Plan Ahead, the first test of its kind to test and predict a woman's "ovarian reserve," will be available in fertility clinics in eleven states in the next few weeks. Marketed by Repromedix, it will be available for $350 to women who want a higher-tech insight into family planning than has previously been available.
How does this thing work anyway?
Plan Ahead's calculations are based on tracking three hormonal tests:
* inhibin B, a protein derived from egg follicles
* anti-mullerian hormone, generated by the cells that surround eggs that have not yet matured
* follicle stimulating hormone, which prompts development of the eggs
These hormone levels are combined with the woman's age and estrogen levels to create a formula for her fertility. Or at least conceive a score for how many eggs are viable for reproduction.
Do they really count the eggs?
The hormonal tests that Plan Ahead depends upon to derive this score aren't new to the market, and some experts are concerned about the use and analysis of the anti-mullerian hormone since the Food and Drug Administration has not yet approved it for commercial distribution. Adding fuel to this fertility testing fire is the lack of published data by marketing company Repromedix. Although Repromedix conducted a study of 200 women's ovarian reserves, the results have not yet been published in a peer-reviewed journal.
Some doctors say the test should be clinically established before the idea -- or Plan Ahead itself -- is sold to women. Although clinical data and FDA clearance isn't being made available by Repromedix at this point, the company is making a very important point about what the test can't do: It can't predict whether or not a woman is fertile or how quickly she will get pregnant. It also cannot determine the rate of deterioration of the viable eggs she does have.
Simply put, it all comes down to the count. All the math and blood tests and money and technology tells a woman one thing: If she's at risk of having a low supply of "good eggs."
Why is this count so controversial?
At Northwestern University's Feinberg School of Medicine, the chief of reproductive endocrinology and infertility, Dr. Ralph Krazer told the Chicago Tribune that he thinks Plan Ahead's being offered to women prematurely "[g]iven the state of the science."
In New York, Dr. Zev Rosenwaks took his concerns a step further. As the director of the Center for Reproductive Medicine and Infertility at New York Weill Cornell Medical Center, he questioned Plan Ahead's value for patients worrying that results could generate false reassurance or panic among women who are tested.
While the science here is fascinating -- just think, a mathematical formula that is essentially a peek into the amazing and previously far more mysterious underworld of our ovaries -- as a woman, a mother, a person who wants to parent again in the future, I think Plan Ahead carries as many (if not more) anxieties than those other pregnancy-related tests.
Do we need to stress over another plus or minus sign?
I can't imagine a woman or couple who haven't been overwhelmed by pounding hearts while waiting for a plus or minus sign to appear on a pregnancy test. And if you've been through an amnio, age-related risk assesments, ultrasound and genetic "abnormality" tests, you're familiar with the worry they produce over issues you never considered when you chose to become a parent. While I've been fortunate to be more fertile than I expected that one night after several pitchers of microbrews and mood lighting, I've known too many women who've experienced the emotional roller coaster of infertility drugs and treatments, hormones and panic in an effort to become pregnant. Sure, the science is incredible and has aided, inspired, guided and gifted many people with pregnancies, but it doesn't mean that it doesn't come free or even cheap.
The cost here, I am concerned, is the opportunity for more anxiety to creep into a woman's biology. While Plan Ahead is geared, the manufacturer says, toward women in their mid-to-late 30s who have already experienced difficulty conceiving and want to test their ovum and themselves to see if they should pursue in vitro treatment, I imagine many more women in that will have their blood drawn for the cause.
Oh yeah. There are plenty of questions. A lifetime of 'em for a lifetime of ovum.
A girl child is born with a lifetime supply of eggs and once she starts menstruating, the eggs are released, with a sharp decline as she moves through her 30s. This basic biology is not new to us, but the cultural move to later motherhood is relatively recent. So how does a test that measures that egg supply factor in?
Will women make different maternal choices if they know they're lacking lots of high-quality eggs?
Will the question of how many "good eggs" a woman has follow whether she's got a clean bill of health, is STD-free and even wants children at all?
Will women who've chosen to put a college, a career, travel, themselves first in their 20s suddenly feel the necessity to put that all aside if there's a chance their eggs may not outlast their other ambitions?
As family planning takes this turn, is the science formulating the potential for anxiety more tests could produce for people who want to become parents, if not now then maybe, possibly one day on down the road?
While we're busy counting "good eggs," are we also accounting for the emotional responses to Plan Ahead just being available?
What's your response to Plan Ahead?: Would you take this fertility test if it was available in your city?
Have more to ask or say about in vitro and the pursuit of pregnancy? Peek into The Infertility Diaries over on parenting and add your experience, questions and comments to the conversation.
[photo credit: istockphoto.com]
