking at personalized medicine and genetics and all sorts of different predictors, I think we're getting closer. I do long for the day that I could tell somebody maybe at their med school entrance, "This is what the landscape looks for you." But at least in 2025, we don't have those tools yet.
And so, I love helping people understand their bodies and what the current tests show.
And I also love helping people with their fertility, which is not just based on testing, but it's based on the whole picture of values and goals and dreams and family size and all those things. And so, it's so much broader than we're taught. And I think taking a holistic approach can be so useful. So, with that said, I think sometimes people also ask me about my personal story just because clearly I'm passionate about this work and I'm very, very motivated to help as many people as I can. And so, let's back up. I was a competitive runner back in the day.
I was the state champion. I was very, very motivated to do well in that realm. But then, went to college and realized that to run cross country in college, it would mean 80 miles a week of running. And at some point I realized I had an eating disorder. And so, that sort of morphed into me just running marathons for fun. So, when I then was in medical school and saw somebody about my lack of periods, the fertility specialist actually told me, "You are infertile and you are going to need fertility treatments if you even want to think about having children." Now, that was like a generation ago. I'm now in my 40s. I think back to that conversation and say, like, "Wow, that particular doctor could have used a lot more training in delivering sensitive information to me, a young medical student who obviously did want children in my future and was totally freaked out by this news. I did not know what any of the potential treatment options were. I didn't know that not having periods was not good for my bones." There was so much that really was left to be desired in that conversation, which I think also motivates me to be as present and complete as possible during my encounters, because I know exactly how that felt.
So, there I was, a third year medical student, basically being told I was infertile. And at that point, I'd wanted to go into OBGYN and maybe an infertility fellowship. And I knew that the road was going to be long ahead of me. So, what do we do in these situations? Well, in my situation, I chose a partner on the early side, because I think I was in my mind, like, "Well, I need to sort this out. I don't want to have infertility if that's the cards that's been dealt with me. So, let's move forward." And so, that was part of it, was that I chose a partner and married a partner on the earlier side who, in retrospect, know better, do better. I do not think that was the right person for me. But again, I think that this whole conversation of, like, you are infertile, this is going to be a long road for you. I really do think that informed that choice, which again, I take full responsibility for that choice, but it has led to a lot of pain and suffering. So, I like to make that clear. I think it's not always, people say, "Oh, it's deferred childbearing." I think sometimes it's the opposite, where people find themselves in less than ideal relationships because of this fear. And I think that's kind of two sides of the same point.
So, fast forward to miscarriages and training and all sorts of terrible things and unexpected divorce.
And then what does any 34-year-old do who's a fertility specialist who is getting divorced?
Well, they freeze their eggs. So, I did freeze my eggs and my divorce. It was grateful that I had that resource available to me. And I fully understand that that's very different than doing the egg retrieval cycle in the context of infertility. However, it did very much give me an appreciation for just the incredible stress and the uncertainty. And even just like, are these eggs going to turn into anything right at the end of the day? This is what the charts show, but what does this mean? So, I think that at various touch points, this whole thread of my personal story has been very intertwined with the mission that I have, which is helping so many people with their fertility journeys to have children when they want them, not to have children when they don't have them, and to also help people have meaningful lives. And so, it's not just like one or the other, but it's how can we build this dream family, this dream life, alongside a meaningful career?
And how can we let fertility discussions not steal everything? So, I became a new attending, and you're kind of taught in medicine that you can help everybody. And what I really noticed in the course of my conversations is that I thought I was doing a good job. I thought I was explaining people's situations clearly. I thought I was going through the data, especially for some of my more educated patients who really wanted that data. They wanted PubMed. I was doing it all, and I'm such an empath, right? I was sitting there across from my patients, just with this sinking feeling in my stomach. I don't think I'm helping them. My mouth is moving. I'm saying things that I think should be useful to them, but the body language back is one of fear, anxiety, analysis paralysis, being shut down, unable to decide what to do next. And I could just tell that so many of my brilliant, wonderful patients were not absorbing anything that I was saying, right? And then I'd say, "Okay, let's meet again, and let's talk about your diagnosis and treatment options," et cetera.
And nothing that I was doing in my doctor role was making a difference, which was, of course, incredibly frustrating. People weren't getting better, many of them, and I felt like I wasn't doing my job. It was kind of like a moral injury of sorts. And around that time, I was also getting into coaching for my own personal reasons. Like I said, I had a divorce, right? So I started to do relationship coaching, et cetera, and I started to make the connection. I think the coaching tools are what my patients actually need. So based on intuition, I signed up for the best coaching school I could find. I did a six month certification course with oral exams and written exams, not quite as bad as the OBGYN and RAI oral and written exams, but still kind of got the adrenaline up. But it was fun. I met so many amazing people. I started to think in different ways.
