You may be a regular reader of The Fertility Advocate, or you may have stumbled over my blog in an internet search. I don’t know where you are in your family building journey – you may just be thinking about getting pregnant – or you have have been trying for several months. And you are looking for answers. I have spent what feels like a lifetime talking about the female biological clock. I even got to bring that conversation to Oprah in 2002 – and I am still talking about it, writing about it – and coaching women, men and couples about how to take charge of their fertility.
The problem is, an awful lot of what’s out there about fertility and reproduction is pulp fiction. The blurring of fact, opinion, myth and misunderstanding makes for a treacherous misinformation landscape. The knowledge gap has claimed millions of victims, people who learned about the fundamentals of protecting and preserving fertility too late to help them have genetically linked offspring they always assumed would be theirs. Armed with essential and accurate information, you don’t have to join their ranks.
What is still not understood across the board is the time line of the biological clock. And most of us don’t have a clue about our own.
So the big question is – what do you know about your fertility?
Well, if you’re like most people, the answer is not as much as you might believe. Just to give you a little perspective, a spate of recent surveys reveals that the overwhelming majority of U.S. women:
· Don’t understand the biological clock – the trajectory of reproductive capabilities from its peak in the early-to-mid-20s to the age of inevitable decline beginning, typically, around 27.
· Mistake overall good health for an indicator of fertility. However wonderfully youthful and fit a 42-year-old might be, her eggs are operating on an independent and fixed timeline.
· Believe they can get pregnant easily until their 40s. The stark truth is women at that age are more likely than not to require medical intervention.
· Are unaware that men, too, carry a ticking reproductive timer.
· Don’t know that lifestyle factors—sleep, diet, exercise and environment, for instance – can have a profound effect the ability to have a child.
Yet this basic information can make a critical difference in the life of every person who dreams of having a child this year, next, or 10 years down the road. If you know about your body’s reproductive lifecycle, you can take steps to protect and preserve your fertility. That way you can have the children you want– if and when you choose.
Start Where You Are: Get To Know Your Baseline
Statistics and general truths aside, every woman is unique. Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool. Consider an annual fertility evaluation or screening.
It is very likely have never heard of a fertility evaluation, and you’re in good company. It’s very likely that even your doctor will give you a blank stare at the mention of a Fertility Evaluation. That’s because it’s a relatively new concept. Simply put, the screening involves a few simple blood tests and an ultrasound to get a handle on your ovarian function. These tests have been around for years, tried and true tools in the diagnosis and treatment of compromised fertility. The piece that’s different is using them in the context of preventative fertility.
Taken together with your individual and your family’s medical histories, the screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there is problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.
More about the nuts-and-bolts of the screening later. First, let’s talk about why the evaluation is so important.
Marking Time: The Biological Clock and You
Let’s start at the beginning. Each woman’s oocytes (eggs) supply is finite. That means the body doesn’t produce new ones. So the 7 million or so eggs each female is born with is all she’s going to have. Ever. By the time the average girl hits puberty, only about 250,000-300,000 oocytes remain in her ovaries. With each menstrual cycle one egg become ripe enough for fertilization and is released. An additional thousand eggs each month are lost through a process called artresia, the natural breakdown of the eggs by the body. After ovulating an average of 400 times through her life, typically around 50 years of age, the store of oocytes is tapped out. That’s menopause.
Then there’s the matter of oocyte aging. Eggs age along with the rest of the body. The older oocytes are more likely to have chromosomal abnormalities making them unlikely to become viable embryos. It’s important to note that a fertilized egg with abnormal chromosomes is the single most common cause of miscarriage. A woman in her 20s has only a 12%-15% chance (about one in every eight pregnancies) of having a miscarriage each time she becomes pregnant. On the other hand, a woman in her 40s faces a 50% risk of miscarriage (that’s one in every two).
Despite the amount of ink and airtime that’s been lavished on the biological clock, most women still don’t know about the direct, inverse relationship between age and procreation. The bottom line is the older we get, the less likely we are to conceive and have a successful pregnancy. What’s harder to grasp is that in this context, women qualify for “older” at 27. You read it right. Statistically speaking, when a women hits 27, her fertility begins an exorable decline. When she hits 35, it take a sharp downturn. At 40, fertility falls off the edge of the earth.
Of course, some women in their late 30s and a few in their 40s conceive effortlessly, carry and deliver healthy babies. But the likelihood of that happening without medical intervention becomes more remote with each passing year. For women under 30, the estimated chance of becoming pregnant in any one cycle is between 20% and 30%. When women turn 40, that probability plummets to approximately 5%.
OK, So Now That You Know, What Next?
Rest assured, this IS NOT a push of the panic button. It’s not a call to rush into loveless marriage, or drop out of school and give up your career in order to guarantee your bloodline continues.
Rather this is a call to arms. Women deserve to know the full truth about reproduction so they can take the family-planning reins and make informed decisions. The goal is to help you and every woman of childbearing years make the choices that help protect and optimize fertility.
