It may not have seemed like it at the time, but an “unexpected” GP appointment that left Sydney PR guru Maz Coote in tears and fearing she wouldn’t be able to have children became the inspiration for Australia’s first at-home fertility test.
At age 31, prompted by a family history of unexplained infertility, Ms. Cote had an AMH test, which measures the amount of anti-Mullerian hormone in the blood and can give a rough indication of a woman’s egg reserve and her remaining years of fertility.
The results revealed that the career-focused Sydney woman was “within range” for her age and took the doctor’s advice “at face value”.
Two years later, while dating her now-husband and WHEN Fertility co-founder, Brett Barnes, she decided to be “proactive” and get a second AMH test, which revealed a completely different result.
“I was told, ‘Your egg count test came back, and it’s low, which means it’s going to be really hard for you to have a family,’” Ms. Cote said.
“Now I know what that actually means, but that’s what I believed in that moment, and there was a lot of sadness in that and it wasn’t necessary at all.”
While the couple later found a fertility specialist and underwent three rounds of egg freezing, they gave birth to their two-year-old daughter, Charlotte, naturally in 2022.
Their fertility journey has now led them to start WHEN Fertility, an at-home AMH test in partnership with medical technology company Trajan Scientific and Medical, giving women an alternative to seeking testing through a GP referral.
The microsampling device means that the user can perform the test using a simple blood sample from their finger before the NATA-certified results are transmitted to the patient and put into context through a written report by fertility experts.
Women with a low egg reserve are also offered a telemedicine appointment with a fertility nurse to discuss their results and provide them with further information.
Mr Barnes said the free consultation meant clients could understand what the AMH test indicated and, more importantly, what it did not indicate.
“The second GP gave us really bad advice because we know there is no test that will tell you whether you can get pregnant or not, but having eggs is a prerequisite for pregnancy,” he said.
“What Maz’s AMH test really told us was that she was likely to have a shorter reproductive path to having a family, whether through one, two or three children.”
He also wanted their project to acknowledge women and help them combat the anxiety and distress that can occur when receiving a less than ideal result.
“We don’t diagnose, we don’t offer solutions or treatments,” he said.
“We want to ensure that when we discover something worth investigating, we make sure that person is back in the existing healthcare system (through a GP or fertility specialist) so that they can proceed appropriately with the support of their usual practitioner.”
The “holy grail” fertility test would be one that measures not just egg reserve but egg quality, said fertility specialist and obstetrician-gynecologist William Ledger.
However, the latter can only be determined by creating an embryo through artificial insemination.
“It’s a radical way of checking. The thing we would really like to have is an egg quality test alongside the AMH quantity test, but I don’t think that’s anywhere near the truth, to be honest with you,” said Professor Ledger, who is also co-medical advisor to WHEN Fertility.
“Egg quality is largely age-dependent. It is unusual to see a woman in her 20s having problems with egg quality even though her egg reserve may be small.
“But if your egg reserve is small, you’re going to run out of time faster than someone with a large egg reserve, so you probably won’t want to wait until you’re 40 or 41 to try to have a baby.”
He describes the AMH test as a tool that could be useful for women in their late 20s or early 30s who may want to have children when they are older.
“If you’re in your early 30s and planning to wait a little longer, it’s a good idea to know your egg reserve because if your reserve is low, you may need to change your plans,” Professor Ledger said.
Professor Ledger said women in their early to mid-20s were getting tested thanks to social media and increased awareness, although it was “probably too early” unless there was a family history of early menopause, or they had severe endometriosis that required surgery or had chemotherapy as children.
“People in this group are at increased risk of losing their egg reserve, so it may be a good idea to have screening in your mid-20s,” said Professor Ledger.
For Ms. Cote, she wants to make sure the test doesn’t cause panic or offer false hope — knowing the harmful effects of both.
“The first time I took the egg count test, I didn’t understand what it meant, so I put it in my pocket and left,” she said.
“Then two years later I went to a specialist’s office, in a state of shock, crying and thinking of the worst-case scenario, which is also the opposite of good healthcare.
“The education element is so important, we want people to refer people back into the healthcare system while ensuring that the person who goes back to their GP’s office is informed about the next steps and able to talk about them in an informed way.”
