What All Twenty-Something Women Should Know About Fertility
Yesterday marked the beginning of National Infertility Awareness Week, and even though I, a 21-year-old single woman, feel so far from even considering what my fertility options look like, this week kicked my curiosity into high gear. Besides what I learned in high school, I realized I knew so little about what my body was (or might not be) capable of and how my current lifestyle could affect those options in the future. Like, embarrassingly little for someone who would like to have children one day. It seemed to me like if I asked questions about infertility that I might be seen as overreacting or thinking way too far in advance — and I’m not alone in those thoughts.
The Colorado Center for Reproductive Medicine (CCRM), one of the nation’s leading fertility treatment centers, found that 40% surveyed Americans believe that infertility is a socially taboo subject, which can keep the topic on the DL. Fortunately, CCRM is looking to change all that by talking openly, honestly, and positively about infertility and family planning.
We rounded up some of our top questions about fertility, family planning, and myths we’ve heard and posed them to our friend over at CCRM, Dr. Rashmi Kudesia, who is Board-Certified in Reproductive Endocrinology and Infertility by the American Board of Obstetricians and Gynecologist. She’s busting our misconceptions, laying all the cards on the table, and starting a conversation about this topic that affects 1 in 8 U.S. couples. #LetsTalkFertility
How much does my age affect my fertility? What should I know about freezing my eggs? At what age should I start thinking about freezing my eggs?
Age is one of the main determinants of fertility, and unfortunately, our ovaries have not recognized that life expectancy has doubled over the past few millennia! Our natural ability to get pregnant still starts decreasing in the 30s and pretty much tapers off by the mid-40s, due to two factors. Not only does the number of eggs we have available (“ovarian reserve”) go down, but the chances for each to be chromosomally healthy also declines. The advantage of freezing eggs is that the ability to turn into a healthy pregnancy is determined by the age at freezing, and not of when you might actually use them! If by the early to mid-30s it seems that pregnancy is still years away, egg freezing is worth at least investigating. At any age, important changes like your menstrual cycle getting shorter or skipping months altogether should be investigated because they can be signs that your ovarian health is changing.
My partner and I have been trying to conceive for over a year — should we start worrying? When should we seek medical intervention?
Unprotected intercourse without pregnancy is considered “infertility” after a year for women under 35, and after 6 months for woman 35 and up. While I would definitely seek a fertility evaluation at this point, I would also say it’s too early to “worry”! In many instances, the evaluation turns up simple fixes, or a minor intervention does the trick. I would make the appointment with a reproductive endocrinologist and treat it like an information gathering session to understand what the diagnostic evaluation and first steps could be. From there, you and your partner can decide what you feel comfortable with, though I would encourage starting at least minor medical interventions at that point.
I feel alone in struggling to conceive — how many women are struggling like I am or dealing with infertility?
You are not alone! In the US, 10-15% of women and couples have difficulty conceiving, making it much more common than many people realize! One in every 4-5 pregnancies ends in miscarriage. Because struggling with these situations is stressful, sad, or sometimes stigmatized, people hesitate to share their stories. Chances are, you know other women sharing your situation! Local or online support groups through your fertility clinic or patient advocacy groups like RESOLVE can help you feel more of a sense of community.
Is my birth control affecting my chances of getting pregnant when I want to?
Birth control does not diminish your fertility, and in fact can help prevent progression of things like endometriosis, adenomyosis, and uterine fibroids that can detract from natural fertility. However, there are a few key things to know about birth control. For some women (but not all!), it can take months after stopping birth control before you resume ovulating. Also, because hormonal birth control influences your own menstrual cycle, you may not get the hints that something is wrong, like changes in the length of your cycle or how heavy your flow is. Overall, though, birth control is an incredibly effective and safe option — and there are many forms of contraception aside from pills you can consider!
What is endometriosis? How do I know if I have it? If you do have endometriosis, what should you know about fertility?
Endometriosis is a condition where the type of tissue that normally lines the inside of the uterus (the endometrium) grows elsewhere in the body. It can cause scar tissue in the pelvis, potentially blocking off the Fallopian tubes, or ovarian cysts, and can even grow in faraway locations like the lungs! The diagnosis is a bit tricky (partly why so many women experience a delayed diagnosis and we’ve seen more public campaigns to raise awareness now!), but extremely painful periods can be one of the tipoffs and definitely something to discuss with your gynecologist. If you are having symptoms, minimally-invasive surgery may be indicated to confirm the diagnosis and hopefully help diminish pain. These surgeries can be complex and should be done by a surgeon experienced in endometriosis cases.
