Wondering what you can do to maximise your chances of having a baby? From 20 to 40+, Natalie Blenford has the expert tips you need…
In 2009, I was 29 years-old and working as a features editor at Marie Claire magazine in London. A wise old lady called Lizzie came into the office one day, and as she edited the Horoscopes page, she told all of us youngsters to get PAP smears and freeze our eggs ASAP. This wasn’t an astrological prediction. No, it was her best suggestion for making sure we’d all be able to have kids whenever we wanted them in the future. We smiled politely but laughed behind her back. Sure, a smear test was a good idea, but egg freezing? Why would we need to do that? We were all late 20s/early 30s, cash poor but rich in fertility and time.
Plus, cryopreservation was a very new technology and damned expensive. If one round of egg freezing was going to cost around £10,000, why didn’t I just spend the same money enjoying my life? I even pitched a feature idea about it. Let’s get one woman to freeze her eggs, and another to invest the same money into dating, partying and living her best life. Let’s see who gets pregnant first, and who winds up happier. I thought it would be a fascinating experiment.
Well it seems the world has finally caught up with Lizzie, because egg freezing – AKA fertility preservation – is now part of the every day lexicon for women. Women are usually born with around 5,000,000 eggs in the ovaries, but their quality and number declines over time. If I’d have known this, I might have understood that putting some on ice in my early 30s was a pretty smart idea. But what else should I have known back then? Are there other things we can do at different ages to protect our fertility? I took these questions to the incredibly helpful Dr Florencia Steinvarcel, a fertility specialist at Repromed in Ireland. Dr Steinvarcel kindly shared her expert advice with us, so you too can be as wise as Lizzie (who was 38, by the way – now younger than me – and not old at all).
“In your early 20s, if you’re having any kind of abnormalities or symptoms like pelvic pain, abnormal discharge or abnormal bleeding, it’s important to investigate what is happening in there,” says Dr Steinvarcel. “Most of the time it’s just hormonal imbalances, but in some cases it can highlight a bigger problem. If you don’t have periods for a long time or have a very irregular cycle, blood tests are a good idea, if only to rule out deeper problems. You’re young so your egg quality will be good, but at this age it’s about making sure everything is functioning correctly. STIs are very prevalent in young people, so practice safe sex and get checked for sexually transmitted infections”. Chlamydia and Gonorrhoea don’t just sound lovely, they can also create blockages in the fallopian tubes that can leave a woman sterile.
“Use condoms if you’re with different partners, not only to protect against Hepatitis B and HIV, but also to protect your fertility”, advises Dr Steinvarcel.
At this age, it’s all about getting set for a healthy future. “Smear tests are absolutely recommended once you’re sexually active,” says Dr Steinvarcel. “In Ireland we start this at 25 and women should get screened every five years.” Now is also the time to get clued-up on your egg reserve. “If you are healthy with regular periods it is recommended to check your egg reserve between the age of 25 to 30″, says Dr Steinvarcel. It’s worth explaining that eggs start their life inside little sacs called follicles. Every month, several follicles on your ovaries start growing simultaneously. Around day 7 of the cycle (that’s the 7th day after the first day of your period), one follicle will start outgrowing the others. The smaller follicles then give up the race and get re-absorbed into the body (they die), while the biggest one bursts open and releases an egg, which travels down the fallopian tube and waits for a sperm – this is called ovulation!
It’s all wildly exciting and complicated and you don’t need to understand it. But if you’re interested in getting a heads up on your own situation, ask your doctor for FSH, LH and Estradiol tests. FSH is your level of ‘follcile stimulating hormone’. “If your FSH and LH levels are high, it’s a good predictor of a low egg reserve,” says Dr Steinvarcel. “Equally, if someone is having long cycles every 2, 3, or 6 months, you should also check Prolactin and Thyroid levels.” You can also get an AMH test, which is the best predictor of your egg reserve. The test can be expensive, although home testing kits are now available, such as this one and you can do it even if you’re taking The Pill. You might think mid-20s is way too young to start stressing about egg count. But right now your eggs are the best quality they will ever be. “The ideal age to freeze eggs is late 20s to early 30s (28-33),” says Dr Steinvarcel. “For me, that’s the perfect age.” If you find out that you have a low egg reserve, this might motivate you even more to look into fertility preservation. So it’s recommended to be brave and take some tests, then discuss the results with your GP or gynae because there’s no clear-cut, one-size fits all interpretation of what they mean.
Fun fact: “Egg quality doesn’t change too much between 25 and 35,” says Dr Steinvarcel. “And this is the best time to get pregnant.” Yet 1 in 7 couples have fertility problems (source: NHS), so if you’re trying to conceive and having difficulty after 6 months, consult your GP.
“You want to role out fibroids, polyps and blocked fallopian tubes,” says Dr Steinvarcel. You should also be on the lookout for things like Polycystic Ovary Syndrome and Endometriosis, which can sometimes affect fertility. Pester your doctor for exploratory tests if you have any pain during sex, during smear tests, ovulation, during your period or frankly – any pain at all.
If you’re not yet trying for a baby, now is a good time to take an AMH test to get more detail on your egg reserve. “If the egg reserve is on the low side, it is absolutely recommended to consider fertility options, such as egg freezing or trying to conceive as soon as possible,” says Dr Steinvarcel. “Low AMH is a warning. It says that although you’re young, you can’t wait that long.” If you don’t want to freeze eggs, re-check the egg reserve regularly (every six months) to see how things are changing. An internal scan (a ‘trans-vaginal ultrasound’, if we’re being technical) conducted on days 1-3 of your cycle is another way to find out more about your egg count. This scan uses ultrasonic waves to look at the ovaries and allows technicians to count your follicles. “A good number of follicles normally would be something over 10, that’s five on each side,” says Dr Steinvarcel. But numbers can vary from month to month, so don’t panic if you get a low count – it’s not set in stone.
“At this age, it’s absolutely recommended to assess your situation,” says Dr Steinvarcel. You could also add supplements to your daily routine. “Folic Acid is vital if you’re planning to get pregnant as it helps the baby to develop normally. And Vitamin D, Iron, a Multivitamin and a balanced diet are important, especially if you live in Ireland where we don’t get a lot of sunshine!” But beware of wellness gurus who say that supplements can turn back the clock. “Supplements don’t change egg quality, unfortunately, but if our health is in good condition, it can help our overall chances,” says Dr Steinvarcel. 39 seems to be the last age that many doctors will recommend egg freezing, so seek advice on this before you hit 40 if possible. A personal tip is to also start acupuncture; it can help ‘wake-up’ otherwise dormant follicles, and subsequently increase your egg count (this author’s follicle count shot up from 4 to 17 after six months of regular acupuncture, which can be useful if you’re doing IVF or freeing eggs.)
“After 40, it’s really time to do something now, or consider egg donation later,” says Dr Steinvarcel. “This could be the time to consider single parenthood if you’re not in a relationship, and look into insemination or IVF using donor sperm.” Because egg quality declines with age, egg freezing after 40 isn’t usually recommended.
“Some patients aged 40+ say to me: ‘Surely it makes sense to have something in storage rather than nothing? And in some cases, that’s true,” says Dr Steinvarcel. “But it’s always better to use fresh eggs, so I would recommend IVF now rather than freezing eggs for use later. Or, perhaps a better option is to do nothing now and to consider using donor eggs in the future when you’re ready to become a mum.”
At this age, it’s also good idea to seek support from a fertility counsellor. “It’s never too soon to seek support as you go on this journey,” says Dr Steinvarcel.
Most importantly, remember we always have options. And at every age, there is help available.
For more information, see www.repromed.ie