• Anne Marie Droste

What if I have a ‘bad result’?

I often meet people who are interested in their hormonal health and fertility, but who don’t want to do a Grip test because they’re worried about the consequences of a bad result.

I get it - it’s scary to think about your fertility. What if it turns out you can’t have kids?


To start with the most common misconception: the Grip test won’t tell you if you can or cannot have kids. There is no absolute predictor for fertility, and there’s also no absolute predictor of infertility. We can’t tell you that you’ll definitely never have a baby, and neither can any doctor. Same goes for being able to predict how long it will take for you to get pregnant. Think of your Grip test as a risk profile, rather than a yes or no answer. If you know your risks when you’re still young, you still have all options to do something about them.


In order to give you some idea of what to expect, we looked at the (anonymised) results of everyone who’s taken a Grip test so far.


What does the data say?


By now about 500 people have taken a Grip test. 267 of them (about 53%) have results that show that as far as we can tell, there’s nothing to worry about. This also means that 237 women have received results that mean it’s worth further investigation.


The four most common ‘bad results’ we see are an increased risk of PolyCystic Ovarian Syndrome (PCOS), an increased risk of blocked tubes, an under-active thyroid, and lastly a low ovarian reserve.

Grip results as of August 2020

Two things to keep in mind:

  1. a flag in your hormones doesn’t mean a diagnosis: it’s just a reason for you to do some extra digging into what might be causing your values to be out of range. As a result, we’re likely to err on the side of caution and likely have more ‘bad results’ than that there will be eventual ‘bad diagnoses’.

  2. we expect that our early customers are likely the ones who have been having issues for a while, and are therefore more likely to have ‘out of range’ results. These numbers aren’t representative of the general population!

Below we’ll give you a brief overview of each of these 'abnormal' results, show you an example report for each, and explain what you can do once you know.

1. Your report says you have an increased risk of Polycystic Ovarian Syndrome (PCOS).


28% of the women we tested at Grip so far had an increased risk of PCOS based on their hormones. This makes it the most common ‘bad result’ we see. There’s been several studies that estimate that 10 to 20% of the female population suffers from PCOS, so no surprises there (Pal et al, 2014). PCOS makes your ovulation (and therefore your periods) irregular, and sometimes even stops you from ovulating at all. Having PCOS does not mean that you won’t have kids. It’s harder to time sex right when you ovulate irregularly, and if you don’t ovulate at all you’ll likely need medical help to get pregnant.


You can see an anonymised but real ‘possible PCOS’ Grip report here.

“I remember having bad periods when I was very young, but I’ve been on the pill since I was 14. Once I stopped the pill, I wasn’t sure if my irregular periods were the result of lingering pill-effects, or if something else was up. After taking the Grip test and seeing how high my AMH and testosterone levels are, I know that it’s a lot more likely that I have PCOS.

- T. (31), Grip customer




What are the next steps once you have a possible PCOS report?


We always recommend you to go see your GP once you suspect you may have PCOS. You’ll likely need an ultrasound to get an official diagnosis. We won’t lie: PCOS sucks, and there’s a lot more research needed on how we can treat it.


The important thing to keep in mind here is that it on average takes 2 years and 3 different doctors to get a PCOS diagnosis (Gibson-Helm et al, 2016). Once you know what is happening, it will take another while to get the syndrome under control so that you have the best possible chances when trying for a baby. ‘Losing’ 3 years sucks when you’re 28 and feel ready to conceive, but imagine what happens if you’re 38 by the time you find out. If you only have a couple of years to get pregnant left when you get your diagnosis, the effects can be heartbreaking. Knowing you have PCOS early, and being able to adjust your lifestyle and expectations accordingly, really matters.


If you want to read more about PCOS, and how a Grip test can help you see if you’re at risk, click here.

2. Your report says you have an increased risk of blocked tubes.


11% of Grip customers have an increased risk of blocked tubes due to old chlamydia infections. Most of them didn’t know they’d been infected. Safe sex really matters!


The first thing a GP will check when you struggle to conceive is your ‘tubal pathology’, or your risk of blocked tubes. Estimates vary, but about 30% of all women who struggle to get pregnant have blocked tubes (NHG richtlijn, 2010). Blocked tubes are the result of scarring. There’s several reasons why you might have scars around your ovaries, but the most common reason is scarring as a result of a chlamydia infection. About 60% of all blocked tubes are the result of chlamydia (NHG richtlijn, 2005).

