‘Bum steer’ that left PR boss in tears

It may not have felt like it at the time, but a “bum-steer” GP appointment that left Sydney PR maven Maz Coote crying and fearing she wouldn’t be able to have children became the inspiration to create Australia’s first at-home fertility test.

At age 31, single and prompted by a family history of unexplained infertility, Ms Coote took an AMH test, which measures the amount of anti-Mullerian hormone in the blood and can give a rough indication of a woman’s egg reserve and her remaining fertile years.

The results revealed the career-orientated Sydney woman was “within range” for her age, and 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 get a second AMH test, which revealed a very different result.

“I was told, ‘Your egg count test is back, it’s low, and what that means is it’s going to be really challenging for you to have a family’,” Ms Coote said.

“I now know what that actually means, but that’s what I believed in that moment, and there was so much heartbreak in that and it was completely unnecessary.”

While the couple later found themselves a fertility specialist and underwent three rounds of egg freezing, in 2022 they conceived their now-two-year-old daughter Charlotte naturally.

Their fertility journey has now led them to start WHEN Fertility, an at-home AMH test in partnership with medtech company Trajan Scientific and Medical, giving women an alternative to seeking the test via a GP referral.

The microsampling device means a user can do the test using a simple finger-stick blood sample before the gold-standard NATA-accredited results are relayed back to the patient and contextualised through a report written by fertility experts.

Women with a low egg reserve are also given a tele-education appointment with a fertility nurse to talk through their results and equip them with more information.

Mr Barnes said the free-of-charge consult meant customers could understand what the AMH test indicated and, more importantly, what it didn’t.

“The second GP had really given us a bum steer because we know there’s no test that will tell you if you can or can’t become pregnant, but having eggs is a prerequisite to get pregnant,” he said.

“What Maz’s AMH test was really telling us was that she would likely have a shorter reproductive runway within to achieve a family, whether it was through one, two or three kids.”

He also wanted their business to acknowledge and help women combat the anxiety and distress that could happen when receiving a less than optimal result.

“We’re not diagnosing, we’re not offering solutions or treatments,” he said.

“We want to ensure that when we find out something that warrants investigation, we make sure that person goes back into the existing healthcare system (through a GP or fertility specialist) so they can move through it appropriately with the support of their regular practitioner.”

Fertility specialist, obstetrician and gynaecologist William Ledger said the “holy grail” fertility testing would be one that measures not only egg reserve but egg quality.

However the latter can only be determined by the creation of an embryo through IVF.

“That’s kind of a radical way to check. The thing we’d really like to have is an egg quality check alongside an AMH test for quantity, but I don’t think that’s anywhere close to be honest with you,” said Professor Ledger, who is also WHEN Fertility’s co-chief medical adviser.

“Egg quality more or less goes with age. It’s unusual to see someone in her 20s who has an egg quality problem even though her egg reserve might be small.

“But if your egg reserve is small, you’re going to run out of time faster than someone who has a big egg reserve, so you maybe won’t want to wait until you’re 40 or 41 to try and 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 when they’re older.

“If you get to your early 30s and you’re planning to wait a bit longer, your egg reserve is a good thing to know because if you are on the low side, maybe need to change your plans,” Professor Ledger said.

Driven by social media and increased awareness, women in their early to mid 20s were taking the test, Professor Ledger said, even though it was “probably too early” unless there was a family history of early menopause, they’d had severe endometriosis that required surgery or received chemotherapy as a child.

“People in that group are at an increased risk of losing their egg reserve, so it could be good to get a check in your mid-20s,” Professor Ledger said.

For Ms Coote, she wants to make sure the test doesn’t scaremonger or offer false hope – having known the detrimental impact of both.

“The first time I had an egg count test, I didn’t understand what it meant, I put it in my pocket and walked away,” she said.

“I then land in a specialist’s office two years later, distraught, crying and thinking the worst-case scenario, which is also the opposite of good health care.

“That education component is so important, and we want people to (refer) people back into the healthcare system while ensuring that that person walking back into their GP’s office is briefed and able to talk about the next steps in an informed way.”