Knowledge Centre

Sex hormone-binding globulin (SHBG) is an important protein involved in the regulation of our sex hormones and in turn our ability to conceive. So what is a good, or ‘normal’ range for our SHBG levels? And how do we know when ours might be too high or too low? We’ve broken down all you need to know about SHBG levels, including what they mean, why they matter and what to do if you suspect yours might be out of range. Quick facts: What is SHBG? SHBG is an important protein that regulates the amount of testosterone and oestrogen available in the body by ‘binding’ to these hormones—which makes them inactive. This is because to bring about an effect in the body, hormones need to be unbound or free so they can enter cells and bring about their effect. The vast majority of testosterone and oestrogen in our bodies is bound to SHBG and other proteins. SHBG also controls the balance between testosterone and oestrogen, which is also important for the healthy functioning of our menstrual cycles. Why do SHBG levels matter? Because SHBG levels regulate the amount of testosterone and oestrogen available to be used by the body, if our SHBG levels are too high or low, this will have a knock on effect on our levels of both of these sex hormones.  If our SHBG levels are higher, we’ll have less free testosterone or oestrogen available. If our SHBG levels are lower, we’ll have more testosterone and oestrogen available.  Both of these sex hormones have important roles in the regulation of the menstrual cycle, ovulation, libido, energy levels and our mental health. Low SHBG When our SHBG levels are low, our levels of free unbound testosterone and oestrogen can become high. Let’s take a look at some of the symptoms, causes and what can be done to help. Symptoms of low SHBG These symptoms can often mirror those of excess testosterone including: Or excess oestrogen: Causes of low SHBG There is no single cause for abnormal SHBG levels, although increases in insulin, prolactin and androgens have been found to block SHBG production which could be a factor for those with low SHBG levels.  Low SHBG can also be caused by a number of lifestyle factors, certain medical conditions and genetics. Here are several conditions, as well as other factors, that low SHBG has been found to be associated with: How to raise low SHBG If you have low SHBG there are a number of lifestyle changes that may help to increase your levels. These include: High SHBG  On the flip side, when our SHBG levels are too high, our unbound testosterone and oestrogen can become abnormally low. Here are some symptoms, causes and what can be done to reduce high levels of SHBG. Symptoms of high SHBG These symptoms can often mirror those of low testosterone including:  Or low oestrogen: Causes of high SHBG Again, there is no single cause for abnormal SHBG levels, although as we mentioned previously, increases in oestrogen and thyroxine (T4) have been found to increase SHBG production, which could be a factor for those with high SHBG levels. There are also a number of conditions associated with high SHBG which include: How to lower SHBG Dietary changes are the most effective way to lower SHBG levels. Decreasing alcohol consumption, gaining weight if you have a low BHM and following a high-fat, low fibre diet may help decrease levels of SHBG. One study involving 48 premenopausal women showed that maintaining a high-fat, low diet decreased SHBG. However, more clinical studies are required to confirm this association. If the levels are elevated due to contraception use, this will usually return to normal levels once you stop using that contraception. Other possible causes such as type 1 diabetes and an overactive thyroid will need further investigation and will require medication specific to these conditions. SHBG tests Ultimately, if you suspect you may have abnormal levels of SHBG, the only way to definitively get a diagnosis is via a blood test. Because symptoms of abnormal SHBG levels can mimic those of high or low oestrogen and testosterone, your SHBG levels should be tested in tandem these hormones. You can test all of these hormones and more, with a Hertility at-home Hormone and Fertility Test. Resources:

Follicle-stimulating hormone (FSH) is really important for our reproductive health. In this article, find out how to know what normal FSH levels look like, what the symptoms of high and low FSH levels are and how to balance your FSH levels. Quick facts: What is FSH?  FSH stands for Follicle-Stimulating Hormone and is one of the main hormones involved in the regulation of your menstrual cycle and ovulation—making it an important hormone not only for your health but your fertility too. FSH is what’s known as a gonadotropin hormone. It’s released by the pituitary gland in the brain and then acts on the ovaries.There is only one other gonadotropin hormone in the body—luteinising hormone (LH). True partners in crime, there’s no FSH without LH, and they act in tandem to bring about changes which essentially regulate ovulation. Normal FSH levels in women Because our FSH levels are intricately linked to our ovarian reserve, what’s considered a ‘normal’ FSH level changes as we age. This is because our ovarian reserve declines as we age which makes our FSH levels increase.  Gonadotropic hormones are hormones released from the pituitary gland in the brain and released into the bloodstream. Gonadotropins then go on to act on the ovaries. There are two types of gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).  The pituitary gland produces FSH which acts on the ovaries to stimulate the growth of follicles containing your eggs. As well as growing the ovarian follicles, FSH stimulates the granulosa cells that surround the follicle to produce oestrogen from testosterone, an essential hormone for regulating the menstrual cycle (1). You can read more about oestrogen here.  What does FSH do? FSH has two primary functions:  Follicular development FSH does pretty much exactly what it says on the tin—it stimulates the growth of follicles which contain your eggs.  You’re born with ‘immature’ eggs. So each month, a number of them start maturing before one is released during ovulation. Your eggs are housed in tiny follicles inside your ovaries, and it’s these follicles that FSH signals to prepare your eggs for ovulation (2). Oestrogen production FSH also stimulates the cells that surround the follicles to make an enzyme called aromatse, which converts testosterone into oestrogen, another essential hormone for regulating the menstrual cycle and reproductive health (1). The relationship between FSH and LH When your eggs are fully mature and ready to be released during ovulation, LH steps in. A surge of LH is released, again by the pituitary gland in the brain, causing the most mature follicle to rupture—releasing an egg into your Fallopian tube. This is ovulation.  