New Genetic Test Could Spot Infertility Before It Starts

A new genetic test could predict whether women are at risk of early ovarian aging — and therefore reduced fertility — while they're still young enough to plan ahead.

An at-home test of a woman's current ovarian reserve — and thus her likelihood of being able to conceive — has been available since spring. But Norbert Gleicher of the Center for Human Reproduction thinks he can go a step further, using a woman's genes to predict when her ovarian reserve will begin to fall. He has discovered that variations in the Fragile X or FMR1 gene are associated with early ovarian aging and thereby with an early drop in fertility. By testing this gene, he believes he can predict whether a young woman is at risk of early ovarian aging, and thus help her make decisions about when to try to conceive. Gleicher says,

Then you can sit down and have a discussion about her reproductive life plan. In other words, 'do you want to have your kids before you get your PhD, or afterwards?' If the answer is 'afterwards', OK, but maybe you want to freeze some eggs.

Of course, it's not quite that simple. Egg freezing, for one, is expensive and not a sure thing. And critics of Gleicher's research say he still needs to do follow-up studies to determine whether women with the genetic markers for early ovarian aging actually have trouble conceiving. Writing in New Scientist, Linda Geddes says,

[A] test reliable enough to transform the lives of a large number of women will likely involve a series of genetic and hormonal markers. It will also need rigorous testing to ensure woman aren't burdened with anxiety - or given false hope.

Her last sentence seems key: Gleicher's test would need to be pretty foolproof for women to be able to plan their lives around it, especially because such planning tends to be messier than he lets on. Deciding when to have a child depends on a lot of factors besides how your Ph.D. research is going — women have to consider their finances, their health, whether they want to raise the kid with a partner and whether they've met that partner yet, and simply whether it feels like the right time for them to reproduce. A reliable test to predict future fertility would give women information to help them make these decisions, but they'll probably never be easy or cut-and-dried.

Of course, there are ways society could make them easier. Subsidized child care and better maternity leave would be a couple. Another comes up in the Daily Mail coverage of Gleicher's research. The old Fail isn't as obnoxious as usual on this, beyond a weird photo of a woman looking pensive while pressing her head to a man's belly (is he pregnant?). But the article, by David Derbyshire, does start with the line, "A DNA test that can tell a women in her early 20s how long she has left to start a family is being developed by scientists." This is a relatively small linguistic quibble, but Gleicher's test doesn't measure "how long a woman has left to start a family" — it measures how long she may have to conceive a child from her own eggs. There are other ways to "start a family," like adoption, and plenty of couples think of themselves as a family even if they don't have kids. If we reformed adoption laws to make adoption easier and more affordable, more kids might find homes and women could stop tying their ability to raise children so directly to their egg reserves. And if we gave child-free people their due as valid families, maybe we'd also stop viewing a woman's ability to reproduce as a measure of her value. More information about women's fertility would be a good thing — but it's worth remembering that no genetic test is going to magically make our reproductive lives easy.

Genes Show When A Woman's Biological Clock Will Stop [New Scientist]
DNA Fertility Test Warns Women How Long They Have Left To Start A Familys [Daily Mail]