When women are born, they already have all the eggs they will ever have in their life. Consequently, as a woman ages her eggs age along with her. So the question becomes: if you are one of the many women waiting to have children until your late 30’s and 40’s, what can you do now for your future fertility?
1. Ask your Mom when she went through menopause
The average age of menopause is 51, but this can vary considerably from one woman to another. The age of menopause is genetically linked so knowing when your mother first started menopause can help you predict when you will as well. Some women can start going through menopause as early as 45 years old and being aware of your genetic predisposition can be very important. Your fertility starts to shift 13 years BEFORE your last period so you can count backwards from this year as an estimate.
2. Determine if you are ovulating
Start paying attention to your cycles to determine if you are in fact ovulating. There are three major physiological signs your body gives you each month that can tell you if and when you are ovulating, read more about them here. If you are not ovulating, it is important to determine why that is. Some common causes of anovulation include PCOS, high stress, premature ovarian failure, thyroid disorders, being under or over weight, excess exercise and many others.
3. Address any issues with your cycle NOW
It still shocks me that the most common prescription for women with long cycles, painful cycles or irregular cycles is the birth control pill. Although the birth control pill can help reduce pain and make periods seem more regular, a “period” on the pill is actually not a period at all. The pill stops ovulation entirely and the bleed you get on the pill is simply due to hormone withdrawal during the week of sugar pills.
If you were put on the pill for symptom management, these symptoms actually have not been treated, but simply covered up. It is very likely that when you are ready to come off the pill these symptoms will come back. If this sounds like you, it may be time to consider looking into what the underlying issue with your cycle is and how to better address it’s root cause now so it doesn’t cause roadblocks and delay your ability to get pregnant later in life.
4. Practice safe sex
STIs, even those without symptoms, can cause fertility issues. Pelvic inflammatory disease, commonly caused by chlamydia, can cause scarring in the ovaries or fallopian tubes. By practicing safe sex and getting screened for STIs you can prevent any future issues that may arise.
5. Fertility Testing
There are a few blood and imaging testing options that can give you a snapshot of your current fertility, helping you to predict your future fertility. These include:
Anti-mullerian hormone (AMH): is a hormone that is released from the immature resting pre-antral follicles or the un-fertilized eggs sitting in your ovaries waiting to be chosen for ovulation. The level of AMH can reflect the size of the remaining egg supply and decreases as a woman ages. The higher the number the better, but an extremely high level can indicate PCOS.
Follicle stimulating hormone (FSH): is a hormone that is secreted from the pituitary gland in the first half of the menstrual cycle. Its role is to tell the ovary to start developing the egg for ovulation. When a woman approaches menopause the ovaries stop being as responsive and FSH rises. If you are having very long or very short menstrual cycles and/or have noticed an increased irregularity in your cycle, getting a FSH screening test is a good idea.
Antral Follicle Count (AFC): The AFC test is done through a transvaginal ultrasound from day 3-5 of your menstrual cycle, where a technician will count the number of follicles visible. An antral follicle is a small fluid-filled sac that contains an immature egg. The number of antral follicles vary from month to month but can help you estimate your current fertility.