It may not have seemed like it at the time, but an “awkward” GP appointment that left Sydney PR professional Maz Coote in tears and fearful of not being able to have children was the inspiration for the development of Australia's first home fertility test.
At 31, Ms Coote, who was single and had a family history of unexplained infertility, underwent an AMH test, which measures the amount of anti-Müllerian hormone in the blood and can give a rough indication of a woman's egg reserve and her remaining fertile years.
The results showed that the career-oriented woman from Sydney was “within the range” for her age and that she 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 take a second AMH test, which yielded a very different result.
“I was told, 'Your egg count test is back, it's low, and that means it's going to be a big challenge for you to start a family,'” Ms Coote said.
“I know now what that actually means, but that's what I believed in that moment and it was so heartbreaking and completely unnecessary.”
The couple later saw a fertility specialist and underwent three rounds of egg freezing. In 2022, their daughter Charlotte, now two, was conceived naturally.
Her fertility journey has now led her to launch WHEN Fertility, a home AMH test in partnership with medical device company Trajan Scientific and Medical, offering women an alternative to testing via a GP referral.
The microsampling device allows the user to perform the test using a simple fingerstick blood sample, then NATA-accredited gold standard results are delivered to the patient and contextualized in a report written by fertility experts.
Women with a low egg reserve will also receive a teleeducation appointment with a fertility nurse to discuss their results and provide them with further information.
Mr Barnes said the free consultation enables customers to understand what the AMH test shows and, more importantly, what it does not.
“The second GP really misled us because we know there is no test that tells you whether you can get pregnant or not, but having eggs is a prerequisite for getting pregnant,” he said.
“What Maz's AMH test actually told us was that she would probably have less time to start a family, whether she had one, two or three children.”
With his company, he also wanted to acknowledge the fears and stresses women face and help them combat them when they receive a less than optimal result.
“We do not diagnose or offer solutions or treatments,” he said.
“We want to make sure that if we find something that warrants investigation, the person goes back into the existing health system (via a GP or fertility specialist) so they can go through it appropriately with the support of their regular doctor.”
Fertility specialist, obstetrician and gynecologist William Ledger said the “holy grail” of fertility tests is a test that measures not only egg reserve but also egg quality.
The latter, however, can only be achieved by creating an embryo using IVF.
“This is a pretty radical method of screening. What we would really like to have is an egg quality check and an AMH test to quantify it, but to be honest I don't think this is anywhere near that,” said Professor Ledger, who is also co-chief adviser to WHEN Fertility.
“Oocyte quality depends more or less on age. It is unusual for a woman in her twenties to have a problem with egg quality, even though her egg reserve may be small.
“However, if your egg reserve is small, you will run out of time faster than someone with a large egg reserve, so you may not want to wait until you are 40 or 41 to try to have a child.”
He describes an AMH test as a tool that can be helpful for women in their late 20s or early 30s who may want to have children later.
“If you are in your early 30s and are planning to wait a little longer, it is good to know how many eggs you have because if they are too low you may need to change your plans,” said Professor Ledger.
Driven by social media and increased awareness, Professor Ledger said women in their early to mid-twenties were taking the test, although it was “probably too early” unless there was a family history of early menopause, they had suffered severe endometriosis requiring surgery, or they had received chemotherapy as a child.
“People in this group are at increased risk of losing their egg reserve, so it might be useful to get screened as early as their mid-20s,” said Professor Ledger.
Ms Coote wants to ensure that the test does not spread panic or raise false hopes, as she knows the harmful effects of both tests.
“The first time I had an egg count test done, I didn't understand what it meant, put it in my bag and walked away,” she said.
“Two years later, I ended up in a specialist’s office, desperate, crying and thinking about the worst case scenario, which is also the opposite of good healthcare.
“This educational component is so important and we want people to refer others back to the health care system while also making sure that the person who goes back to their GP’s office is informed and able to talk about next steps in an informed way.”