Despite FSH causing numerous follicles, and therefore numerous eggs, to mature each cycle, only one follicle will release an egg each month. This is because FSH and LH are both involved in negative feedback loops, controlled by E2. But what does negative feedback loop mean? Increasing FSH levels in the early stages of your menstrual cycle leads to more oestrogen being made, but this ha, a negative feedback effect on FSH levels. In other words, when you have lots of oestrogen, it feeds back to the brain that it needs to stop making more FSH. Similarly, with LH, oestrogen levels keep increasing through the cycle and once they reach a peak around the middle of the cycle, it causes a sudden surge in LH that promotes ovulation. After ovulation, the empty follicle that once contained the egg makes another hormone, progesterone, to support conception, implantation and the early stages of pregnancy. High levels of progesterone tell the brain to stop making more FSH. Now if a pregnancy doesn’t happen, there is a drop in oestrogen and progesterone which triggers your period. It also tells the brain it needs to start making FSH to start the whole process all over again in the next menstrual cycle (5). High FSH levels Okay, but what happens when we have high FSH levels? Let’s take a look at the causes and symptoms of high FSH levels. What causes high FSH levels? The most common reason for high FSH levels is a low ovarian reserve (egg count), or ovaries that aren’t functioning properly. When we have a low ovarian reserve, this essentially means we have a smaller number of immature follicles available in our ovaries and our bodies will produce less oestrogen.  Because oestrogen controls how much FSH we produce (remember that negative feedback loop), when we have less oestrogen, our FSH levels may go up.  High FSH levels can therefore indicate that our ovaries aren’t functioning properly, be an indicator of low ovarian reserve or an indicator of the onset of menopause. Other reasons for high FSH levels can be ovarian cancer (although this is very rare) (9) and Premature Ovarian Insufficiency (POI) which is the loss of ovarian function before the age of 40 (6,7). In some cases, dietary and lifestyle factors can moderately raise FSH levels. Symptoms of high FSH levels Symptoms of high FSH levels usually mimic symptoms of menopause and are related to low oestradiol levels —which is why it’s so important to test a range of your reproductive hormones to get to the bottom of symptoms. Symptoms can include: How to lower FSH levels? It is important to understand that if high FSH levels have been caused by menopause or a low egg reserve, modifications to your diet or lifestyle will not be able to reverse this. However, there are some dietary lifestyle factors associated with a higher FSH, such as smoking and high alcohol consumption.  If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy (17). For advice on how to quit smoking, see the full list of NHS quit smoking services here. Nutrition can be a really powerful tool in balancing hormones and helping to alleviate symptoms. You can book a nutritional health consultation with one of our registered nutritionists via your health hub. […]

A common symptom of endometriosis is fertility issues. Up to 50% of people with endometriosis will struggle to conceive, with the causes still relatively unknown. Here take a deep dive into what you need to know about your fertility if you have diagnosed or suspected endometriosis. Quick facts: What is endometriosis? Endometriosis is a reproductive health condition where tissue similar to the lining of the womb grows in other places. This is called endometrial tissue. This tissue can grow in the ovaries and fallopian tubes and can cause painful symptoms.  It’s one of the most common reproductive health conditions. 1 in 10 women and those assigned female-at-birth (AFAB) will develop endometriosis, yet its definitive cause is still unknown.  As a long-term condition, endometriosis can significantly impact some people’s lives. One of the most common concerns is how does endometriosis affect fertility? Will endometriosis affect my fertility? In short, it might. Fertility problems are common in those with endometriosis, with 30-50% experiencing fertility problems (1). But having endometriosis does not automatically mean you will have fertility problems—every case is different. It will depend on the severity of your symptoms and any structural or hormonal issues you may have.  Is it possible to get pregnant with endometriosis? Yes, it’s possible to get pregnant with endometriosis. However, you may experience difficulty getting pregnant. Those with endometriosis have a lower chance of getting pregnant with each monthly cycle (2). This can result in it taking longer for people with endometriosis to conceive (3).  Infertility is also common in those with endometriosis, and in subfertile (failure to conceive after one year of trying) women the prevalence seems to be considerably higher, ranging from 20% to 50%, but it varies with time and age (1). How does endometriosis affect fertility? Again, not necessarily. But those with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other obstetric complications compared to those without (4). How does endometriosis affect fertility? Exactly why and how endometriosis affects fertility is still unknown. But here are the latest theories of possible links and causes.  Structural issues One of the ways endometriosis is likely to affect fertility is by distorting the position of reproductive organs. Growth of endometrial tissue and adhesions around the uterus and Fallopian tubes can cause this distortion. In turn, this may block mature eggs from reaching the uterus to be fertilised. The risk of blocked Fallopian tubes, in particular, increases in the more advanced stages of endometriosis.  Endometriomas The presence of cysts on your ovaries, called endometriomas, could also affect fertility and ovulation. Endometriomas can damage ovarian tissue and the precious ovarian follicles which house immature eggs.  