Here’s what you need to know about your fertility in your 20s and 30s
A year after having my daughter, my husband and I started trying for a second child–being in my late 30s, I knew I didn’t have the luxury of waiting a few years–but I knew that something wasn’t right. Although I had stopped breastfeeding, my period never really came back after my pregnancy. My ob/gyn brushed it off, but a year later, after still not conceiving, I had a hysteroscopy and a diagnosis: Asherman’s Syndrome and endometriosis.
I had an emergency c-section with my daughter and my uterus had extensive scarring as a result. My doctor felt the scarring was so significant that the likelihood of carrying another pregnancy to term is low and the likelihood of conceiving in the first place is even lower.
I’m grateful for my daughter, of course, but secondary infertility is still tough–you have to let go of the vision you had for your family. So many friends who were pregnant around the same time I was with my daughter are now having their second child and while I’m happy for them, I have to admit that it hurts to see their kids interacting and knowing my daughter will never have a sibling relationship.
The point is: infertility is something we should be able to talk about. And if you’re thinking of starting a family, even if it’s not for several years, fertility should be on your mind. I recently spoke with Dr. Rashmi Kudesia of CCRM Houston, a CCRM network clinic, about what those of us in our 20s and 30s should know about fertility.
Women are waiting longer and longer to start a family. As someone who waited until her mid-30s to have her first child, I kind of love this trend–I feel like I was in a really good place in my life to become a mother and I can’t imagine feeling so prepared in my 20s. As a physician, do you view this trend differently?
Pregnancy, childbirth and parenting are all life-changing experiences that can be very joyful, but also incredibly stressful. I don’t believe that women should choose to alter their life plan based on fear that they may encounter infertility if they wait. Of course, no one is ever truly “ready” for the shift into parenthood, but an ideal pregnancy might involve taking the time to establish healthy habits before pregnancy, discussing plans with your healthcare provider, and taking stock of your personal and financial circumstances and goals.
For many women, just as this mom said, that may happen in their 30s. However, these decisions should be made with as much information as possible. Our ability to spontaneously get pregnant, assuming no other major diagnoses, is about 25% each month at age 25 and closer to 5% by age 43. So, as a physician, I would recommend any woman in her mid-30s or beyond (or younger women feeling anxiety on this topic!) who wants children but not in the imminent future to seek consultation with their gynecologist, or even better, with a fertility specialist.
The goal would be to review your specific gynecologic and medical history, ideal family-building plans, and current ovarian health. Though there is no way to fully predict the future, this information can prove reassuring or an impetus to consider egg or embryo cryopreservation.
We take a holistic view of health on Hello Glow. What can women do to best prepare their bodies for pregnancy?
The best preparation for pregnancy involves a little bit of planning and some discipline too!
On the more medical side of things, I encourage women to talk to their gynecologist about a preconception evaluation. This can include a review of one’s history to pinpoint any potential problems (irregular cycles, history of pelvic inflammatory disease or infections), optimize any medical problems (especially hormonal or metabolic conditions like thyroid disorders, hypertension or diabetes), and consider the option of genetic screening to minimize your chances of having a baby with a genetic diagnosis (like cystic fibrosis, Tay Sachs and so forth).
On the lifestyle side, try to incorporate the habits of a healthy lifestyle – eating cleanly, moderating caffeine and alcohol intake, curbing drug usage, and getting regular exercise (usually 2-4 times weekly depending on intensity). Being stable at a healthy weight improves the prognosis for conception, pregnancy and childbirth, so it’s an investment in mom and baby that’s definitely worth making! And start a prenatal vitamin well ahead of time (studies show that even pre-pregnancy vitamin use can make a difference!).
How do you define “trouble conceiving”? At what point should a woman start feeling concerned?
Things that should definitely prompt a visit with a fertility specialist include trying to get pregnant without success for 12 months if under 35, or 6 months if 35+, as well as 2 or more miscarriages.
On top of this, anyone who suspects they may have an underlying issue – irregular cycles, prior pelvic infections, fibroids or endometriosis, prior history of radiation or chemotherapy for male or female partners – should consider just coming in for an initial evaluation rather than waiting.
That said, just meeting one of these criteria isn’t necessarily a cause for concern. Often times, just a minimal intervention (or none at all!) does the trick after someone comes in for consultation in these circumstances. I would love it if women viewed their visit as an information-gathering one that would hopefully remove some anxiety and help them feel like they have a concrete plan to move forward – rather than something to give them more stress!