From a fertility perspective, endometriosis can cause tubal blockage or decrease ovarian reserve. Women with endometriosis should definitely come in on the earlier side to see a reproductive endocrinologist when they’re ready to conceive, consider freezing eggs at an early age (especially if they have a history of ovarian cysts or cyst removal), and at the minimum talk to their doctor about using hormonal treatment to minimize disease progression and how they can track their ovarian reserve.
What is PCOS and how do I know if I have it?
Polycystic ovary syndrome (PCOS) requires at least two of three signs or symptoms for diagnosis: irregular or absent menstrual cycles, high androgen levels (the “male” hormones, like testosterone) or hirsutism (excess facial or body hair), and a polycystic appearance on vaginal ultrasound. Know that having ovarian cysts in the past is not a part of the diagnosis and nor does it mean you have PCOS! If your cycles are irregular (not coming every 21-35 days), discuss this possibility with your gynecologist. If you get the diagnosis, make sure the impacts on your reproductive system, as well as on your metabolism, cardiovascular system, and mental health, are discussed!
Should I be taking any supplements or vitamins to increase my chances of fertility?
Any time you are having unprotected intercourse, you should be on a prenatal vitamin! Though that sometimes scares people who aren’t regularly taking birth control but aren’t exactly trying to conceive, it is the best advice. By the time you know you’re pregnant, you’re already four weeks along, and there is evidence to suggest that vitamin use prior to pregnancy is good for children.
Aside from this, though, supplements are unfortunately not very well-studied or regulated. There may be some specific supplements that could augment your particular situation, especially if you have PCOS or lower ovarian reserve. Acupuncture is another option that many women opt for when trying to address fertility issues. Discuss with your fertility specialist which specific approaches are best for you — they are not one size fits all!
What does family planning look like for single mothers or for partners?
Every family is unique in its own ways, and thinking through your specific challenges, whether single or partnered, is critical! For many of my patients who are single moms, this planning means finding local communities of other single parents, having honest conversations with family and friends about how reliably supportive they will be, and advance-planning backup options for how they will balance all their commitments if they develop a pregnancy complication, or their baby gets sick, etc.
For partners, it means understanding that the physical processes of trying to conceive or being pregnant are incredibly emotional and also rife with hormonal changes! This time is all about being generously supportive, and not feeling jealous of how priorities or life are changing, and kindly and preemptively addressing any concerns you might have over your partner’s well-being and health before, during or after pregnancy.
What are lifestyle habits I should be breaking now to increase my chances of fertility? What habits should I be forming? Are there foods that impact fertility?
The most important lifestyle habit to avoid is cigarette smoking. Aside from all the other health risks, tobacco is also toxic to sperm and eggs, and can make the ovaries age faster. In general, I advise for a clean lifestyle – curbing drug use, moderating alcohol use or abstaining altogether, focusing on lean proteins and vegetable intake, cutting out sweetened beverages like sodas or juices, and getting some good heart-pumping exercise a few times weekly. Take your prenatal vitamin regularly, and work toward limiting caffeine intake to 200mg daily (about one cup).
Though many myths are out there about pro-fertility foods like pineapple core, we don’t have any scientific studies to prove or disprove these! Sometimes people get very extreme in trying to perfect their lifestyle, but I don’t like my patients to give themselves extra stress by being too strict — the key is moderation and putting your health first!
What are common misconceptions you hear about fertility?
There is good scientific literature to demonstrate that many people, regardless of their background, education, or job, don’t fully understand the facts about fertility! Perhaps the most common misconceptions have to do with fertility rates — even at our peak fertility in the mid-20s, the monthly chance of conceiving (if egg and sperm are present and intercourse happens around ovulation time!) is about 25-30%! By the time we are in our early 40s, that number is down to 5-10%, and even IVF is not guaranteed to succeed (though success rates continue to rise with improvements in technology).
Many people are never taught the basics of timing intercourse, or understanding the signs that suggest if and when a menstrual cycle is ovulatory. Talk to your gynecologist if you need a primer! It’s also important to know that about a third of infertility cases are due to a male factor, and so a semen analysis is important –]— even if your partner is completely healthy, has had children in the past, and so on, I always recommend a recent evaluation!
What are the top causes of fertility problems?
Each of the major reproductive organs contributes to the list of top causes of fertility problems. From the ovarian perspective, fertility diminishes with age or if one doesn’t ovulate regularly. Tubal blockage can occur due to endometriosis or prior pelvic infection. Uterine fibroids, polyps or scar tissue can prevent embryo implantation. Other hormones, particularly your thyroid, can impact your fertility. And abnormal sperm numbers make up about a third of fertility problems too! The good news is that a basic fertility evaluation can review all of these issues, and complete a full evaluation within a few weeks at most!