Immune reaction Another theory is an immune reaction to endometrial tissue growing outside the uterus. This is because this tissue is recognised as ‘foreign’ to these parts of the body. The immune system responds by attacking it, causing inflammation. Inflammation leads to harmful toxins which may affect Fallopian tube function, sperm function and egg quality (5). Womb reciprocity There is also debate about whether endometriosis affects the receptivity of the womb to a fertilised egg. However, there is currently no conclusive evidence to prove this theory.  Painful sex Painful sex is one of the symptoms associated with endometriosis. Pain during or after intercourse can negatively impact your sex life and make the trying-to-conceive process difficult. Can treating endometriosis improve fertility? Various treatments for endometriosis that aim to improve fertility. The right ones for you will depend on the location and severity of your endometriosis and what your symptoms are.  One treatment that aims to improve fertility is laparoscopic surgery. This is surgery to remove the endometrial tissue deposits and adhesions. It aims to free the pelvic organs of any structural issues or blockages and reduce inflammation.  For people with endometrioma, laparoscopic ovarian cystectomy can remove the endometriosis-related cysts on the ovaries (6). This has been shown to lower the recurrence rate of both cysts and pain symptoms.  However, there are risks associated with any surgery. For example, ovarian cystectomy can also negatively affect ovarian reserve by the removal of healthy tissue.  It’s important to discuss the potential for surgery with a specialist. And to explore the individual risks. How can I improve my chances of conceiving with endometriosis? If you’re trying to conceive with endometriosis, there are options to improve your chances. These include expectant management and assisted reproductive techniques (ARTs).  Expectant management  This is for heterosexual people who are trying to conceive naturally and:  To improve your chances of conceiving with every menstrual cycle, it is recommended to have sex every 2-3 days so there is a good chance of catching your fertile window.   Assisted reproductive techniques (ARTs) ART options include ovarian stimulation (COS), intrauterine insemination (IUI), and in-vitro fertilisation (IVF).  Depending on your age, ART is recommended if: IUI is usually offered to couples with minimal or mild endometriosis if their partner has normal semen quality and is typically not offered to those with moderate/severe endometriosis, because of a probable effect on the Fallopian tubes. IVF can be offered to those with moderate or severe endometriosis. It can also help those with a very low egg reserve. IVF has been found to be less successful in people with endometriosis compared to those without endometriosis. However, lots of factors influence IVF success, like age, whether you’ve been pregnant before, if you’ve had treatment before body mass index, underlying health conditions, lifestyle and your partner’s sperm quality.  Resources:  

Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime. But what are fibroids, how do we look out for symptoms and what are the treatments if we’re diagnosed? Read on to find out.  Quick facts: What are fibroids? Uterine fibroids are benign or non-cancerous growths in and around the uterus, or womb. They are made up of fibrous muscle tissue and are extremely common. Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime (1). Your risk of developing a fibroid increases with age and if you: Where do fibroids grow? Fibroids can vary in size and you may have one or multiple fibroids. They can develop as singular fibroids or as clusters. There are three different types of fibroid, depending on where in the body they grow: Signs and symptoms of fibroids Not all people who develop fibroids experience symptoms. Most are actually asymptomatic and have no symptoms at all. Only approximately 1 in 3 people with fibroids will experience symptoms. The symptoms of fibroids can include: What causes fibroids?  Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. What we do know though, is they’re affected by oestrogen and progesterone—two hormones important for regulating the menstrual cycle. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (3). How are fibroids diagnosed? To diagnose fibroids you’ll need a pelvic ultrasound scan. Usually, your doctor will discuss any symptoms you’ve been experiencing with you first. Then they’ll carry out an abdominal examination to look for any areas of tenderness or masses in your abdomen, before referring you for a scan.  The ultrasound will look at your reproductive organs including your uterus, Fallopian tubes, ovaries and general pelvic area. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen). A scan is the only way to definitively diagnose fibroids and to determine their size and location. You may also be offered a blood test to screen for iron deficiency anaemia, which is a condition that can occur as a result of heavy bleeding.  Because lots of people with fibroids don’t experience symptoms, often fibroids are found coincidentally. This could be during an ultrasound for a pregnancy or another suspected condition. Black women have an increased risk of developing fibroids Black women are three times more likely to develop fibroids than white women. They’re also more likely to be diagnosed with fibroids at a younger age, have a longer duration of symptoms and have larger, more rapidly growing fibroids. Although the increased risk of fibroids in Black women is known, there’s been little research conducted to understand why this is. Some research suggests genetics, such as Vitamin D deficiency in Black women (4) could be a link. Other research has suggested certain environmental factors could be linked. These include exposure to chemical relaxers, used for afro-textured hair, which have been linked to a higher risk of developing fibroids (5). Will fibroids affect my fertility? Some fibroids can cause problems with fertility (6). This largely depends on their size and where they are located.  Fibroids can affect the structure of the uterus and its surrounding organs. Meaning they can prevent sperm from fertilising an egg or prevent an embryo from implanting. However, lots of people with fibroids do not have any difficulties getting pregnant. How are fibroids treated?  Treatment for fibroids depends on:  If you have fibroids that are not causing symptoms and aren’t likely to affect your fertility, then generally no treatment is required. But if you begin to experience any new symptoms, it is really important to go back to the doctor to have a check-up.  