· The Contraception Contradiction. While all contraceptives prevent pregnancies with greater or lesser efficacy, some actually help preserve fertility. Oral contraceptives decrease the incidence of tubal disease because birth control pills make it more difficult for some infections to grow. They also minimize the growth of the endometrium (the lining of the uterus), reducing the incidence of endometriosis, a condition that can closely linked to infertility. Condoms and, to a lesser extent, diaphragms, protect against sexually transmitted diseases, which contribute to or cause compromised reproductive function and infertility.,
· Weight of the World. When it comes to baby-making, you absolutely can be too thin. Or too fat. A woman’s body is at its reproductive best when it’s within 15% of the ideal weight. And by ideal, we don’t mean runway ready. It’s the weight at which your body and its hormonal systems hum like a finely-tuned Ferrari. There are individual variations, but, many women experience problems when they’re less than 95% or more than 124% of that weight. Using a standardized measure called the Body Mass Index (BMI) you can determine your “ideal” weight.
At less than 95% of the ideal weight, women might stop ovulating, having regular menstrual cycles – or any at all. On the other end of the scale, excess weight is associated with unpredictably long gaps between menstrual periods and superabundance of ovulation-interfering hormones.
· Feed Your Fertility. Eat all the things you know you should but probably don’t, including fruits, vegetables and low-fat protein. In fact, adequate protein is absolutely essential because without it, estrogen breaks down into inactive byproducts more rapidly and menstrual cycles become longer.
· The Drink That Refreshes? Sorry but you’ll have to cap your caffeine and alcohol drinks to one cuppa joe (or latte or cappuccino) a day and maybe the occasional glass of wine. Heavy drinking is a fertility wrecker for both women and men.
· Get Exercised. Regular, moderate workouts are the gift of the fertility gods. They help keep your hormones happy, your weight under control and bring down your stress levels. Heavy exercise, say running 35-40 miles a week, can trigger amenorrhea (no periods), diminish progesterone levels so that an making it difficult for an embryo to implant.
· Smoke Signals. Tobacco is no friend of fertility. It increases susceptibility to sexually transmitted diseases in both men and women, increases the likelihood of tubal pregnancies, cervical cancer and pelvic infection. It’s just plain bad.
· Drug Drag. It’s not just the obvious culprits like cocaine and marijuana that spell trouble. It’s the pharmaceutical that people routine take to treat common diseases and conditions, such as Crohn’s Disease or ulcers or even psychological disorders, that could be problematic. If you’re contemplating getting pregnant in the near future, consult with your doctor.
Fertility Screening for Your Reproductive Life
Knowing what you know, you can actively in shelter your fertility from harm and even get it to optimal levels. Now there’s an important tool to help you identify where you are on your own fertility curve. Perhaps even more important, the screening can help pinpoint women whose ovarian function is on the wane so they can get timely treatment.
The screening itself is fairly low-tech. Part one consists of four blood tests to check the levels of FSH, estrodial, MIS (mullerian inhibiting substance), inhibin-B, all critical to conception and pregnancy. Ideally this is done on the third day of your period. Each blood factor is an indirect assessment of ovarian reserve. Any one of them is helpful. But the combination of all four allows for much greater precision in identifying potential problems.
Part two is a vaginal ultrasound to count the number of antral follicles in ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least eight antral follicles per ovary.
What you and your doctor are looking for is a dramatic shift in values from one year to the next.
Although none of these tests is in of and of themselves an absolute predictor of ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a sit-down with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.
It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better have the corrected sooner rather than later when the becoming pregnant is an urgent matter.
Precisely because your fertility profile is as singular as your fingerprint, it’s important to get a baseline as early as possible. Currently, specialists recommend that annual screening beginning at 21 years of age would be most helpful in establishing your own benchmark. If you are not 21 – don’t lose sleep. Remember that these Fertility Evaluations are a new concept. If you are concerned about your ferility at any age – you can go find out the facts by having these simply tests performed.
Fertility Preservation: The Egg Freezing Revolution and The Biological Clock
As so many women discovered late in life, procreation is a far more delicate and complicated process than most of us ever suspect. After all we spend so much time trying to avoid pregnancy, it never occurs to us that we may not be able to when we want.
So what do you do if you are in the midst of getting your degree or your career is on an upward trend that you don’t want to derail? Until recently, the options were few and unreliable.
But the recent breakthroughs in egg freezing gives young women the opportunity to put the best of their oocytes into a safe deep freeze until they’re ready to use them. .
Their are new techniques known as Array CGH and CGH which can screen the eggs for chromosomal abnormalities prior to freezing. This scientific breakthrough allows fertility specialists to freeze only those with a full complement of chromosomes. And those are the ones most likely to become healthy embryos once fertilized. Array CGH and CGH is also being used to help women with recurrent pregnancy loss.
For the first time, women can be fairly certain they will be able to have their own biogenetic children when their life circumstances allow them to provide the best upbringing possible.
With careful attention to fertility protection, a program of annual fertility screening and the egg freezing option, for the first time young women really do have reproductive choice. Not just the promise but the real thing.