And I realized I started experimenting with my patients kind of in the clinic, like, "Okay, somebody's done three IVF cycles. Let's start to have the conversation about what does motherhood mean? And do we think about donor-ag IVF? Do we keep doing autologous IVF?" Those sorts of questions. And it was amazing. Like all of a sudden, my patients started to feel seen and heard and empowered and really started to make truly empowered choices for them, choices in alignment with their values and in really making empowered choices and decisions.
And interestingly, the treatments were working better. It was almost like helping people get back into their bodies, help people trust the process, trust me as a physician, really feel confident in the plan that this was now taking shape as something that was actually improving people's, not just their ability to stay with the process, but the treatments were actually working.
And so that's when really when I decided to create Love and Science, which is this amazing, amazing universe where we support women, we meet them where they're at, we listen, we hold the hand, we use the science, we use the emotional support tools. We even have a community where we help people navigate all the difficult things. We celebrate the wins, we hold space for the hard things, but it's really so present in what we're doing and the transformations continue.
I am just amazed that all the time people are messaging me about the children who have been born through Love and Science. I'm going to interview some of them coming up. I'm very excited about that, but I just wanted to share how much this works and how I almost arrived at it by accident because nothing else was working, but I really do believe this is a secret sauce.
And so what I would say is I have learned that many people are not as far off as they think they are.
When I meet people, either for a consult call or my coaching practice or as a new patient in my fertility office, people often think that they're a zebra or that they're like the one person that all these weird, bad, random things have happened to them and that nobody else is in the situation and that it's probably never going to work for them. I mean, that's really the assumption is like, I'm on this journey, but all this badness has happened and like, how can this possibly work for me? And what I've learned is that from that state, it's a very shut down withdrawn state. So people often feel hopeless or powerless or despair or sad or frustrated or angry.
And all those feelings make sense. But what I usually come back to is like, okay, tell me your story and let me find reasons for authentic hope because people are usually not as far off as they think. There's usually some very strong reasons, compelling reasons to keep going with treatments in the face of even some bad news or unsuccessful treatment cycles as of yet. And so sometimes it's as simple as saying, like, let me listen to your story, huh? That sounds a lot like, you know, polycystic ovarian syndrome. Maybe you don't need IVF. Maybe you haven't tried letrozole, maybe less is more, you know, and sort of taking a sort of less invasive approach.
Similarly with unexplained infertility, I feel like there's this sort of rush to, you know, bank embryos and do IVF and do all of this when sometimes that's actually not what people need. And we do know that, you know, IVF tends to be more stressful than less invasive treatments. Not to, not to say the others aren't because they're still stressful. They can be very stressful, but really to say that every person needs a tailored approach. And I think there's this scarcity mindset that drives people into thinking they need, they need IVF, they need to bank embryos, they need kind of the most involved treatment and that's not always the case. And so I think, you know, listening to each person's story is important and really listening to what the pain points are. And the other thing that I've noticed is that the pain points are pretty universal, right? I think the isolation, the overwhelm, the fear that it's not going to work, how this changes relationships, relationships with ourselves, relationships with partners, you know, family members, holidays, all those things. There's so many very, very similar elements to each person's story. And so on my mission to help as many people as possible, and in the face of not even having any true fertility, infertility tests to tell people if they're infertile or not, I have created a resource to help people thrive, truly thrive through the infertility journey. And, you know, I will share more later, so stay tuned. I'm super excited, but there is going to be a wait list because it's coming out soon. And this resource really has the building blocks of what I've learned after over a decade of doing fertility treatment specifically, on how to help people navigate the journey in the most successful way possible. So people contact me all the time. They're like, listen, or, you know, it's not working, or my sisters had this many cycles and hasn't connected yet, or maybe there is a loss in there, but nothing else. And, you know, I think that what we need to do is we need to find alignment.
We need to align the love and the science. We need to give people the building blocks to make the most empowered choices, to regulate their nervous systems, to have the authentic voice to build the boundaries that they need. And, you know, eventually to bridge people to success. So I have this ready to go. We are just doing a little tinkering. I could not be more excited about it.
And like I said, I've always been obsessed with this notion of thriving instead of surviving. And I think so many people are truly in survival mode, especially if you're working as a busy professional, maybe even as a physician. What I'd love to do is to turn that survival into thriving, to make the fertility journey just one piece of the pie of your life, to bring back the joy, to ditch the overwhelm, maybe even to bring in some community, right? But thriving is truly possible. And I have seen how people can do this. They can take power in their own lives and really have a successful outcome. And so stay tuned. There is more coming. I really can't wait to help you if you're listening and struggling and your sister, your friends, you know, I'm on a mission to truly heal the world.
I know it's lofty, but it's there. And I've seen it. I have the tools and I can't wait to share them with you. Okay. Until the next time I love. Bye.