The treatment methods for fibroids can be broken down into non-surgical and surgical methods. Non-surgical methods If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid. This is a medication which breaks down blood clots in the womb. You may also be given anti-inflammatory medications, like ibuprofen or an oral medication called Ryeqo. The combined oral contraceptive pill and hormonal IUD can also be prescribed to help you have lighter, less painful periods.  As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone (GnRH) analogue. This is to try and shrink your fibroids and is also commonly prescribed before any surgical treatment.  GnRH analogues work by reducing your levels of oestrogen. Low levels of oestrogen can lead to several other long-term complications, so this method can only be used for a short period.If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is used to block the arteries which supply blood to the fibroids. If you have smaller fibroids, you may also be offered a procedure which removes the lining of the womb called Endometrial Ablation. Surgical methods There are various surgical techniques which can be used to treat fibroids. Surgery can be explored if medical treatments don’t work for you or aren’t suitable in the long term.  You may be offered one of the following surgical treatments for fibroids:  What type of procedure is most suitable for you depends on the location, size and number of your fibroids. Each varies in terms of invasiveness, risks and its potential effect on fertility. Some people’s fibroids may grow back after surgery, known as ‘recurrence’.  Suspect you may have fibroids? As the symptoms mentioned above are commonly experienced in various types of pelvic issues, they may be linked to other causes apart from fibroids.  If you’re suffering from painful periods or any of the above symptoms, it’s important to get your hormones tested, to rule out a hormonal cause. This, alongside a pelvic ultrasound scan, can help you get to the bottom of symptoms and get a recommended care plan based on your biology.  If you’ve been diagnosed with fibroids, you can also talk to our team of […]

On Wednesday, the 15th of February, we hosted our first community event to launch our Black Women’s Health Initiative. It was a privilege to have brought together so many people who were actively engaged in the topic.  The event provided us with such insightful information and has helped us not only hone our commitments to change but also acted as the first step in our journey as a company. We are still learning and growing as a young seed-stage start-up, but that doesn’t stop us from having big aspirations, and we hope to build on these year after year. We are so thankful to everyone who attended the event. We really appreciate the time, energy and support each person gave.  It was an incredibly proud moment to be able to share the findings from our recent research looking into the role that ethnicity played in access to fertility testing and reproductive healthcare. A roundtable discussion followed, moderated by Hertility’s CEO and founder Dr Helen O’Neill, where we heard from clinical gynaecology experts, community leaders, and patient advocates Dr Christine Ekechi, Dr Stephanie Kuku, Noni Martins and Sophia Ukor. In case you missed it, here’s a rundown of what was covered: The changes to Black women’s reproductive healthcare over the years All the panellists agreed that they are seeing a positive trend, with more conversations being had around women’s health in general, and increased awareness and advocacy from colleagues within the healthcare system and doctors for their patients. We heard about positive interactions with healthcare providers  or seeing positive changes in healthcare delivery in the last five years.  “I feel there is a change with the language, culture and even the way they listen to you. They listen and you feel understood. I felt seen, I did not feel alone. The language, the care and the attention is evident.” – Sophia Ufy Ukor, Founder & CEO of Violet Simon We heard from Dr Christine Ekechi that not only is there an increased awareness of conditions that are more prevalent in Black women, but they are more cognisant of their experiences.  We briefly touched on the current state of the healthcare system and what needs to be done to support healthcare professionals further to provide compassionate care. As the healthcare system becomes more stretched and there is continuous pressure to shorten GP appointments, there will be limitations on the capacity of doctors. It is no surprise that the average GP appointment in the UK lasts just 9.2 minutes, with an average of 2.5 health concerns being discussed (1), and there is not enough time to allow for a  comprehensive discussion about someone’s reproductive health or pregnancy history. Women whose first language is not English and/or who have had a negative experience with a healthcare practitioner are at more of a disadvantage.  “We all swear on the Hippocratic oath to do no harm, but if the system works such that the resources and the human capacity are lacking, there is a dearth of compassion. As a result, unfortunately, I think that, as with everything in life, some people are going to suffer more than others, and the human reflexes are that when you have no capacity, you are less likely to treat people the same” –  Dr Stephanie Kuku Advisor, Consultant and Health Technology Executive (MBCHB MRCOG MD) However, Dr Christine Ekechi also highlighted that the majority of UK-based doctors are willing to learn to improve the care of Black women and there is room for positive impact.  Looking to the future, we heard from both the event and post-event feedback about the importance of framing positive conversations around Black women’s reproductive health to stop the further victimisation of Black women and ethnic minority groups and to empower them so that we can help give women strength and power in healthcare situations, instead of reinforcing currently accepted narratives. The power of knowledge and tips on advocacy Throughout the discussion, a salient theme that shone through was the value and power of having the right information in a healthcare setting, especially when it comes to advocating for ourselves. Noni Martins emphasised the importance of going into GP appointments with symptom diaries and the knowledge about what is going on with your body, as no one knows your body better than you. Dr Christine Ekechi also highlighted that everyone deserves a right to a second opinion if they feel they do not understand or agree with the outcome of their appointment.   “One thing about doctors, particularly doctors now, is that we are cognisant about working in partnership with you…Of course, you’re not going to go into a consultation and understand everything about gynaecology, but you should leave with an understanding of what the concerns are and what the approach is going to be. For me the key is if you come away thinking I have no idea what they said, then you ask for a repeat explanation or ask for a second opinion” – Dr Christine Ekechi Consultant Obstetrician & Gynaecologist and Co-Chair, Race Equality Taskforce, Royal College of Obstetricians & Gynaecologists. We briefly spoke about the prevalence of myths in reproductive health, fertility and women’s health more generally. We know from the Women’s Health Strategy that many women get their information from the NHS website (2), so as Dr Christine Ekechi said, “it’s about going to the trusted sources and addressing those gaps by filling it in with the correct information”. “I think my biggest concern when we have these kinds of discussions is for people who don’t have that voice. I worry about the people who, in their homes and in their communities, cannot speak out about the fact that they have been trying to conceive and it is not working out. I’m always thinking about how we can get to those people, I don’t have the answers. I hope that by being someone who looks like them and talking about it, we can draw them out. Even if you are having a […]

Fertility testing is much more common than it used to be. But with the growth in the at-home fertility testing market, how do you know which one is best? In this article, we explain why Hertility is a cut above the other at-home tests available.   Quick facts: What at-home testing can tell you Whilst there is no way to 100% definitively determine how fertile you are, testing our hormones can give us key insights into the functioning of our reproductive health and ovarian reserve (egg count).   There are a whole range of different hormones that can work hard to regulate the menstrual cycle and ovulation. If just one becomes imbalanced, it can throw the whole system off.  At Hertility, we’ve spent years building the most accurate diagnostic tool in female health and our tests can give indicative diagnoses within just 10 days of testing.  We don’t believe in doing things in halves—so unlike a lot of other at-home tests on the market, we provide full end-to-end care. Here’s what to expect with each step of our test.  Online Health Assessment  Your test starts with an Online Health Assessment. It takes around 5 minutes to complete and is essentially everything you would cover in an initial private gynaecologist appointment before being referred for a hormone test.  Up to 60 questions cover your medical history, period and cycle, symptoms and individual biomarkers. Each question has been carefully selected to build a 360-degree view of your health and fertility.  Our proprietary algorithm will then determine your risk factors, using 835,000 data variables, for various conditions or hormone imbalances. You’ll then be recommended a personalised hormone panel for your test, based on the analysis of your Online Health Assessment results.  Some other at-home tests don’t include this crucial step and will simply test you for a generic hormone panel. Which hormones do Hertility test? Depending on the outcome of your recommended panel, your test could include the following hormones:  Some fertility tests will only look at E2, LH, FSH and testosterone. These are all very useful in determining how your menstrual cycle is working, but without looking at the full picture and the interplay between different hormones, you’ll only be able to get half the picture.  That’s why we take a comprehensive, whole-body approach when it comes to your hormones and fertility.  You’ll receive your at-home test kit with your personalised panel 3-5 days after you place your order. Our kits are easy-to-use with detailed instructions on each step with links to video instructions. Anti-Müllerian Hormone (AMH) A key part of any fertility test is measuring the levels of a hormone called Anti-Müllerian Hormone or AMH. Produced by the cells in your developing eggs, AMH can be used as a really powerful indicator of how many eggs you have left.  Studies comparing the levels of AMH with the number of eggs seen on a pelvic ultrasound scan (when done on the same day of your cycle) have shown AMH to be a reliable way to gauge egg count.  After peaking in your 20’s, AMH levels decline, dropping more rapidly after your mid-30s. However, this rate of decline differs from person to person so it’s important to test regularly to understand what this rate of decline looks like for you.  Based on over 10 years of clinical research, AMH is established as the single most important marker of ovarian reserve and forms a core part of our Hormone & Fertility test. AMH will always feature in your hormone panel, however, it’s important to know that if you’re currently taking hormonal contraception this can temporarily suppress your AMH. Although you can still test AMH while on contraception and get valuable insights, we recommend waiting three months after coming off contraception to give the most accurate results.  Furthermore, research has found that AMH has the potential to be used as an indicator of when someone will go through menopause, a predictor of fertility treatment success and can be used when diagnosing reproductive health conditions such as PCOS & POI.   A fertility test isn’t all about AMH. AMH alone cannot give you the entire picture, it’s just one piece of the puzzle. So, when looking at your fertility, and overall reproductive health, it’s crucial to take a whole-body approach.  Results and follow-up doctor-written report Just 10 days after sending your test kit back to us, you’ll be able to access your hormone results in your online health hub. Each hormone result comes with an explanation, so you can easily understand what your result means.  Along with your results, you’ll receive a doctor-written report that will consider your Online Health Assessment results alongside your blood work. Your dedicated doctor will outline a care plan based on any symptoms you might be experiencing and will recommend any onward care or treatments should you need them. The takeaway At Hertility, we care deeply about your health and well-being. Our mission is to arm women with the answers they need about their reproductive health so that they can make informed decisions about their futures. Our Online Health Assessment and at-home test kits have been rigorously quality tested and are CQC-approved, MHRA-regulated and CE-marked. Start your Health Assessment here.

