What I Wish I Knew About Fertility Before I Turned 25
For many women in their mid to late 20s (like myself), their sexually active lives thus far have been spent trying to NOT get pregnant. It's a bit TMI, but it's true.
Then almost overnight, it happens: your friends grow up and start having babies. And it changes everything. For them, of course, but for you as well.
I had to get my head around the concept of having sex for the purpose of conception, which turns out is what sex is actually for. Go figure.
As my girlfriends' beautiful bellies grew, I started to wonder, 'if I tried to not not get pregnant, could I?'
It doesn't matter that it might not be the 'right time.' It doesn't matter that I've never properly thought about getting pregnant before. Ever.
At that moment, my current relationship/career/financial/life status all seemed to fade away. Suddenly I needed to know, what -- if anything -- would happen if I wanted to have a baby, now?
Is everything in working order down there? How do I know? Should I get a fertility test? How much does it cost to freeze eggs? Is that even a thing or did I see it in a movie once??
Even though I'm close to 30, tertiary educated, gainfully employed and able to make Vietnamese rice paper rolls from scratch (they're quite tricky, okay) I can't actually answer any of those questions.
The whole concept of fertility is just a mystery to me. Obviously I've got the basic facts. Beyond that, it's a bit ... vague, and I'm not okay with that. I don't know if kids will be part of my future -- immediate or otherwise -- but a girl's got to keep her options open, right?
A professional opinion
So I chatted with Associate Professor Kate Stern, Head of Fertility Preservation at Melbourne IVF and the Women's Hospital in Melbourne. I was nervous, half expecting to be scolded for a) my cluelessness, and b) my lax regard for my own body.
That didn't happen. But it turns out I'm not alone in my concerns. While most of the young women Dr Stern sees are having cancer treatment, or other serious treatment that might damage their fertility, more and more healthy women in their 20s are booking appointments.
They're not there for a specific test or procedure, but just to find out more, and in Dr Stern's opinion it's a refreshing trend:
Becoming more educated and informed about your fertility, and not taking it for granted is enormously positive.
Dr. Stern did point out that healthy young women shouldn't even really need to visit a fertility specialist such as herself to get the info they need.
"Good, solid non-biased scientifically-generated information should be out there in the public sphere... so that women grow up knowing what's important about their fertility."
That's not yet the case, which isn't great, but hearing it made me feel a bit better about my lack of fertility know-how.
Testing the waters
What I really wanted to know was if I should get a fertility test. I'm 29, single, career-focused and not exceptionally good at planning, so I should just book one in, yes?
"I'm not recommending all young, healthy women go out and test their fertility. Absolutely not," was Dr Stern's response.
But what about all that 'knowledge is power' stuff?
Understanding about your fertility is one thing. Testing your fertility is another.
Turns out, fertility testing -- the most common being something called an ovarian reserve assessment -- isn't that useful or accurate.
The test is twofold. It involves an antral follicle count done via ultrasound, which looks at small follicles within the ovaries, and a blood test that measures levels of Anti-Mullerian Hormone (AMH), a hormone secreted by cells in developing egg sacs.
Problem is, as Dr Stern explained, the test is far from perfect.
"It's rarely a useful test. There's enormous variation in results in women of different ages, and having lots of eggs at 25 years old doesn't mean you'll have 'better' eggs when you're 40."
Put simply, the ovarian reserve assessment doesn't reflect your ability to get pregnant, nor your egg quality. At all.
"What it can and does do," Dr Stern elaborated, "is a lot of damage to women who are told they have a low-ish ovarian reserve, who then think 'oh my gosh, do I have to get pregnant right now even if I don't want to?'"
To Dr Stern, this type of testing is "completely inappropriate," and that routine testing of ovarian reserves without a specific reason is unlikely to be useful.
So, it's a no on the test then? "Even if we had all the money in the world I wouldn't be saying, 'okay let's test everyone at 25 years old.'"
There are other ways to assess fertility -- ensuring there's no vaginal infection, that the Fallopian tubes are open -- but again Dr Stern says that they're only done if necessary.
Her top tips for keeping your fertility in good shape sound a bit like they're taken from a fit-spo blogger's Instagram post.
I know it sounds pathetic but just eating well, exercising, staying healthy and moderation in coffee and alcohol are helpful for your general fertility.
