When I broke up with a boyfriend in my early 30s, I was devastated—not because he was the perfect guy who I was meant to marry but because I feared I might never have a baby.
Every woman’s fertility is biologically unique, but it is a fact that our egg quality declines and pregnancy becomes both riskier and harder to achieve as we age. According to Health Canada, a 30-year-old woman has a 90 percent chance of getting pregnant. That declines to 77 percent by age 35, and the chances decrease sharply after that. It’s also true that we have a harder time getting pregnant as we age.
So what’s a girl to do?
If you want kids, it’s to your advantage to think about these issues early on and get tested. We’re used to being in control of our lives, professionally and financially. The fact that we don’t have control over the duration of our fertility can be incredibly frightening and something that many of us would like to ignore for as long as possible. But I’ve learned that, no matter how scary this information is at first, it’s ultimately liberating to understand your own body’s reproductive possibilities, as well as its impossibilities. And the earlier you know what’s going on in your body, the more control you’ll have later on.
I love the advice of Aimee Eyvazzadeh, a California-based fertility specialist who is otherwise known as “the Egg Whisperer”: “Most OB/GYNs are busy delivering babies and doing hysterectomies and Pap smears and aren’t focused on fertility,” she tells me, “so patients aren’t getting the proper care or advice about what fertility means for women. My goal is for them to say to their patients, ‘Hey, let’s talk about fertility risk factors,’ and offer them the option to check their fertility the way they might check their cholesterol.”
It is much, much harder to change your fertility in your 40s, but there are many things you can do in your 20s and 30s to ensure that you have more choices available to you as you age. We have more options than ever; understanding them can empower us and, perhaps more importantly, turn panic into peace.
Getting pregnant in your 20s
While you’re young and the world is your oyster, you should consider talking to your OB/GYN about testing your fertility. There are home tests available that involve peeing on a stick on day three of your period to measure your follicle-stimulating hormone (FSH), which can be an indicator of the quality of your eggs. However, many doctors say that FSH and antral follicle counts performed in a doctor’s office are a better bet. “It’s not that they’re bad tests,” says Todd Deutch of the Advanced Fertility Center of Chicago, “but they shouldn’t be used in isolation without proper interpretation from a doctor because they give a lot of false positives and false negatives.”
Recent studies have found that it’s best to test Anti-Mullerian Hormone (AMH). In March 2015, the American Society for Reproductive Medicine (ASRM) practice committee published a paper in the journal of Fertility and Sterility that stated that “there is mounting evidence to support the use of AMH as a screening test for poor ovarian response.” The paper also said that FSH, estradiol and inhibin B are only poor to fair measures of how a woman’s ovaries will respond to stimulation or her ability to conceive.
Fertility test options
- Antral follicle count (AFC)
- Follicle-stimulating hormone (FSH) and estradiol on Cycle Day 2 or 3
- Anti-Mullerian Hormone (AMH)
- Age is best predictor
- Comprehensive chromosome screening (CCS) + in vitro fertilization (IVF)
Try a home test, but make sure to share the results with your doctor so that he or she can follow up with some additional blood tests to get the best overall sense of your fertility. If you really want an insurance policy, consider freezing your eggs.
Getting pregnant in your 30s
Let’s face it: Your 30s are exhilarating and hard. You’re building your career and trying to balance a lot. Maybe you’re married and have kids, or maybe you’re single and trying to figure that part out. Just know that the mad rush to have it all shouldn’t make you crazy. Everything will look different in your 40s.
Wherever you are in your life, if you think kids are in your future, take charge of your fertility. You may decide to get a fertility test at your yearly OB/GYN appointment. If you’re under 35, this is an optimal time to freeze your eggs. In 2014, the Canadian Fertility and Andrology Society declared that egg freezing is no longer an experimental procedure. The rates of pregnancy with frozen eggs may be lower compared to those with fresh or frozen embryos, but the data also show that in vitro fertilization cycles conducted with frozen eggs cause no increase in birth defects, developmental disorders or chromosomal abnormalities. (The ASRM, however, warns against freezing eggs for the sole purpose of circumventing reproductive aging as there is no data to support its safety, efficacy and cost effectiveness.)
Getting pregnant in your 40s
Trust me, everything will get better when you turn 40. You’re more confident, you know what you want, work and relationships actually get easier and there’s less second-guessing. If you haven’t married and had kids, then you may be thinking about whether you will or you may decide to put the cart before the horse and choose to have a baby on your own with a sperm donor. Since it can be harder to get pregnant, be sure to get your fertility checked by your doctor sooner than later. The number of women who give birth to healthy babies in their 40s is on the rise and, medically speaking, the dangers of a having a child when you’re older have become significantly reduced by developments like non-invasive genetic screening and diagnostic pregnancy tests. The statistics aren’t in your favour, but remember that every woman has her own unique fertility health.
Rachel Lehmann-Haupt (@rlehmannhaupt) is the author of In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family.
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