Frequently Asked Questions

Questions about fertility

What is infertility? What are fertility risks and how do they differ from infertility?

Infertility is a clinical diagnosis; it refers to not successfully getting pregnant after 12 months of trying to conceive (under age 35) or 6 months (over age 35). Fertility risks refer to any factor, such as PCOS, low total progressive motile count for sperm, or any other factor/combination of factors, that increases the likelihood of an infertility diagnosis.

I’m only [age] and not planning on having kids for a while. Do I really need to worry about my fertility?

In the US, around one in seven couples find they can’t conceive on their own within a year of trying. Struggling with fertility is more common than breast cancer, diabetes, or owning a smart-watch. Luckily, many fertility issues have solutions – and the younger you are the more options you have. So: it is reasonable to be concerned. But if you are reading this, you are already on track to taking action, getting the facts, and proactively managing your fertility and any risks that might be discovered.

No home test can discover 100% of the causes of infertility. Some factors, like blocked Fallopian tubes, require more invasive, in-clinic procedures to identify. Others issues are “idiopathic,” meaning that nothing is obviously wrong, yet a couple cannot conceive. We estimate that about 80% of fertility problems can likely be identified based on our home fertility consult.

What causes infertility?

Fertility issues can result from issues with a woman’s eggs, a man’s sperm, or in getting them together in just the right way. There are many underlying causes, from the number of eggs decreasing as a woman ages to low Total Progressive Motile Count of sperm to PCOS to fibroids. Moreover, multiple borderline factors can also be a fertility risk. No single test can identify all these conditions – which is why Turtle Health’s fertility assessment combines multiple tests, a health history, and statistics to identify possible risks.

What can I do if I find out I have a fertility risk?

Recent advances in fertility science mean it’s more likely than ever that those families who want to have a child, can have a child. Often times, when a fertility risk is identified, the best strategy is to start trying to conceive sooner than you otherwise would have; since we identify risks, starting earlier gives you the advantage of time to work out whether the risk identified impacts your ability to conceive, and if so, to seek support.

Sometimes, when we identify more acute risks, we will connect you with a Reproductive Endocrinologist who will help you navigate your options – including semen, egg, and embryo freezing, IVF, IUI, trackers, strips, surrogates, and strategies – to find what makes sense for you and your personal goals. And our coaches are always available if you need more guidance.

Where can I learn more about the science?

Take a look here! We stay up to date on the latest fertility research and keep our patients informed of discoveries that may provide new insight or options.

Questions about Turtle

Can I see the consent forms before I book my consult?

Sure! You can check out the consent forms here.

How are you different from other fertility tests out there?

We’re the only comprehensive fertility consult that you can do from the privacy of your home. We offer a set of tests similar to what you would find at many Reproductive Endocrinologists: health intake, blood, semen, and investigational ultrasound.*

Other in-person clinics, like CCRM, Northwell, Kindbody, Texas Fertility Center, and others offer a similar set of tests in-person. Just like at these clinics, at the Turtle Health virtual clinic, a doctor reviews your health intake questionnaire before deciding which tests are appropriate. But unlike at these clinics, the Turtle Health consult happens completely at-home, privately.

We are also the only company that has published data on the use of self-administered at-home transvaginal ultrasound, which is an important piece of evaluating reproductive health. Note that the ultrasound piece of our solution is still “investigational” meaning that it is still being studied in a trial. It is currently available through a clinical trial in select states. And if you do not wish to participate in an ultrasound trial, but still want the rest of the consult at home, that’s great too – we can help you “bring your own” ultrasound data from a local clinic, that we can integrate with the rest of your home testing.

What happens when I book a consult?

If you opt to participate in the ultrasound clinical trial as well as the consult, you’ll first go through an online eligibility screening and informed consent process. Then, you’ll be able to pay for your consult, and complete your health intake questionnaire. This questionnaire will be reviewed by a physician, who will prescribe the appropriate testing. Most of the time, but not always, this will include bloodwork and, if testing with a male partner, semen analysis. But this is up to the discretion of the doctor.

Why wouldn’t I just go to an OB/GYN? (or PCP, Reproductive Endocrinologist, Urologist, etc.)

OB/GYNs tend to focus primarily on contraception and pregnancy management. Reproductive Endocrinologists are most focused on patients with known infertility, and helping them find solutions. While many Reproductive Endocrinologists and OB/GYNs offer testing to patients seeking proactive reproductive health information, both types of doctors may have waitlists for this service and there isn’t a centralized, easy way to find out which doctors do this. One of the reasons our founders started Turtle Health was because they realized how difficult this service can be to access. Turtle Health aims to empower you with information about your fertility from the convenience and privacy of home. And if we find something that would benefit from a second look or from more focused care, we’ll refer you to see an OB/GYN, Reproductive Endocrinologist, or any other type of doctor that our own clinicians think would be most helpful.

How can I contact you?

You can always contact us using our Contact Us form. You can also email support@turtlehealth.com at any time.

What’s with the Turtle?

Turtles have very special fertility journeys. They use magnetic fields to navigate up to 3,700 miles back to the beach they were born to lay their own eggs. Turtle Health is here to help you on your own unique fertility journey — even if it may not involve navigating back to your birth place to have your own kids.

I’ve already been trying to conceive. Can I get a virtual consult?

Yes! If you’ve been trying to conceive for less than 6 months (if you’re a woman over age 35) or less than 12 months (under age 35), doing a home consult can be a great way to get more information. It’s perfectly normal for it to take several cycles to get pregnant and most likely the testing will suggest that you keep trying. However, if we do spot something wrong, we can help you get to a fertility doctor faster.

If you’ve already been trying for over 6 months (over age 35) or over 12 months (under age 35), then you meet the clinical definition of infertility. You can opt to go directly to a fertility doctor in-clinic to potentially get treatment and support like IUI or IVF. However, if going in-person sounds like too intimidating of a place to start, then testing from home can be a great way to get some additional information and increase your comfort level with fertility care. Several of the doctors overseeing the ultrasound trial are fertility specialists, and if you decide you are open to in-clinic follow-up after testing at home, they may be able to help you take that next step, depending on how close you live to where they practice.

My doctor/hospital system recommended I do your consult. Why?

You may have received outreach because your health records suggest you belong to a group that is at higher risk for infertility. For example, you might have some symptoms of PCOS but have previously declined to do in-clinic imaging, perhaps because you felt it was invasive or expensive.

Or, your health system might be supportive of proactive fertility evaluation and sent you to us for a general workup.

Questions about my report

What information will I get? How will it be useful to me?

Turtle Health’s doctors look at all of the testing you had done: your health intake questionnaire alongside, if applicable, bloodwork, semen analysis, and investigational* at-home ultrasound (or ultrasound data from your local clinic, if you choose the “bring your own” option), to compile your personalized comprehensive fertility report. The report evaluates whether different types of fertility risks were observed and the severity of those risks. It also provides a total risk profile, considering all the different risks together.

Your report will help you understand how you look for your age. Female age is the largest driver of fertility risk on average in a population. Depending on your personal fertility goals and your risk tolerance, you can use that information to inform your family planning approach.

Can I send a copy of my report to my doctor?

Absolutely! On the last page of your fertility report, there is an option to share a copy of the report with your existing OB/GYN or other doctor. If you have any concerning findings, we can either share the imaging or other testing directly with your existing doctor, or help you find the right specialist. If you don’t already have a doctor you like but would like to be seen in-person, we can help you find someone.

Might my results change over time?

Yes — your results can change over time, and fertility can change especially quickly if you’re in your 30s. We recommend everyone retest every 2 years for the most accurate results, or more frequently if that is what is recommended in your personal report, based on your fertility risks.

What if I have questions about my report?

There is always someone to help answer questions about your report. If you have questions, please email support@turtlehealth.com.

How do I know my testing is accurate?

Giving you the most accurate results is our top priority. We invested in validation trials to make sure that each piece of our testing is as accurate as possible. Our investigational ultrasound already went through a peer-reviewed trial. It was presented as a late-breaking abstract at the national fertility society meeting in 2021, and published in the “Green Journal” (formally called Obstetrics & Gynecology) in April 2022. Our blood trial was presented at the PCRS conference, and a manuscript is pending. Our semen analysis was validated by the Cleveland Clinic’s andrology lab.

In addition, our management team has over 40 years of experience in delivering high quality healthcare. And our Advisory Board includes leading clinicians from a range of top institutions and relevant specialties. The clinical and management team regularly review patient data together for accuracy.

Of course, the accuracy of results also depends on following the instructions for each of the tests. We send very detailed instructions with each test, and if you have any questions, please reach out to support@turtlehealth.com.

No test is perfectly accurate. As with any test – whether at home or in-clinic – the possibility exists for inaccurate results, such as false positives or false negatives.

Questions about AMH testing (blood test)

What makes your AMH test different than other companies?

We utilize a device that collects blood from the upper arm. We’ve tested it for performance on three dimensions. First, it produces results that are more comparable to traditional bloodwork than other devices currently available for home use. Second, it is less painful than a fingerprick. And third, it is less prone to hemolysis (when blood cells explode). The abstract of this trial was presented at the PCRS conference and a manuscript is pending.

Our AMH test is a Lab-Developed Test that has been developed and validated pursuant to the Clinical Laboratory Improvements Amendments of 1988 (CLIA), and as such it has not been reviewed by FDA.

I’ve already had AMH testing done, do I need to do it again?

Using an AMH test that we didn’t validate independently or an AMH test that might be outdated could result in low quality results. Using the Turtle Health AMH test ensures a high-quality sample and analysis, and the ability for our providers to integrate the AMH results with the other tests a comprehensive report on your fertility.

I’ve heard AMH testing doesn’t predict fertility issues. Why do you do it?

On its own AMH only predicts a small subset of fertility issues. However, when combined with other tests (like a transvaginal ultrasound, patient health history, and, in the case of couples, semen analysis), it’s an important piece of the puzzle, because it tells us whether the immature follicles on the ovary are emitting an appropriate amount of hormone. AMH is most predictive in the context of IVF (and whether IVF may be a likely safety net for you, if you don’t want to get pregnant now). Studies are mixed on whether it is predictive of conception through sex, though most fertility doctors agree that very low AMH values warrant considering speeding up family planning and/or fertility preservation. You can learn more about what AMH testing, transvaginal ultrasounds, and semen analysis can tell you about your fertility on our Science page.

How much blood will you need?

Very little. Our test collects about a pea-sized sample.

Will it hurt?

Most patients tell us it is not painful. In our validation trial, patients reported an average pain score of less than 1 on a 10 point scale (for comparison, the pain score from a fingerprick was rated at 2.73/10).

Questions about investigational transvaginal ultrasound (follicles, uterine health, other)*

Wait, really? A transvaginal ultrasound?

Yep! Really!! Conducting a transvaginal ultrasound is often a very important piece of fertility testing. Fertility testing that doesn’t include a transvaginal ultrasound is unlikely to give you the full picture. A transvaginal ultrasound can help identify the antral follicle count, a proxy for the number of eggs that you have left; PCOS (when combined with a health intake questionnaire); and sometimes other ovarian issues like cysts. We also look for any uterine abnormalities that could affect an embryo implanting or growing, like fibroids. You can read more about why a transvaginal ultrasound is important on our Science page.

Turtle Health’s transvaginal ultrasound is “investigational,” meaning it is still being studied in a trial. If you choose to book a consult, you have the option to either get the ultrasound at home through the trial in select states, or go to a clinic and “bring your own” ultrasound data, which we can incorporate into your report.

Can I really get a transvaginal ultrasound at home?

Yes – for those who qualify. Turtle Health is currently sponsoring a clinical trial of self-administered, at-home transvaginal ultrasound.  Trial participants will receive a top-of-the-line ultrasound probe from our exclusive partner Clarius and conduct the scan during a telemedicine appointment with a remote ultrasound tech. At the time of the appointment, the ultrasound technologist provides guidance on inserting the probe and completing the scan. The ultrasound technologist will be able to see the ultrasound images in real-time. The complete scan process usually takes less than 30 minutes. No clinic visits or purchases are necessary. Click on Book My Consult to learn more.

How is an at home transvaginal ultrasound different from those I’ve had in a clinic?

In many ways, it’s similar. The device used in the clinical trial is currently FDA-cleared for in-clinic use, so the imaging technology and the device itself is identical to one you might find in an OB/GYN office. The difference is, of course, trial participants will not be in an OB/GYN office. Whereas in a clinic an ultrasound technologist may have inserted the ultrasound probe into your vagina, with Turtle Health, you’ll do this yourself with the help of an ultrasound technologist guiding you throughout the ultrasound over the phone. For the purpose of a fertility consult, the types of images collected will be similar whether you participate in the trial or provide ultrasound images collected in a clinic.

One way the ultrasound is different than in-clinic is that the home ultrasound is still being studied, so it can take longer to get the results of your imaging. Part of the trial entails sending your images to at least two “blinded” doctors to interpret the images. They will not be able to see your health intake questionnaire, only the ultrasound pictures and videos. This means it can take longer to get your results than if you went to a clinic for a scan, where the doctor on call often may interpret images the same day. We usually try to send you your report within 3 weeks of doing your home testing.*

Who administers the ultrasound? How does this work?

For those participating in the clinical trial: You do! With the help of an ultrasound technologist via telemedicine. Trial participants receive instructions, and the telemedicine ultrasound technologist can also answer questions during the scan. At the time of the appointment, the ultrasound technologist provides direction on inserting the probe and on controlling the scanner to collect the right images. Both participants and the ultrasound technologist will be able to see the ultrasound images in real-time, but the remote ultrasound technologist cannot otherwise see a trial participant’s room or body.

Is it safe?

Transvaginal ultrasonography is generally low risk and has a long and excellent safety record according to the FDA. A meta-analysis involving over 1,000 scans did not find a single published severe adverse event related to administration of a transvaginal ultrasound.  While this record reflects in-clinic ultrasound use, our previous, peer-reviewed clinical trial involving self-performed ultrasound did not identify any new safety concerns. Self-performed ultrasound is not yet authorized by FDA for use outside of clinical trials, so Turtle Health is currently sponsoring just such a trial to further demonstrate the safety and efficacy (and potential convenience) of home scanning. That trial is conducted by independent investigators under the oversight of an institutional review board to ensure all participants are protected and well-informed in their choice to participate.

Can I get the ultrasound for purposes other than a fertility/infertility consult?

Yes! The investigational ultrasound can be used for any non-obstetric (meaning you aren’t pregnant) and non-emergent (meaning it’s not an emergency) case where a doctor decides that an ultrasound scan is appropriate. For example, you might have been told that you need regular cyst monitoring and want to try doing this from home. If so, choose the “Ultrasound trial only” option under Book My Consult. Once you’ve completed the screening questionnaire, it is helpful if you can email the trial manager at support@turtlehealth.com with any background on why you are requesting this scan. However, as the ultrasound is still in a trial, the accuracy for these uses is still being studied.

Do I have to pay for the ultrasound?

No! The ultrasound is currently investigational, meaning it is still being studied. So: there is no charge to participate in the ultrasound trial. The charges for the consult apply only to the bloodwork, semen analysis, and physician review. The price for the consult is the same whether or not you choose to additionally and optionally enroll in the ultrasound trial.

Can I get only the ultrasound without the rest of the consult?

Yes! When you go to Book My Consult, choose the ultrasound trial only option and follow the instructions.

Can you diagnose PCOS?

For a doctor to diagnose a patient with PCOS, two of three Rotterdam Criteria must be present: 30 or more antral follicles on the ovaries, irregular menstrual cycles (generally greater than 35 days or otherwise quite irregular), and excess hair growth. We ask about irregular cycles and hair growth in the health intake questionnaire. And typically on the ultrasound, the doctors are able to see the number of follicles (in around 96% of images in our previous trial, the follicles were able to be counted). Thus, we are able to tell you whether you likely have a high risk of having PCOS. However, as the ultrasound is investigational – meaning it is still being studied – home evaluation cannot definitively confirm PCOS.

Moreover, women’s follicle count varies somewhat from month to month and from one physician interpreting the scan to another. If your AFC is just above or just below 30, you might see variation from one month to another or one doctor to another, in terms of whether you are considered to have PCOS.

Questions about semen testing

What can you tell me about my sperm?

Semen analysis will test semen for Total Progressive Motile Count (how many sperm swim forward) as well as sperm shape (morphology). You can read more about semen testing on our Science page.

What makes you different from other semen analysis providers?

Turtle Health utilizes the Cleveland Clinic for semen analysis, to ensure you receive the highest quality information.

Our semen analysis is a Lab-Developed Test that has been developed and validated pursuant to the Clinical Laboratory Improvements Amendments of 1988 (CLIA), and as such it has not been reviewed by FDA.

How do I know my semen sample will be well protected?

Your semen sample will be processed by the Cleveland Clinic. Their lab has received many certifications and awards. The Cleveland Clinic and Turtle Health track when each semen sample has been destroyed after testing.

What are my semen storage options?

Semen storage is not a great option for most couples, as it can limit you to IUI/IVF. But contact us if you want options, and we’ll point you in the right direction.

Questions about who can test

Can I test if I’m pregnant or might be pregnant?

If you’re pregnant, you cannot do a fertility consult. The results may not be accurate while pregnant.

If you are actively trying to conceive, you are welcome to book a consult. If you get pregnant after you’ve booked but before the date of your home testing, let us know and we will refund you.

I’m in a couple with a partner of the opposite sex. How can we get testing?

The Turtle Health Couples Consult sounds perfect for you. You’ll both fill out a health history and we’ll order you the tests our doctors deem appropriate for a full workup. While individual cases may vary, this typically includes a transvaginal ultrasound (for the woman), an AMH test (for the woman), and a semen collection kit (for the man). All testing is self-performed at home and processed in one of our partner labs, with the exception of the transvaginal ultrasound which may either be performed in a local clinic or obtained by participating in our clinical trial. Check out our Couples option here.

I’m not currently in a relationship. How can I get testing?

We currently offer a female-only Turtle Health Consult for women who want a personal work-up. You will fill out a health history and we’ll order you the tests our doctors deem appropriate for a full workup. While individual cases may vary, this typically includes a transvaginal ultrasound test, and an AMH test. All testing is self-performed at home and processed in one of our partner labs, with the exception of the transvaginal ultrasound which may either be performed in a local clinic or obtained by participating in our clinical trial. Unfortunately, we don’t currently offer a Turtle Health Consult for a man testing alone, but we hope to in the future. Feel free to use the Contact Us form if you are a man interested in testing your fertility and we’ll be in touch with updates.

I’m in a partnership with another woman. How can we get testing?

We suggest that each partner interested in learning more about her fertility purchase her own female-only Turtle Health Consult. If you are interest in receiving a joint coaching session afterward, you can reach out to support@turtlehealth.com for an authorization so we can have a doctor review both partner’s data together and provide guidance directly tailored to your specific fertility goals. We’re also working on a fully integrated consult for couples like you – please use the Contact Us form if you are interested in hearing updates!

I’m in a partnership with another man. How can we get testing?

We don’t offer this yet, but we hope to in the future. Feel free to use the Contact Us form if you would like to be an early adopter.

I’m a trans man. Can I use your product?

We welcome transgender, gender nonconforming, and non-binary people, and can support our investigational at-home transvaginal ultrasound* for many people who were assigned female at birth—reach out to support@turtlehealth.com.

I’ve already had a child (or more!). Does it still make sense for me to get tested?

Definitely! Your fertility changes over time, and can change quickly, especially once you’re in your 30s. Even if you’ve already had a child (or multiple!), if you are still thinking about having more kids in the future, testing can empower you with information about how to make that happen, and when it might make the most sense to start trying!

I’m a woman older than 38. Should I get tested?

It may make sense to start with a counseling session. Reach out to us at support@turtlehealth.com.

What if I don’t want to do a particular test?

If there are certain tests you are unwilling to perform, you should indicate them in your health intake. You will receive a report based on what you conduct. We suggest you follow your doctor’s personalized recommendations in order to get the most out of your virtual consult.

Since the ultrasound is investigational, meaning it is still being studied, we offer the option to “bring your own” data if you have an ultrasound done at a local clinic, or you can optionally book the consult without the ultrasound, though the information may be less complete.