Women who want to be in control of their lives need to recognize an important truth: our fertility really is regulated by a biological clock.
Women are born with a full complement of eggs and their number decreases each year. Does this mean that every woman who defers having children until her late 30s or 40s will face infertility? No, but the likelihood of infertility definitely increases with normal aging. To keep a healthy perspective, it helps to realize that there are a number of factors which determine how fast a fertility clock is ticking. Women can’t change their genes but there are a number of things they can do to help keep their fertility options open.
So what’s a woman to do if she’s not ready to conceive now but wants to safeguard her future ability to have children?
1. Stop smoking. This is one of the few lifestyle changes that can positively impact egg supply. Studies show that women who smoke have an increased risk for early menopause (by several years compared to non-smoking women). I’m constantly asked by women if a healthy diet/exercise can affect egg supply, the short answer is no: once the eggs are gone, they’re gone. But stubbing out that cigarette for good may help slow the egg aging process.
2. Practice safe sex. Sexually transmitted infections like chlamydia can be pretty insidious—you may not even know you’ve been infected. But these frequently silent infections can increase a woman’s risk for future infertility by potentially leading to scarring of the pelvic organs (especially the fallopian tubes). So use a condom each and every time you have sex (until you’re ready to try and conceive).
3. Stay on the birth control pill. If you have endometriosis, staying on the pill may slow the progression of this benign but painful condition, which raises the risk of infertility by causing scarring of the fallopian tubes; cyst formation in the ovaries; and implantation problems in the uterus. Endometriosis usually spreads over time (as it feeds off of the natural hormones that go up and down during each menstrual cycle). The birth control pill helps suppress these hormones and may stave off the progression (and potentially damaging effects) of endometriosis.
a. BUT—because the Pill can mask your body’s natural aging changes, it’s sensible to ask your gynecologist to periodically check your ovarian reserve. I’ve seen some women who stopped using the Pill after years of use only to find that they’re in menopause and didn’t know because the Pill masked the hormonal changes associated with menopause.
4. Maintain a healthy BMI (body mass index). Overly high and low BMIs can be associated with infertility (in addition to a myriad of health conditions, which can also be associated with fertility and pregnancy problems). Because it’s hard to achieve a healthy BMI overnight, why not start maintaining now so your body’s ready when you are to try and have a baby?
5. If you’re comfortable, ask your biological mother when she went through menopause. Studies suggest that there’s a genetic component to ovarian aging. Average age of menopause is around 51-52 so if a woman tells me that all her female relatives (mother, aunt, older sisters) went through menopause in their early 40s or 30s—she may also be at risk of earlier/faster egg aging. In these instances, I’ll recommend testing of her current egg supply and talk to her about what she can do now before more time elapses (and her ovaries head closer to menopause).
6. Talk to your gynecologist/ fertility specialist about fertility preservation options. Reproductive aged women about to undergo certain treatments for autoimmune disorders and cancers may be at very high risk for premature menopause, so I definitely encourage them to think about freezing their eggs (or embryos, if they’re with a long-term partner) before starting treatments. But because healthy women are at risk of infertility the longer they defer conception attempts, they should also consider at least a conversation about whether or not egg/embryo freezing may be an option for them.
7. Start trying to conceive as soon as you’re ready! And if you don’t conceive after 3-6 months (for women over 35) or 12 months (for women under 35), don’t panic but consult your gynecologist/fertility specialist. Fertility treatments (if needed) are definitely most effective the younger you are, so don’t delay seeking evaluation.