A Guide to Understanding Fertility in Your 20s, According to Doctors
I've learned a lot from celebrities on social media, but the most eye-opening has been the nudge or outspoken decree to start looking into my reproductive health and fertility in my 20s, especially if I see myself having a family in the future—which I do. I hope to have a big family one day with three or four kids; however, I'm almost 25 years old, seriously single, and am currently putting all my eggs (pun intended) into one basket: my career.
So, you can imagine the near panic attack I had when I read on The American College of Obstetricians and Gynecologists (ACOG) website that my peak reproductive years are basically over once I turn 30. By age 35, my chances of natural conception are even lower.
The reason for this, as Sanaz Ghazal, a double board-certified fertility specialist and co-founder and medical director of RISE Fertility in California, so eloquently explains, is that women are born with all the eggs they will ever have in their life, which is about two million. We don't grow more eggs as we get older; in fact, we actually lose them. Hence, our periods.
"By the time we reach puberty, our egg count has dropped from about two million down to about 300,000 to 400,000. We end up losing about 800 to 1,000 eggs per month," she tells HelloGiggles. "Fertility begins to decline in the late 20s and early 30s and decreases faster after age 35. By the time you reach 40, you have less than 10 percent of your fertility potential."
While having children is extremely personal and no two journeys are alike, these statistics are why family, friends, celebrities, doctors, and more advocate so strongly for reproductive health and fertility education, especially for younger women. The adage may say our biological clock is ticking, but thanks to modern medicine, there are avenues to preserving our future options like egg freezing, for example.
"By learning about fertility early on, you are empowering yourself with valuable information to help you achieve your family planning goals," Dr. Ghazal encourages.
Below, I spoke with three fertility experts to better understand the relationship between age, fertility, and egg freezing, and how women around my age, who are interested in learning more about fertility and early-on family planning can do so.
At what age, should I begin to look into freezing my eggs?
Because our eggs decrease in both quality and quantity as we get older, it's best to undergo egg freezing at a younger age, Dr. Ghazal says. "The younger you are, the better your egg quality, which means you have a higher pregnancy success rate if you choose to use those eggs in the future." She further explains that from retrieval to pregnancy, frozen eggs retain their age or youthfulness. For example, if you freeze your eggs at 29-years-old and decide to use those eggs at age 37, the frozen eggs are still 29.
So what years are considered prime for egg freezing? While there's no right or wrong answer, 28 to 32 years old seems to be the sweet spot, given what we know about egg quality and quantity and age, Serena H. Chen, MD, FACOG, director of reproductive medicine at Institute for Reproductive Medicine and Science, tells HelloGiggles.
Albeit, Stephanie Gustin, MD, FACOG, a double board-certified ob-gyn and REI and owner of Heartland Fertility in Nebraska, points out that from a financial standpoint, the best time to freeze your eggs may be in your early 30s. According to CNY Fertility, the national average cost of egg freezing is $15,000 per cycle, not including storage fees. Keep in mind, this is merely an average and there are a variety of factors that go into determining the cost for every individual, starting with insurance. Likewise, price packages can vary by fertility clinic and their available offerings. She also mentions that having an information meeting at a fertility clinic is a great way to gauge what your journey may look like from cost to treatment.
"There is no harm in freezing oocytes prior to age 30, especially for women who know that they intend to wait to start or grow a family in their late 30s to early 40s," Dr. Gustin continues. "But for those that simply are interested in preserving their future options, the cost of the process (i.e. physically, emotionally and financially) should be balanced with the likelihood of utilizing those oocytes in the future."
When I approached the same question in regards to fertility testing, the doctors relatively all had a similar response: it's up to the individual. "I think if a woman wants to have more information about their body, including their egg supply and perhaps a comparison of how their testing relates to similarly aged women, it should be offered," Dr. Gustin says.
If you're interested in egg freezing, Dr. Ghazal advises that taking a fertility test beforehand can "help predict how you may respond to treatment." She added that test results are generally good for about one year.
Can hormonal birth control affect my fertility?
In short, the answer is no! All three experts assure that hormonal birth control will not impact your fertility or ability to conceive in any negative way. In fact, Dr. Gustin says it's not uncommon for fertility doctors to use combined oral contraceptives when preparing an individual for treatment, such as in-vitro fertilization (IVF).
On the flip side, Dr. Ghazal says it's important to know that birth control won't preserve your fertility or "stockpile your eggs" either. Additionally, once you do decide to go off your birth control method, it may affect how quickly your body resumes ovulating and the significant pains (aches, cramps, bloating, etc.) that sometimes accompany periods. Each form of hormonal birth control is different so be sure to speak with your doctor to learn more, especially if you're thinking about conceiving.
Are there early steps I should be taking to preserve my fertility?
While it's not possible to increase your number of eggs, there are things you can be doing to optimize your natural fertility. The key ones being taking care of your general health and wellness through regular exercise, eating a well-balanced diet, and avoiding tobacco and smoking whenever possible. Understanding your family medical history and risk factors is equally important, Dr. Chen adds. She recommends speaking with your doctor in regards to your family or personal history as endometriosis, polycystic ovary syndrome (PCOS), and premature menopause can significantly impact your fertility.
If an individual is diagnosed with PCOS and endometriosis, do they need to start researching fertility options even sooner?
For those living with PCOS or endometriosis, all three doctors recommend speaking with a fertility specialist sooner rather than later. According to the ACOG, the inflammation and scar tissue brought on by endometriosis can stand in the way or block the sperm or egg from traveling through the fallopian tubes and uterus, which can make natural conception more difficult. On the other hand, the likelihood of experiencing complications during pregnancy increases in people with PCOS, per the National Institutes of Health (NIH). They are at higher risk of gestational diabetes, preeclampsia, miscarriage, and preterm birth. Cesarean is also common for those with PCOS.
Dr. Gustin went on to explain that knowledge is power, especially when it comes to navigating your diagnosis and fertility options. "The more information you have, the better—seeing a fertility specialist doesn't mean that you have infertility and it doesn't mean you will need treatment," she continues. "What it does do is establish a connection with an expert who can help you navigate you and your diagnosis, and if necessary, assist you with conception, should you need it."
How and where do I start to learn more about my fertility?
Whether conception is something you'd like to try for in the next year, five years, or 10 years, Dr. Chen suggests speaking with your OB-GYN yearly about your reproductive health during your annual gynecology checkup. This doesn't mean you have to take immediate action, but it helps get the conversation rolling so when it does come time to take that next step, you hopefully feel more prepared. If you are ready to seek out more information or speak with a specialist, your doctor can point you in the right direction of a specialist and provide you with personalized literature for further education.
Likewise, it's important to remember everyone's reproductive health and journey to motherhood are different. What may work for you may not work for someone else, and that's perfectly okay and normal. You've got this.