See an example Grip report of someone with an increased risk of blocked tubes here.

“It sucks to have found out that my chlamydia antibodies test was positive. I had no idea that I’ve ever had chlamydia. I’m of course still going to try and get pregnant naturally first, because the odds don’t seem too bad, but it was a deciding factor in not waiting too long in case I need IVF in the future.

- A. (36), Grip customer


What can you do once you have a possible blocked tubes report?


If you know that you’re at risk of blocked tubes, we usually recommend telling your GP before you start trying to get pregnant. It might be worth getting checked after 6 months of trying instead of the usual 12, for instance.


To be clear - there’s a big difference between a positive chlamydia antibodies test and actually having blocked tubes. Researchers have tried to estimate how often a chlamydia infection results in blocked tubes, and if you didn’t experience any symptoms, then the risk of blocked tubes is only between 1 and 4%. If you had a ‘PID’ (that can include severe abdominal pain and for instance a fever), the risk goes up to between 10 and 20% (Teng et al, 2014).


A Grip test can’t measure if your tubes are actually blocked. That’s only possible with an HSG test or a foam echo. Both are pretty invasive procedures where a doctor has to put a dye into your fallopian tubes to see if the color comes out on the other side. As such, we don’t recommend anyone to do the HSG test/foam echo until you’ve started trying to get pregnant.


If you want to read more about Chlamydia IgG testing at Grip, click here.

3. Your report says you might have an under-active thyroid.


9 out of every 100 Grip customers so far has had an indication of a slow thyroid. Research suggests that 1 in 6 women will deal with a thyroid issue at some point in their life (American Thyroid Association, 2014). Your thyroid is responsible for a bunch of processes in your body, including your metabolism and your fertility. People with a slow thyroid often take longer to get pregnant, and have an increased risk of miscarriages (Krassas et al, 2010). Symptoms related to an under-active thyroid can be tiredness, weight gain, and feeling depressed.


We test TSH, which is only one of the hormones that determines your thyroid function. A raised TSH is a first indication that something might be wrong, but you’ll need more tests to determine exactly what.


My cofounder Ling knows she has a (slightly) under-active thyroid. You can see her report here.

“I didn’t recognise myself in the symptoms associated with a slow thyroid, but after additional analysis at my GP it turns out it is indeed slow. My fT4 was only mildly raised, and so I’m trying to adjust my lifestyle for the next 6 months to try and get it down. If it doesn’t work, my GP will start me on meds. I’ll definitely make sure to have it under control before I start trying to get pregnant.
  • Ling (32), co-founder Grip Fertility


What can you do once you have an under-active thyroid report?


If your TSH is elevated, you’ll need additional thyroid analysis at your GP. We expect that your GP will at least want to check the hormone fT4, and maybe fT3.


If it turns out that your thyroid is indeed slow, you’ll likely be prescribed medication to fix the imbalance. There’s also certain lifestyle changes that you can try if the imbalance is small. Thyroid imbalances are relatively easy to fix, and having a balanced thyroid can make a hugely positive impact on your life and wellbeing.


If you want to read more about how we test your thyroid function at Grip, click here.

4. Your report says that you are likely to have a low ovarian reserve.


6% of the women we tested at Grip seem to have a low ovarian reserve. Your ovarian reserve is a fancy way of saying how many eggs you have left, and what is considered a normal amount of eggs changes as you get older. The hormone AMH is the most reliable predictor of your ovarian reserve (Iwase et al, 2015). We define a ‘low amount of eggs’ as being in the 0-5% category of women of your age. This means that 95% of the women your age have a higher amount of eggs.


We can’t stress it enough: how many eggs you have says very little about how likely you are to get pregnant naturally right now. In fact, women with a low ovarian reserve (AMH <0.7 ng/ml) are just as likely to fall pregnant within 12 months of trying as women with a normal ovarian reserve (AMH between 0.7 ng/ml and 8.4 ng/ml) (Steiner et al, 2017).


See an example Grip report of someone with a low ovarian reserve (AMH) here.

What can you do once you have a low ovarian reserve report?


The main reason why knowing you have a low ovarian reserve matters is because it helps you understand when you’re likely to enter menopause. If you know you’re at risk of going into menopause earlier than average, and you really want to have kids, then you might want to decide to start trying for kids younger. If that’s for whatever reason not possible, then you can consider trying to preserve your fertility via egg- or embryo freezing.


