The psychological impact of ovarian reserve testing: a qualitative analysis

Abstract

To investigate the psychological and emotional responses of women being informed of their Anti-Mullerian Hormone (AMH) result with a view to informing the possible introduction of universal AMH screening for young women. Prospective qualitative study using semi-structured in-depth interviews of women attending a reproductive medicine clinic who had ovarian reserve testing performed via measurement of serum AMH levels, as part of their fertility work-up. A semi-structured interview schedule was developed after a review of the literature. Hospital Ethics Committee approval and participant informed consent were obtained. A broad range of women, in terms of age and AMH levels, were recruited. Data collection continued until thematic saturation was reached (n=10). Interviews were audiotaped, transcribed verbatim and imported into QSR NVivo for analysis. The following areas were explored: (i) Pre-test knowledge of AMH testing (ii) Experience of being informed of the result (iii) Initial feelings when given AMH result (iv) Longer-term feelings regarding result (v) Effect, if any, of AMH result, on childbearing intentions of the woman and of the couple, (vi) Subjective views of the advantages and disadvantages of having an AMH test and (vii) Feedback for the clinic regarding experience of AMH testing to help improve patient experience. Using thematic analysis, the sorted categories evolved into a coding system, which was applied independently to each transcript. Interview analysis identified the following dominant themes. Women were often unaware of the clinical relevance of the test, and their main source of information was the internet, rather than a medical practitioner. The result of the test determined the woman’s initial and subsequent feelings about the result. Those with a low AMH level reported feelings of devastation, isolation and loss of femininity and purpose. With a normal result, the overwhelming theme was reassurance and surprise that the result was normal. Overall, women felt that knowledge of their ovarian reserve was of paramount importance and it guided their decision making in relation to childbearing intentions. These opinions and views were consistent among the interviewees regardless of their AMH result. This is the first study to investigate the psychological impact of AMH testing. Although an exploratory study, the women in this study advocated to provision of ovarian reserve testing. However, knowledge of a low AMH result has a negative psychological impact. This must be anticipated and appropriate supports put in place prior to implementing universal screening. The results of this initial qualitative study will be used to identify suitable measures and develop a detailed quantitative questionnaire for the next stage in this study which will recruit a larger and more representative sample of women.