Tuesday, January 01, 2013

The one blood test that every young woman should do

Many people go in for annual physical checkups routinely . Doctors do a panel of blood tests , in order to judge how healthy they are .  One of the tests which is routinely performed is a cholesterol level , in order to check for the risk of heart disease . In my opinion, this is quite a pointless test for young women, because the risk of their having heart disease is very low in the first place. This is why the chances of finding an abnormality are very slim. However, in spite of this , the test is routinely performed every year for all young women going for an annual medical checkup.

One size does not fit all ; and rather than use a mindless protocol for testing everyone, it would make much more sense to customize the testing, depending upon the age of the patient.

A far more valuable test for young women would be their blood AMH level – a test which assesses their ovarian reserve – the quantity and quality of eggs they have left. We know that ovarian reserve declines irreversibly with age; and this test is especially valuable for women who want to postpone childbearing.. This is relatively new test which is become widely available recently , and which provides a good index for ovarian function.

As society evolves , women are now choosing to postpone having babies for multiple reasons. Firstly, they want to pursue a career ; and secondly, successful young women want to wait until they find Mr Right, rather than accept the first guy who catches their eye. While it's great that biology no longer dictates destiny , the fact remains that young women are now paying the price for delaying childbearing. When they are 35 and well settled , and are finally ready to start a family, they find much to their dismay that their biological clock has ticked on ; their ovaries have grown old ; and they can't have a baby without medical assistance. This comes as a rude shock to many of these women , especially since they are usually physically healthy ; have regular cycles; and have no symptoms whatsoever of declining ovarian function. Many regret the fact that they put off child bearing ; and a lot of them wish they had been told that their ovarian reserve was going to get compromised as they got older, so that they could have done something about it when they were younger.

This is why I feel that women who are more than 25 and who have decided that they do not want to start a family in  the near future should start getting their AMH blood test done on an annual basis. This is a simple blood test , which is not very expensive. It provides a marker for ovarian reserve and will give the woman a rough picture of how good her egg quality is - and therefore how much time she has before she needs to start getting  serious about having a baby. Serial tests are helpful because they provide a baseline with which it's possible to compare levels, so that we can obtain information tailored to the individual patient.

Does this advice have a downside? Am I biased because I'm an IVF specialist , and see a lot of infertile women? The answer is yes on both counts - but when I see 35-year-old woman who are in tears because they didn't understand the basic biology of ovarian aging , I feel women need to take a more proactive approach in managing the age-related decline in their fertility. The test can be offered to them – and whether or not they do it should be left upto them.

We don't treat numbers - and there are likely to be false positives , which  may create a lot of “ worried well “ women. After all , interpreting a low AMH level in an infertile woman is completely different from interpreting it in a woman with unproven fertility. Thus it is much more likely that a woman with unproven infertility with a low AMH level will be able to have a baby without any medical assistance. However, acquiring this data ( perhaps on a research basis ) can help provide us with useful information about the natural history of decline of AMH levels and ovarian reserve in young women . We could use this information more intelligently for counseling young women in the future. This is likely to become an increasing problem as time goes by, because social infertility ( as a result of delayed childbearing) will become increasingly common as the world becomes more developed and women have more choices and freedom.

Thus , a 25-year-old woman who has a normal AMH level she can make a well-informed decision that she has enough time to have a baby , so that she can both have her cake and eat it too. However, if she finds she has a low AMH level, she may decide either to prioritize having a baby; or freezing her eggs when their quality is good , so that she can then use these frozen eggs if she needs them in the future.

Knowledge is power , and for women who can afford it,  I feel this is a useful test young women should ask their family physician to do for them on an annual basis, so they can make well-informed decisions about balancing their childbearing and their career.

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