Article| Volume 46, ISSUE 3, P642-650, March 2023

Direct-to-consumer fertility testing: utilization and perceived utility among fertility patients and reproductive endocrinologists

Published:November 17, 2022DOI:


      Research Question

      What is the utilization of direct-to-consumer fertility tests (DTCFT) among fertility patients? How does the perceived utility of DTCFT differ between patients and reproductive endocrinologists (REI)?


      Infertility patients visiting the Duke Fertility Center between December 2020 and December 2021 were sent an electronic invitation to participate in a patient survey. Members of the Society of Reproductive Endocrinology and Infertility were also sent e-mail invitations to participate in the REI survey. DTCFT were defined as tests not ordered by a physician or performed at a physician's office, including calendar methods of ovulation prediction, urinary ovulation prediction kits, basal body temperature (BBT) monitoring, hormone analysis, ovarian reserve testing and semen analysis. Patients and REI were asked how likely they were to recommend a given DTCFT, on a 0–10 Likert scale.


      In total, 425 patients (response rate 50.5%) and 178 REI (response rate 21.4%) completed the surveys. Patients reported the utilization of calendar methods of ovulation prediction (83.8%), urinary ovulation prediction (78.8%), BBT monitoring (30.8%), hormone analysis (15.3%), semen analysis (10.1%) and ovarian reserve testing (9.2%). REI rated the utility of all DTCFT significantly lower than patients did (average discordance –4.2, P < 0.001), except for urinary ovulation prediction, which REI gave a significantly higher score (discordance +1.0, P < 0.001). Prior pregnancy was significantly associated with home ovulation prediction utilization among patients (adjusted odds ratio 3.21, 95% confidence interval 1.2–9.83).


      Methods of ovulation prediction are commonly used by fertility patients. Significant discordance exists in the perceived utility of DTCFT between patients and REI. Patient education and guidelines are needed to better inform individuals considering DTCFT.

      Key words

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      Benjamin J. Peipert, MD, is the Education Chief Resident in Obstetrics and Gynaecology at Duke University, USA. Ben is a passionate provider and advocate, research interests including access to care, medical innovation and health policy. After his residency, he will start his fellowship in Reproductive Endocrinology and Infertility at the University of Pennsylvania, USA.
      Key message
      Ovulation prediction tests are commonly used among fertility patients. Reproductive endocrinologists gave significantly lower utility scores for all forms of direct-to-consumer fertility testing compared with patients, except for urinary ovulation prediction. Patient education and guidelines are needed to better inform individuals considering direct-to-consumer fertility tests.