Hertility partners with Pearl & Dean for the launch of #MeToo film, ‘She Said’, to rally women in the UK for the next women’s rights movement, the Reproductive Revolution.   Women’s health company Hertility’s award-winning film, ‘Ooh Someone’s Hormonal,’ spotlighted the lack of research on women’s bodies and called out society for using women’s hormones against them. Now, they’re teaming up with Pearl & Dean, the UK’s best-known cinema advertising contractor, to take the “Mother of all movements” to the next level in a bid to urge millions of women across the UK to get to know their bodies. For 5 weeks from November 25th, ‘Ooh Someone’s Hormonal,’ created by female-founded creative content agency Be The Fox, will be shown before every screening of ‘She Said’ in Pearl and Dean cinemas nationwide, the film starring Carey Mulligan and directed by Maria Schrader telling the story of the #MeToo movement.  Founded by women and powered by an (all female) research team, Hertility is setting a new standard of scientific rigour in female health by empowering women with information about exactly what’s going on under their skin using at-home diagnostic testing, telemedicine and treatment. By joining forces with cinema ad sales firm Pearl & Dean, the partnership aims to fuse science and art in the fight for equality. ‘The #MeToo movement was such a huge step forwards in women’s rights but from a reproductive perspective, women are still second-class citizens. We want to inspire women watching ‘She Said’ to join us in our fight in the next revolution – the Reproductive Revolution – by getting to know their bodies and taking control of their life choices. For themselves and for all women worldwide.’ – Dr Helen O’Neill, CEO and Founder of Hertility Carey Mulligan, has spoken openly about the lack of support for women in the film industry but as a middle finger to the male-dominated Harvey Weinstein era, ‘Ooh Someone’s Hormonal’, produced by female-led production company, Be The Fox, shows Hollywood how it’s done. Echoing the equality seen in the production of ‘She Said’, the female-powered cast and crew of ‘Ooh Someone’s Hormonal’ worked to the soundtrack of female artist Rebecca Taylor of Self-Esteem, complete with childcare on set, changing the outdated landscape and showing what’s possible when women, fully supported, come together. Diana Ellis Hill, Co-Founder, Be The Fox comments: “Empowering women and having true representation is an important cause that’s close to our hearts. We gathered an 80% female team to make the film from DOP and Director to Editor and Colourist as we wanted it to be real and authentic. We are immensely proud of what’s been produced and to see our film on screens at cinemas nationwide ahead of She Said.” Kathryn Jacob OBE, CEO at Pearl & Dean, said: “Cinema is a unique advertising medium in the sense that it is both a personal and shared experience. Cinema has the power to truly reach an individual, and to speak to them one on one, as well as spark a conversation. We are honoured to be working with Hertility to launch its first ever cinema campaign and to be a part of helping to better articulate an important issue that is often hidden or ignored by wider society.” Watch the cinema advert ‘Ooh Someone’s Hormonal’ More information on ‘She Said’

Pioneering new egg-freezing research has been published by Hertility Doctors, Dr Lorraine Kasaven and Dr Benjamin Jones. Read on for a summary of their findings on the optimal age to freeze your eggs. Quick facts: Is it worth freezing your eggs in your 40s? This is one of the most frequent questions our Doctors get asked by women over 40. The answer, to date, has been—there really isn’t enough data to answer this confidently.  So, in true Hertility fashion, where the data doesn’t exist, we make it our mission to change that. This month, two of our Hertility Doctors, Dr Lorraine Kasaven and Dr Benjamin Jones, published a new study, ‘Reproductive outcomes from ten years of elective oocyte cryopreservation,’ using data from 373 women over ten years to find out the answer to this question once and for all. Their findings suggest that women should get their eggs frozen before the age of 36 to increase their chances of successfully conceiving.  Whilst previous research focused on the number of good quality eggs successfully frozen, Dr Lorraine and Dr Ben’s research looked at the real-world outcomes. Basically—what happened when women tried to use those successfully frozen eggs to get pregnant?  The research outcomes Of the 373 women who froze their eggs, only 36 returned to use them. Those 36 women went through a total of 41 frozen embryo transfers which resulted in 12 live births.  None of those who froze their eggs after the age of 40 had a baby. 82% of the babies were born to women who froze their eggs between the ages of 36 and 39 years of age. This research therefore suggests that egg freezing is a viable option for having children later in life but it’s not a ‘fail-safe’ way of preserving your fertility.  This research indicates: One step closer to closing the gender data gap We are immensely proud to have our doctors flying the flag with such important research. This research directly arms our doctors with the most up-to-date research for patient consultations.  It’s another small step forward in our universal understanding of female reproductive health and a giant step towards empowering the lives of women everywhere to have kids (or not) on their terms.  Read the full paper here.  References:  Kasaven, L.S., Jones, B.P., Heath, C. et al. Reproductive outcomes from ten years of elective oocyte cryopreservation. Arch Gynecol Obstet306, 1753–1760 (2022). https://doi.org/10.1007/s00404-022-06711-0