When I was having trouble conceiving, I got all kinds of well-meaning but not very useful advice–the most common being to relax and stop stressing about it. Can stress impact fertility?
There is an over-abundance of non-useful fertility advice out there! “Just relax” is one of them. Making women feel guilty for their anxiety is simply not useful. The scientific literature on stress and fertility is conflicting, but the summary is this: high-level stress and anxiety will not completely prevent pregnancy. Our physiologic stress response is tempered by personality and other psychological factors, and so some women may experience more of a reproductive impact from stress than others.
Though we know extreme events like famine or war have substantial negative impacts on fertility, the impact of daily life stressors are harder to quantify. But because there’s no reason to suppose that having a lot of stress is good, I do encourage my patients to take time for self-care and do things that bring them joy, strengthen satisfaction and intimacy in their marriage or relationships with friends and family, or otherwise engender peace of mind. There are other health benefits to developing healthy techniques for stress management, and so I encourage it, but going overboard and trying to squeeze in activities that sound good but don’t actually make you feel calm is counter-productive!
What’s the first line of treatment for infertility? And what would you tell women who are concerned about the cost?
The first line treatment for infertility does vary a bit, but an evidence-based scientific diagnostic evaluation is the first step.
For most, the first treatment will involve minimal medication, mostly oral, with timed intercourse or intrauterine insemination. There are a few specific situations (very low sperm counts, planned screening for genetic mutations, both tubes blocked, or desire for future fertility preservation) that necessitate “going straight to IVF.” Your initial fertility consultation should describe which of these options is likely most appropriate, and how much your insurance will cover.
The good news is that more minimal interventions can cost “just” a few hundred dollars but still confer some benefit! Though IVF without insurance coverage costs on average $12,000 in the U.S., meeting with a finance counselor can help you determine what your specific costs would be, and whether you might qualify for assistance programs or payment plans to bring the cost within reach. I would never encourage someone to skip the consultation because of a presumption that the treatment will be too costly.
Are there any myths about infertility treatments or fertility in general you’d like to debunk?
There have been whole scientific papers written about the preponderance of myths related to fertility! But if I had to pick a few, I’d say this: first, all fertility clinics are not the same. They vary a lot in style of practice, success rates, and supportiveness. At CCRM, we are dedicated to providing people who want a family with the very best chance to do so; this means industry-leading fertility research and innovative technology and equipment, as well as award-winning physicians who value excellent care unique to each patient. You should do some research on local options and see if you can get a recommendation from family or friends. You want a doctor who will take the time to listen to you and make a treatment plan with which you both feel comfortable, pricing structures that are transparent, and (if you’re doing IVF) high success rates in the laboratory. A convenient location, empathetic nursing staff and other amenities like on-site nutritionists, mental health professionals or acupuncturists will also improve the experience dramatically!
And on a more medical note, I find there is a lot of confusion over birth control pills. Though you’re typically not ovulating while on them, your fertility still declines with age. The period experienced on pills does not reflect your own cycle, so after coming off, you may find it has changed (shorter, longer, heavier, etc.) since the last time you had spontaneous cycles. While it may take time for your cycle to resume after stopping pills, some women get pregnant right away, so be prepared for either outcome! These are not reasons to avoid pills, which can be a lifesaver for many women, but just factoids to be aware of.
Finally, take your pop culture news with a grain of salt. Each time a celebrity over 45 has a child, I get a wave of patients coming in to discuss their chances. Public figures don’t (and shouldn’t have to) always disclose that they may have used donor or previously-frozen eggs to achieve pregnancy, or gone through many cycles at a price tag that would not be feasible for most women. Some 44-year-olds conceive naturally and some 28-year-olds have difficulty. You have to know your own situation, and not rely solely on averages and press releases!
Dr. Kudesia is Board-Certified in Reproductive Endocrinology and Infertility by the American Board of Obstetricians and Gynecologists. She joined CCRM Houston in 2018 after practicing in New York City, where she was named a “New York Super Doctors Rising Star” in 2016 and 2017. She actively promotes women’s health and wellness on social media via Twitter, Facebook and Instagram.
There you have it – the time is now! #LetsTalkFertility.
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