Your ovarian reserve isn’t particularly important for getting pregnant naturally, but it does have important implications for getting IVF or freezing your eggs (Broekmans et al, 2006). The first step of treatment for both IVF and egg freezing are the same: a doctor will use medication to ‘stimulate’ your ovaries, and effectively trick your body into releasing multiple eggs for fertilisation rather than one. People with a high ovarian reserve tend to ‘yield’ more eggs per round of treatment than people with a low ovarian reserve. That doesn’t mean they also get more viable eggs frozen, because AMH says nothing about egg quality. There’s certain hospitals and clinics who have a minimum AMH threshold for fertility treatment, but more importantly: if you know you have a low ovarian risk and you want to freeze your eggs, the age at which you do so really matters. When you’re younger, you’ll have more high quality eggs, and therefore more viable frozen ones, even if your ovarian reserve is low (Chang et al, 2018).


There’s no ‘cure’ for a low ovarian reserve, and the biggest influences are age and genes. Smokers enter menopause on average 2 years earlier than non smokers, so you may want to quit doing that (Sun et al, 2012).


If you want to read more about AMH and how we test at Grip, click here.


“My mum entered menopause when she was mid 40s, and so I’ve always been worried about my fertility. My Grip test told me my AMH is currently 0.8 ng/ml. That’s not crazy low, but I don’t see myself having kids before I’m 35.
I started looking into egg freezing, and will start my first round of retrieval in 3 months. I’m really glad that I found out about my ovarian reserve whilst I am still young and my eggs are high quality. Grip has moved up my timeline. I think it’s likely that I’ll still try to get pregnant naturally once me and my boyfriend are ready, but I feel reassured knowing that I have the option to take control of my future.

- M. (29), Grip customer

As a reminder: everyone who gets their Grip results doesn't just get a report, but also a free video consultation with one of our doctors, to make sure you really understand what your report says.


We really care about making sure you can make better choices because you understand your body better. Fertility isn't one size fits all, and it's time we acknowledge that.


If you want to order your test, click here.


References:


Pal L. Polycystic Ovary Syndrome. New York, NY: Springer New York; 2014:7.


Melanie Gibson-Helm, Helena Teede, Andrea Dunaif, Anuja Dokras. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2963 DOI: 10.1210/jc.2016-2963


Iwase, Akira et al. “Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?.” Reproductive medicine and biology vol. 15,3 127-136. 23 Nov. 2015, doi:10.1007/s12522-015-0227-3


Steiner AZ, Pritchard D, Stanczyk FZ, et al. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017;318(14):1367-1376. doi:10.1001/jama.2017.14588


Chang, Y., Li, J., Li, X., Liu, H., & Liang, X. (2018). Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve. Medical science monitor : international medical journal of experimental and clinical research, 24, 7279–7284. https://doi.org/10.12659/MSM.910410


Sun L, Tan L, Yang F, Luo Y, Li X, Deng H-W, Dvornyk V. Meta-analysis suggests that smoking is associated with an increased risk of early natural menopause. Menopause 2012; 19: 126-132.


F.J. Broekmans, J. Kwee, D.J. Hendriks, B.W. Mol, C.B. Lambalk, A systematic review of tests predicting ovarian reserve and IVF outcome, Human Reproduction Update, Volume 12, Issue 6, November/December 2006, Pages 685–718, https://doi.org/10.1093/humupd/dml034


NHG richtlijn Subfertiliteit, 2010. Werkgroep Van Asselt KM, Hinloopen RJ, Silvius AM, Van der Linden PJQ, Van Oppen CCAN, Van Balen JAM. https://richtlijnen.nhg.org/standaarden/subfertiliteit


NHG richtlijn Pelvic Inflammatory Disease, 2005. Werkgroep Dekker JH, Veehof LJG, Hinloopen RJ, Van Kessel T, Boukes FS. https://richtlijnen.nhg.org/standaarden/pelvic-inflammatory-disease


Teng Y, Kong N, Tu W. Estimating age-dependent per-encounter chlamydia trachomatis acquisition risk via a Markov-based state-transition model. Journal of clinical bioinformatics 2014; 4: 7.


American Thyroid Association (2014). Prevalence and Impact of Thyroid Disease


Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-755. doi:10.1210/er.2009-0041


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