Fertility
“We gravitate towards things that are instantly gratifying. IVF is one of them”
As the global IVF market is estimated to reach US$36.2b by 2026, embryologist Cynthia Hudson tells FemTech World why IVF has become the logical response when struggling to conceive.
It is estimated that infertility affects one in seven heterosexual couples in the UK.
Since the original NICE guideline on fertility published in 2004 there has been an increase in the prevalence of fertility problems and a greater proportion of people seeking treatment.
A study from 2021 published in Sociology of Health & Illness found that in the UK, IVF is presented as an entirely predictable, and linear course of action when dealing with infertility.
The increasing age at which women start families, declining male fertility along with greater social acceptance of fertility treatment has meant the market has been enjoying steady growth in recent years and so has IVF.
“If a couple runs into a perceived level of infertility, the quickest way to get pregnant statistically, is to do IVF,” says Cynthia Hudson, embryologist and VP of clinical strategy at TMRW Life Sciences.
“The reason why the odds are stacked so heavily in our favour is because we can effectively condense time. We can stimulate the ovaries to produce multiple eggs at once, as opposed to the typical menstrual cycle output of one egg per month.
“But there is a certain level of impatience in our world, and we tend to gravitate towards things that can get us to our stated goals faster. In the rush, we may not take the time to understand all of the reasons behind the infertility.”
There is a lack of awareness around what might require IVF and what might not, says Hudson. Age, lifestyle choices and timing are often overlooked, although they play an important role in achieving parenthood.
“IVF may be required as part of your fertility journey, but it’s also important to treat what the symptom is in the first place, if it is possible to do so,” Hudson explains.
“Age is the most significant predictor of success. So, if you are 25 and you’re not achieving quick success, it’s unlikely that the eggs are the cause of the problem. It could be a timing issue or an issue on the male side.
“If you’re in your 40s, however, it is likely that age is why you can’t become pregnant – your chance of success is reduced. I think it’s important to accelerate the decision-making process at this point.
“You don’t need a fertility specialist to tell you that you’re 42. But sometimes we just get impatient, and we don’t take the time to investigate the cause. We will go right to solution, rather than try to see if we can figure it out.”
During IVF, an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg or the embryo is then returned to the woman’s womb to grow and develop.
As embryos vary in quality, research has predominantly focused on advancing the methods of selecting embryos. However, scientists are now looking at ways to improve the gamete and embryo quality to begin with.
“We’ve spent a lot of time investigating how to screen the embryos and choose the best of the cohort, but what we haven’t really done is improve the egg and sperm cohorts to begin with,” says Hudson, adding that working on the development and growth of the gametes is an exciting area.
“At this point, all we can do is take the material that we have, and then put them together. But what we want to do is try and make that cohort develop better, so that we could improve success rates both in vitro (IVF) and in vivo (in the human body), and help couples conceive without IVF in the first place.”
Cellular reprogramming – the act of reverting mature, specialised cells into induced pluripotent stem cells – is another interesting area of research, says Hudson.
“This means you would get a cheek swab, you would submit that to a lab and the researchers would then deprogram those cells back to where they were at their earliest point. Then they would get those together with an egg or a sperm and eventually, grow an embryo out of that without having to go through the entire egg retrieval cycle.
“Although this is not something that we are likely to see in the next five years, it remains an area that will be further explored.”
Currently, many couples still face barriers to getting fertility treatment. According to the World Health Organisation (WHO), between 48 million couples and 186 million individuals struggle with infertility globally, but only three per cent have access to IVF and similar treatments.
Disparities – largely determined by complex social, cultural, racial, and economic factors – require further studies and cultural enrichment.
For embryologists like Hudson, improving access to fertility treatment remains a priority.
“The vast majority of humans do not have access to fertility treatment and that’s a tragedy. I think we owe it to ourselves and our fellow humans to change that.
“I would like to get to a place where we can say what definitively does or does not work in the lab to improve pregnancy rates. We need to stop charging people for treatments that haven’t been proven clinically beneficial”, the expert adds.