Recent research conducted by some of our Hertility Team, led by one of our co-founders Dr Natalie Getreu, has been published in the Fertility and Sterility Journal. Fertility can be affected by cancer and cancer treatment to such an extent that women may have reduced family planning options once they’ve completed their treatment. Although, records of the success of fertility preservation methods in cancer patients are not routinely collected by hospitals, fertility clinics or researchers. Instead, when it comes to egg and embryo freezing, clinicians routinely use success rates from patients that have undergone fertility preservation for social reasons as opposed to medical reasons. Therefore, our research team aimed to look into pregnancy outcomes in cancer survivors who had used their frozen tissues to provide more up-to-date and relevant information for these patients. Check your fertility The results revealed that between fertility preservation methods: egg, embryo or ovarian tissue freezing, there was no significant difference between these methods for women to have live births after pregnancies. At Hertility we are so proud to not only offer new and different care pathways for women but also to be home to so many amazing researchers. So we thought in this article we would take you through the research, and the findings and explain them to you. After all – knowledge is power! First up, let’s recap on fertility preservation…. We’ve already published an article that covers all the different types of fertility preservation for people with ovaries but here is a brief sum up: There are both medical and social reasons to undergo fertility preservation.  Medical fertility preservation means preserving parts of your fertility in people who might lose their ability to reproduce due to upcoming medical treatment, for example, cancer patients about to undergo chemotherapy/radiotherapy or people undergoing gender reassignment surgery, or for some who have an autoimmune condition that want to protect their fertility. Whereas, social fertility preservation is when you are opting to freeze your eggs because of social and age-related factors. There are several different fertility preservation methods, some of which include: Egg freezing – This is what it says on the tin: collecting your egg cells and putting them on ice for later use. Embryo freezing – This process involves fertilising your collected egg with IVF using either donor’s or your partner’s sperm and then the resulting embryo is frozen until you are ready to use it. Ovarian tissue cryopreservation – This method is created mostly for younger patients who have not yet gone through puberty and are therefore not able to fully mature their egg cells. Tissue containing immature eggs is cut from their ovaries and is preserved in a tissue bank until the tissue can be re-implanted and used at a later stage, however, this is not routinely used for the general population. There are more fertility preservation options but in this study, researchers only included cancer patients who had undergone oocyte, embryo or ovarian tissue cryopreservation (freezing) What did this study do? Researchers followed cancer patients that had both fertility preservation and then had fertility-damaging cancer treatment (gonadotoxic therapy) who were now looking to start a family using their cryopreserved oocyte, embryo or ovarian tissue. The main outcomes this research looked at were if there were clinical pregnancies (clinical signs of the foetus can be either seen or heard), miscarriages (pregnancy loss) and live birth (completed pregnancies that result in a live birth). What were the results? This study found that between fertility preservation methods: egg, embryo or ovarian tissue freezing, there was no significant difference between these methods for women to have live births after pregnancies. (In science it’s all about whether a difference is significant or not!).  Also high clinical pregnancy rates and live birth rates were observed in all techniques. They also found that freezing ovarian tissue results in significantly less miscarriages than embryo freezing, which is interesting and is something to further investigate! What do these results mean? Like anything in science, there are limitations in the study and this research does report some limitations since it was an early analysis. However, this is a really important and interesting starting point in this area of research and for cancer-related fertility preservation.Researchers hope that this study helps to establish better reporting of outcomes in cancer patients and will encourage clinicians to use appropriate statistics and information to counsel women who find themselves facing a cancer diagnosis on their chances of biological motherhood. If you fancy having a read of the article yourself, have a look here! At Hertility, we are dedicated to revolutionising women’s healthcare, whether that be through improving care pathways, helping women receive answers about their bodies through our at-home tests or contributing to the Women’s Health research. It’s all part of our mission for a #ReproductiveRevolution.