Most importantly, Dr Stern just wants us to be aware about our fertility.
"Think about it, read about it, know your own menstrual cycle, and if there's anything worrying you can pop to the GP."
The big freeze
Of course that's not where your journey of fertility discovery has to end. There are young women who see Dr Stern knowing that their fertility will decline in their mid 30s, and have decided they want to be proactive now.
That's where something called human oocyte cryopreservation -- or egg freezing -- can be an option.
There are mainly two types of women that Dr Stern encounters here. The first group are single women whose lives hasn't turned out the way they expected, who want to have a baby very soon.
Here, Dr Stern is keen to bust the stereotype of the selfish, aggressive and career-obsessed woman whose maternal instincts have kicked in too late.
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"It's complete rubbish and I have data to back that up. Life has simply not gone the way they expected it to, and they're in their late 30s/early 40s, and the problem is that their fertility has already declined."
Dr Stern is also seeing a smaller yet increasing number of younger single women who want to be proactive about their future and are keen to freeze their eggs now.
"But I don't think you need to rush to do it when you're 24, 25, as your egg function won't even start diminishing even subtly until your mid 30s," she said.
Is there an ideal age to think about freezing your eggs? "I would be say late 20s/early 30s -- that's before egg count and function has yet to change."
There is a very rational argument around 'why wait if you can do it now?' but Dr Stern is careful to remind patients that they don't freeze their eggs at 24-years-old thinking 'okay now I can wait 'til I'm 40 to use them.'
"You can freeze your eggs, but you must not make life decisions based around it," was her advice.
Even though frozen eggs last a long time -- there's no scientific data to say they deteriorate -- Dr Stern made it clear that the service doesn't exist so that women in their 50s can get pregnant.
Yes, the chance of a successful pregnancy does depend on the embryo and not the environment -- that is, the woman carrying the embryo -- but from the late 40s onward there is a significant increase in pregnancy complications.
Dr Stern requires her patients undergo counselling before freezing eggs so they can think about these 'downstream' issues beforehand.
The egg freezing process itself is very expensive, often prohibitively so. But it might be a less-costly option.
Dr. Stern cited a government-funded egg freezing pilot program in Denmark by way of example. "They realised that the cost to society of assisting women to get pregnant later in life was greater than the cost to freeze eggs."
It's also full-on. "Freezing eggs is a medical procedure that carries risk and needs to be taken very seriously," explained Dr Stern.
It involves a rigorous health assessment, a series of hormone injections in the 10 to 14 days before the procedure which is performed under sedation. Patients typically take the following day off to recover.
Risk of infection, blood clots and, particularly in younger women, ovarian hyperstimulation -- swollen and sore ovaries -- are all potential risks. So the decision to freeze your eggs should not be taken lightly.
On top of that, Dr. Stern quoted for every 10 eggs collected you might only end up with one to three viable embryos.
At the end of the day, Dr. Stern wants to make [egg freezing] an "out-and-proud proactive thing rather than an I-failed-at-life thing."
That is something I can get on board with.
I don't know if I'll explore fertility testing, or even pop some of my eggs on ice. But I sure feel a heck of a lot better knowing what my options are, and that I'm not alone in my wild, late 20s baby-related panic.
If anything, I wish I'd found out all this earlier, before said panic.
TL;DR? Here are the key fertility takeaways:
- More and more healthy women in their 20s are booking appointments with fertility experts to learn more about their own fertility
- Fertility testing in healthy young women is not common, but is increasing
- Tests like the ovarian reserve assessment are far from perfect, and can do more harm than good
- Exercise, healthy eating and not too much coffee and alcohol are your best bet for healthy fertility
- The egg freezing procedure is expensive and carries risk
- The majority of women who choose to freeze their eggs tend to be single and older
- There is a small yet growing group of younger women in their 20s who are starting to freeze their eggs
- Late 20s/early 30s is the ideal age to freeze your eggs, if you so wish
- Your egg count and function won't start diminishing even subtly until your mid 30s
- Freezing your eggs at 24 doesn't mean you should wait 'til you're 40 to use them
- Be well-educated about fertility and be brave to make decisions that allow you to have a baby when it's right for you
Feature Image: Getty