“There are a lot of manual steps in the IVF process right now and we’re at a point where we need to standardise these in order to help us figure out how to improve. I’ve focused a lot of my time recently trying to raise the bar and automate some of those processes.
“We need to make sure that we don’t leave things to chance. We don’t have the infrastructure yet, but we’re getting there.”
For more info about TMRW Life Sciences, visit tmrw.org.
Peers have called for law reform after two House of Lords debates on fertility treatment, surrogacy, embryo research and declining birthrates.
The first debate was put forward by crossbench peer Baroness Ruth Deech, who previously chaired the UK’s fertility regulator, the Human Fertilisation and Embryology Authority.
She discussed proposals from the HFEA to reform the Human Fertilisation and Embryology Act, along with proposals from the Scottish Law Commission and the Law Commission of England and Wales to reform the Surrogacy Arrangements Act.
She called for parliamentary scrutiny of possible changes to regulatory powers, consent rules, donor information and future scientific developments.
Baroness Deech said: “Parliament should plan by setting up a Select Committee to examine the HFEA’s proposals to expand regulatory powers, simplify consent rules, modernise donor information provisions and create a flexible framework for future scientific developments.”
Former fertility professionals were among those contributing to the debate.
Professor Lord Robert Winston, a Labour peer who founded the IVF service at Hammersmith Hospital in London, said: “Infertility is not a disease; it is actually a symptom of something wrong.”
Professor Baroness Geeta Nargund, a Labour peer, current HFEA member and former medical director of CREATE Fertility, disagreed.
She said: “Infertility is a disease, as stated by the World Health Organisation.”
Liberal Democrat peer Baroness Caroline Pidgeon highlighted regional differences in access to NHS-funded fertility treatment.
She cited figures from the Progress Educational Trust’s NHS Fertility Funding Tracker showing that only two of England’s 42 integrated care boards comply with the recently updated fertility guideline published by the National Institute for Health and Care Excellence.
Integrated care boards are local NHS organisations responsible for planning and funding healthcare services in their areas.
Baroness Pidgeon said many boards were offering only a partial IVF cycle rather than a full cycle as defined by NICE.
A full IVF cycle generally includes ovarian stimulation, egg collection and the transfer of all suitable fresh and frozen embryos created during treatment.
Crossbench peer Professor Baroness Clare Gerada, a former president of the Royal College of General Practitioners, said: “The proportion of NHS-funded IVF cycles has fallen to just under 30 per cent, the lowest level since 2008.”
She added that, in relation to IVF, “the NHS system has collapsed”.
Liberal Democrat peer Lord Monroe Palmer said it was “very ironic that it is difficult for many patients to access publicly funded fertility treatment in the very country where IVF was originally pioneered”.
Conservative peer Edward Howard, Earl of Effingham, also raised concerns about the NICE fertility guideline.
He said: “Access remains highly variable across England, because ICBs are not required to implement that guidance.”
He described the situation as “a clear gap between guidance and enforceable entitlement”.
Baroness Deech called for “automatic record sharing between clinics and the NHS central records system”.
Baroness Nargund supported this and linked the ambition to the Single Patient Record in the government’s Ten-Year Health Plan for England and the Health Bill currently before Parliament.
Baroness Pidgeon said such ambitions were at odds with the exceptional degree of medical secrecy that currently applies to IVF.
She also pointed to “a clear desire for the HFEA to be able to permit patients to give generic consent for the use of their embryos in research”.
Patients cannot currently give broad consent for unspecified future research involving their embryos.
Responding for the government, Labour peer Baroness Judith Blake said “immediate legislative reform” was not possible because “the legislative programme for this Parliamentary session is very full”.
Baroness Deech replied: “It might well take some years, but the Government really needs to set up that Select Committee and do the legislative scrutiny right now.”
A second debate on related issues followed immediately afterwards.
Baroness Nargund asked the government “what assessment they have made of the UK’s declining birthrates in an ageing population”.
She also said: “We still have a postcode lottery for IVF provision, with nearly 70 per cent of ICBs funding only one cycle of treatment.”