Anti-Müllerian Hormone (AMH) is a really important hormone for fertility. It can give insight into your ovarian reserve and how many eggs you have left. But what is a good AMH level for your age? Here’s everything you need to know about AMH levels.  Quick facts: What is AMH? Anti-Müllerian Hormone (AMH) is an incredibly important hormone when it comes to fertility and overall reproductive health.  AMH is made by the small sacs, called follicles, in your ovaries. These follicles house your eggs. Because of this close relationship with your eggs, testing your AMH levels can therefore give you an insight into your ovarian reserve, or how many eggs you have at the time of testing.  We are all born with all of the eggs we’ll ever have. As we age, both our egg quality and quantity declines. This is due to both the natural ageing process and eggs being lost with each menstrual cycle. This happens right up until menopause when all your eggs are gone. As our egg count diminishes, generally so do our AMH levels, unless we have an underlying condition or lifestyle factor which is affecting our AMH levels (like PCOS).  What is a normal AMH level for my age? AMH levels will steadily decrease year after year from your mid-20s onwards. This occurs in tandem with your ovarian reserve declining.  After your mid-30s, AMH decline becomes much more rapid. It completely drops off as you near menopause (usually between 45 and 55 years old).  Although the overall levels of AMH by age is a general downward trend, each person has an individual rate of decline depending on genetics, lifestyle, medication and underlying conditions. What is a good AMH level? The higher your AMH the better, right? Well… not exactly. Like all of our hormones, too much or too little can indicate problems.  High AMH levels In general, higher AMH levels indicate a larger number of ovarian follicles and therefore a larger ovarian reserve.  However, some underlying reproductive health conditions like polycystic ovarian syndrome PCOS are associated with high AMH levels too. PCOS can cause hormonal imbalances which can negatively impact your fertility. Symptoms of high AMH levels Generally, high AMH levels don’t have any specific symptoms. But if you’re experiencing any symptoms that indicate a possible problem with your cycle you should test your hormones including AMH levels to investigate the possibility of PCOS. These symptoms could be things like irregular or no periods, or any other PCOS symptoms like acne, excessive body or facial hair, hair thinning or loss.  Low AMH levels On the flip side, low AMH levels can indicate lower numbers of remaining follicles and therefore, a smaller ovarian reserve.  Very low AMH levels are often seen in premature ovarian insufficiency (POI), which is a condition where menopause occurs before the age of 40 or even when you are going to experience menopause. Ovarian surgery can also carry a risk of low AMH levels afterwards. Some lifestyle factors have also been linked to low AMH levels – smoking, obesity, and poor diet and nutrition—specifically insufficient Vitamin D levels.  How to increase AMH levels? Unfortunately, you can’t stop your AMH from declining with age. That being said, there are some lifestyle and diet changes that can improve your fertility.  Monitoring your AMH levels with an at-home blood test if you have low AMH levels and are actively trying to conceive, or wanting to do so soon is a good idea to understand your rate of decline. Additionally, if you’re worried about your future fertility but not ready to have kids yet, you may want to consider egg freezing. Or, if you have low AMH levels and are struggling with conceiving, IVF treatment could be a good option for you.  If you’re concerned about your AMH levels, you can speak to our Private Gynaecologists at any time. Our Doctors can help you with a care plan that’s right for you and your body.  Do AMH levels fluctuate? Unlike your menstrual hormones which are cyclical, meaning their levels fluctuate throughout the month, your AMH levels stay relatively stable throughout your menstrual cycle. How do I know if I have normal AMH levels?  Testing your hormones is the only way to definitively know if your AMH levels are within the normal range for your age.  Doing an AMH blood test can give you an accurate insight into your current AMH levels, and give you an insight into your reproductive health because it is reflective of your ovarian reserve (egg count). Your AMH levels can also be used as an indication of whether you have polycystic ovaries, however, it can not currently be used to diagnose PCOS based on current guidelines. Understanding your AMH levels and ovarian reserve can also help to determine if you would be suitable for certain fertility treatments like IVF or egg freezing.  During fertility treatment, AMH levels are often tested to help determine the doses of medication and to predict the outcomes of the egg collection process.  Investigation of AMH levels is often done in combination with an Antral follicle count (AFC), which is an internal ultrasound scan where the number of small follicles seen on the ovary is counted. What is a good AMH level to get pregnant or to have IVF? Successfully getting pregnant is not entirely dependent on your AMH levels and ovarian reserve. Other factors can affect fertility such as: There is, therefore, no evidence of a good AMH level to increase the likelihood of pregnancy.  The success of IVF treatment is also dependent on many different factors. However, there is evidence that an AMH level lower than 5.4 pmol/L may have a poorer response to fertility medications. This is why some NHS IVF clinics will not accept patients who have an AMH level lower than this threshold.   Resources: