Science - Turtle Health

Our Publications

Green Journal – Ultrasound Clinical Trial | 2022 Read
Reproductive Biology and Endocrinology – AMH Blood Testing Clinical Trial | 2022 Read
AMH Validation Abstract at PCRS Conference | 2022 Read
Ultrasound Late-Breaking Abstract at ASRM Scientific Congress | 2021 Read

Our Collaborations

Mayo Clinic Bringing Gynecology Care to Patients’ Homes Read
Clarius Health Building a Patient-Enabled Gynecology Solution Read
YourBio Health Establishing Reliable Serum At-Home AMH TestingRead

Our Past Clinical Trials

Blood work Anti-Müllerian Hormone (AMH) – At My Home Read
Ultrasound Sonograms Enable Looking Forward (SELF-HELP) – Home ultrasound examinations Read
Semen analysis Evaluation of New Semen Collection & Transportation kit Read

Disclaimer:

The information that follows discusses a consult that might be done at a fertility doctor’s office or at home through the Turtle Health virtual clinic: health questionnaire, blood work, semen analysis, and ultrasound. It is up to the doctor to prescribe the right testing for you after reviewing your health information.*

What risk factors lead to infertility?

Fertility risks can be caused by a variety of factors, from lifestyle to hormone levels to age and abnormal sperm shape. To predict if a couple will experience fertility challenges, doctors look at various aspects of biology to understand all possible causes. If we look for just one cause, we risk missing others.

Click on the interactive wheel below to learn more about fertility risks and testing.

Which tests are used to assess fertility risk?

Select one or more tests to see which fertility risks they assess.

How to use the diagram

The left side represents male biology.

The right side represents female biology.

Select the tests commonly used in fertility assessments to see which risks they assess. In some cases (e.g., ovarian reserve), a combination of several tests is needed for a more accurate conclusion. Striped shading means that more than one test is needed to predict that risk accurately.

Each segment represents a condition or risk factor for infertility. The segment’s size roughly represents significance of the factor, or the ability for the factor to predict infertility.

The bar scale symbol next to each test illustrates the impact of that test on the risk (i.e., level of predictive power).

What is the scientific basis for comprehensive testing?

There is evidence from two landmark studies that comprehensive testing can help identify people at risk of infertility – before they are diagnosed with infertility.

The Peterson study followed about 500 women over several years. It showed that gathering 21 data points from three tests – blood work, ultrasound, and health questionnaire – could stratify women into three risk groups. Within these risk groups, women who had greater risk factors took longer to get pregnant and had lower overall pregnancy rates.

Another study using real-world data from Utah analyzed 11 data points across thousands of men to predict probability of pregnancy. Certain risk factors led to a lower rate of pregnancy in a couple. Factors like sperm quality combined with smoking history led to lower rates of paternity than sperm quality alone.

Why doesn’t blood work alone tell the full story about female ovarian reserve?

Ovarian reserve refers to the quantity of eggs a woman has left. Doctors usually use two types of assessments to estimate ovarian reserve: Anti-Müllerian Hormone (AMH) bloodwork, and antral follicle count (AFC) which counts the visible immature follicles on a woman’s ovaries via ultrasound.

While AFC and AMH are often correlated, there could be instances where they’re not – given they measure slightly different underlying biological mechanisms. For example, some women have a large number of eggs emitting less-than-expected amounts of AMH. Others may have fewer eggs, but with robust hormone levels. Where possible, doctors look at both metrics to get a complete picture of ovarian reserve.

Why is semen analysis alone not enough to test male fertility?

Semen analysis is valuable in understanding the male factor in infertility, but it is only one piece of the puzzle. Semen analysis tests for the total number of sperm that swim forward (Total Progressive Motile Count, or TPMC), as well as sperm shape. However, some studies have shown that lifestyle factors are an even larger predictor of fertility for men.

Also, semen alone only accounts for about 20% of infertility risk in a heterosexual couple.

What does a Turtle Health investigational ultrasound* look like?

Image of Turtle Health patient ultrasound. Dominant follicle is the black round structure.
White dots call out 4 antral follicles seen.

*The Clarius Ultrasound Scanner is cleared by FDA (K213436) for diagnostic ultrasound imaging in gynecological applications, in environments where healthcare is provided by trained professionals. In-clinic, cleared scanners are used for gynecologic imaging that is a component of fertility evaluation, when reviewed by a doctor together with other testing, in the majority of IVF and many OB/GYN clinics around the US. The Turtle Health clinic is currently investigating the remote use of the Clarius Ultrasound Scanner for gynecologic imaging in a clinical trial, and the uses under investigation have not been authorized by FDA. The clinical trial is currently IRB approved and recruiting participants in the following states: MA, NH, ME, VT, DC, MD, VA, UT, FL, and TX. For more information about participating in the clinical trial, see Book My Consult or FAQ pages.