Responding for the government, Labour peer Lord Philip Wilson said: “The Government are committed to improving fair and equitable access to fertility services, recognising the significant emotional and health impacts of infertility.”
Article produced in association with Spital Clinic
AMH has become one of the most-requested blood tests in private women’s health. The number it gives back is useful, but only when it is read in context.
AMH testing in the UK has gone mainstream over the past few years. Home-testing kits sell it as a snapshot of “your fertility”.
Private clinics include it in screening packages. On social media, individual AMH results are now routinely treated as a verdict on whether a woman will be able to have children.
That reading isn’t accurate. Anti-Müllerian Hormone (AMH) does carry useful information, but only inside a wider clinical picture.
Looked at on its own, it produces a lot of unnecessary anxiety, and often hides the questions that matter more.
What AMH measures
AMH is a hormone produced by the small follicles in the ovaries, the ones that haven’t yet been recruited for ovulation. Because these follicles are relatively stable across the menstrual cycle, the test can be done on any day, without needing to be timed to a period.
A higher AMH level tends to indicate a larger pool of these follicles. A lower level suggests the pool is smaller. That, broadly, is what the result shows.
The HFEA, the UK’s independent regulator of fertility treatment, describes AMH as an indicator of ovarian reserve, while making clear that fertility test results of this kind “are not guaranteed” as a predictor of fertility outcomes.
Put simply: AMH is a count of what is there. It says nothing about how well the body will use it, and it cannot predict if or when conception will happen.
Where AMH fits in a modern fertility assessment
In current UK private practice, AMH is rarely tested in isolation. A meaningful fertility assessment will pair it with a fuller hormone profile (FSH, LH, oestradiol, prolactin and thyroid function), along with markers such as Day 21 progesterone, vitamin D and rubella immunity where relevant.
This is the structure used in a trying-to-conceive screening, and there is a reason for it: each of these tests answers a different question that AMH on its own cannot.
It is this combination, not the AMH number on its own, that gives a clinician enough information to say anything meaningful about an individual’s reproductive picture.
Misconception 1: “A low AMH means natural pregnancy isn’t possible”
This is the misconception that causes the most distress, and it is consistently wrong.
Several large prospective studies of women in their 30s and 40s trying to conceive naturally have found that women whose biomarkers, including AMH, pointed to a diminished ovarian reserve were no less likely to conceive within twelve cycles than women with reassuring results.
That is why neither UK regulators nor national guidance treat AMH as a test that can predict natural fertility in women who have no known infertility issue.
The reason is simple. Natural conception only requires one good egg, released in a normal cycle, in the right window.
AMH doesn’t measure egg quality, and it doesn’t reveal whether ovulation is happening. A woman with low AMH may still ovulate every month with high-quality eggs.
A woman with high AMH (often the pattern seen in polycystic ovary syndrome) may not be ovulating regularly at all.
The NHS emphasises that age is the strongest single predictor of natural fertility. A 35-year-old with a low AMH and regular cycles is, on average, more likely to conceive naturally than a 40-year-old with a normal AMH and irregular ones.
If AMH comes back low for someone who is trying to conceive, the more useful question isn’t whether pregnancy is still possible (the answer is almost always yes), but whether there is reason to investigate the wider picture now rather than waiting twelve months.
Misconception 2: “A normal AMH means everything is fine”
The opposite assumption is just as risky.
AMH tells you about egg quantity. It does not tell you about:
- Egg quality, which is closely tied to age
- Whether ovulation is happening regularly
- Whether the fallopian tubes are open
- Whether there are structural issues such as fibroids, polyps, ovarian cysts or endometriosis
- Sperm parameters in a male partner
- Whether implantation will succeed
A reassuringly normal AMH at 38 still sits alongside age-related changes in egg quality. A slightly lower-than-average AMH at 28 may carry no real-world implications at all.
That is why no UK clinical body recommends AMH as a routine screening test for healthy women who have no fertility concerns. NICE’s fertility guideline, NG73, treats AMH as one component of a broader investigation, not as a verdict in itself.
Imaging is the natural counterpart to the blood test. A transvaginal pelvic ultrasound directly visualises the small follicles that produce AMH, the antral follicle count. It also picks up structural findings a blood test will never reveal, including ovarian cysts, fibroids, polycystic ovarian morphology, and abnormalities in the uterine cavity. A full ovarian reserve assessment normally includes both.
Where the AMH number actually matters
There are three settings in which AMH carries real, decision-relevant information.
Before IVF or egg freezing. AMH is one of the better predictors of how the ovaries are likely to respond to stimulation medication.
A higher AMH usually predicts more eggs collected per cycle, and a very low AMH may shape decisions about protocol or whether to bank cycles before treatment.
During a fertility investigation. If a couple has been trying for twelve months, or six months if the woman is over 35, AMH becomes part of a wider assessment that should also include ovarian ultrasound, a fuller hormone profile, semen analysis and an assessment of tubal patency.
As context for women planning ahead. Women who want to understand their reproductive options before they are ready to conceive (for example, ahead of a decision about egg freezing) can find AMH informative, provided it is interpreted alongside age, antral follicle count, and other markers, by a clinician who can place the number in context.
Reading the number properly
For anyone who has had an AMH test, three things make the result more useful:
- Pair it with age. A “normal” AMH at 25 means something very different from the same number at 38. Age is doing more work in the equation than the AMH value itself.
- Pair it with imaging. Ultrasound shows what is actually in the ovaries today, rather than relying on a single biochemical marker.
- Read it with a clinician. A number on a screen, with no context, no follow-up and no plan, is the worst way to use a test that, properly interpreted, can be very informative.
AMH is a useful tool. It just isn’t the headline it has often been turned into.
Disclaimer
This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published HFEA, NHS and NICE information available as at May 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Women with primary infertility may face a higher risk of early menopause and reach it about a year earlier, a study suggests.
The findings suggest women with primary infertility may be more likely to enter menopause before the age of 45.
The increased risk appeared most notable among women with unexplained infertility or a history of endometriosis.
Dr Stephanie Faubion, medical director for The Menopause Society, said: “This study shows that women with primary infertility, specifically those with unexplained infertility or a history of endometriosis, were at risk for early menopause.
“Given that early menopause is linked to adverse long-term health consequences, these women may benefit from counselling that they are at risk of early menopause.
“This will allow them to monitor for early menopause and to seek treatment with hormone therapy, if indicated.”
Early menopause is usually defined as menopause before age 45, while premature menopause is menopause before age 40.
Women who experience menopause earlier may face symptoms for longer and have a higher risk of long-term health problems.
These can include cardiovascular disease, osteoporosis and neurocognitive disorders. Osteoporosis weakens bones, while neurocognitive disorders affect memory, thinking or brain function.
The study, highlighted by The Menopause Society, involved nearly 700 people, roughly half of whom had been diagnosed with primary infertility.
It found that women with a history of primary infertility underwent natural menopause about one year earlier than those without such a history.
Researchers found no association between infertility and premature menopause.
Infertility affects around one in six people globally and can have consequences beyond family planning.
Previous research has linked infertility with higher rates of cancer and cardiovascular disease, although causes vary and may involve genetic, hormonal, in-utero or lifestyle factors.
In-utero factors are influences that occur while a baby is developing in the womb.
Earlier studies looking at links between infertility and early or premature menopause have produced mixed results, with some not accounting for different types of infertility.
The new study suggested that women with unexplained infertility or a history of endometriosis may have an increased risk of early menopause.
Endometriosis is a condition where tissue similar to the lining of the womb grows elsewhere in the body. It can cause pain, heavy periods and fertility problems.
Known risk factors for early or premature menopause include tobacco use, low body mass index, not having given birth and starting periods at a younger age.
Women who have had more childbirths and those with a history of oral contraceptive use have previously been linked to later menopause.
The researchers said women with primary infertility may benefit from additional counselling because of the systemic and long-term health effects of early menopause.
They also said women should be encouraged to seek evaluation and treatment if they experience a new loss of menstrual cycles.
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