How Much Do You Know About Your Fertility?

Most young women spend years ensuring they do not have an unplanned pregnancy and the majority of sex education in schools up to now has concentrated on contraception and STi’s.

Recent news reports however have highlighted the number of older women, who having put off starting a family, are struggling with infertility and are being taken advantage of by unscrupulous fertility clinics. 

Sally Cheshire, Chair of HFEA (Human Fertilisation and Embryology Authority) feels that “older women are being exploited by IVF clinics “trading on hope” - despite the fact that just 1% will achieve success after the age of 44” She said “those seeking motherhood later in life were being targeted by increasingly aggressive sales tactics from the sector.” The NHS will normally refuse fertility treatment to those over 42 years. NICE guidelines state that under this age the NHS will fund 3 rounds of IVF but this is very much a postcode lottery with only 24% of NHS trusts able comply with these guidelines. 

This dialogue re older women experiencing fertility issues has started a debate about how much or how little younger people need to know about fertility. 15% of women who would like to start a family will experience fertility issues. Fertility experts deal with many couples who feel that if they had been aware of the facts they may have made different decisions earlier. They also believe that ‘understanding your body is a skill for life’. 

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Competing pressures that young people are under - the need to get a degree, a career, somewhere to live, to pay-off debt and all the while trying to find a committed relationship is more than enough to cope with, without worrying about potential fertility issues later in life is one argument. Others feel that young people should be given fertility advice and education to better equip them to make wise choices about relationships.

Young people may feel that they have control over contraception but many have little idea of the various factors that may affect their fertility - lifestyle, diet, smoking, recreational drugs, STi’s. Most - even if they have thought about a family have probably quickly parked the idea thinking “I am too young”, “I need  a career first, “I want to have fun”, “that’s ages away”, “I need to be in a committed relationship first”. All good reasons but fertility experts want all young people to understand the main reason for loss of fertility - getting older. 

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Females are born with their lifetimes supply of eggs and when they are gone, they are gone. Fertility dramatically reduces for women over the age of 37 years. Currently IVF has a success rate of over 30% with women under 37 years but this drops dramatically for women in their 40’s. Social media is over-run with ‘older’ celebrities having babies via IVF leading many to believe that success rates are high but what we are not told is that many of these pregnancies are the result of donor eggs (provided by women under 35years)  and multiple attempts as cost is less likely to be a barrier.

‘Social egg’ freezing is widely promoted as an effective way for younger women to delay motherhood and ‘have it all’ but procedures are expensive, invasive and not guaranteed to work. Age is also associated with increased miscarriage rates and pregnancy complications. 

Susan Seenan, Chief Executive of Fertility Network UK, says “time and time again, people express sadness at not having a better understanding of the lifestyle factors that influence fertility, leading them to ask me 'Why did no one tell me?'

Fertility Network UK hopes to help prevent future distress by informing younger people about lifestyle choices they can make to preserve their fertility. Now in its fourth year, the project provides fertility education and awareness through universities and via GPs. They state the below as factors affecting fertility;

FACTORS AFFECTING FERTILITY

Age - The reduction in both the quantity and quality of available eggs means that older women are less likely to get pregnant and, if they do get pregnant, they are more likely to have a miscarriage. Male fertility may also decrease with age although to a much lesser degree.

Previous Pregnancy - Couples are more likely to get pregnant if they have previously achieved a pregnancy together (irrespective of whether or not that pregnancy resulted in the birth of a baby) compared to couples that have never been pregnant.

Duration of subfertility - The longer couples have been trying to get pregnant, the less likely they are to be successful.  If a couple have been trying to get pregnant for less than 3 years they are almost twice as likely to get pregnant than couples who have been trying for more than 3 years.

 Timing and Frequency of Sexual Intercourse - Most women have a 28-day menstrual cycle: this means there are 28 days between the start of one period and the start of the next period.  Ovulation (when an egg is released from the ovary) occurs on day 14 of a 28-day cycle.  Whether or not that egg gets fertilised by a sperm depends on the day(s) in the cycle in which intercourse occurs.  The chance of getting pregnant is low at the beginning of the cycle and starts to increase from about day 8 onwards.  Women are most likely to get pregnant if they have sex 2 days before they ovulate (i.e. on day 12 of 28-day cycle).

Once ovulation has occurred, the chance of getting pregnant decreases dramatically: sperm need to be present in the female genital tract prior to ovulation to maximise the chances of getting pregnant.  The reason for this is that once ovulation has occurred, levels of the hormone progesterone increase and this causes cervical mucus to become thick and sticky which prevents sperm from being able to swim through it to get to the egg to fertilise.

Couples that have regular sex 2-3 times a week are most likely to get pregnant because this frequency ensures that a good volume of fresh sperm will be present in the female reproductive tract at the time of ovulation.  If couples are only having sex once a week, the chance of getting pregnant is less because there will be less fresh sperm present in the female genital tract at the time of ovulation.

Weight - Overweight women who have irregular periods are less likely to release an egg each month (ovulate) than women with regular periods.  This means the chances of getting pregnant are reduced.  Losing weight, even as little as 5-10% of the total body weight, may restore a regular menstrual cycle thereby increasing the chance of getting pregnant. No one diet has been shown to be better than any other but group exercise programmes that involve both exercise and dietary advice leads to more pregnancies than weight loss advice alone. Men who are overweight may have suboptimal sperm and therefore reduced fertility.

Being underweight can also affect female fertility as it may mean that an egg is not released each month.  Being underweight is also associated with problems during pregnancy.  Gaining weight is likely to improve fertility.

Smoking - Women who smoke are 3 times more likely to experience a delay in getting pregnant than non-smokers.  Even passive smoking can be harmful.  Smoking reduces a woman’s ovarian reserve (so her ovaries will have fewer eggs in them than a woman of the same age who does not smoke) and damages the cilia inside the fallopian tube (which are important for transporting the egg and/or embryo along the fallopian tube into the uterus).  In men, smoking may reduce sperm quantity and quality.

Caffeine - Contrary to popular opinion there is no clear association between caffeine consumption and infertility

Alcohol - Some studies report that drinking more than 5 units of alcohol a week may reduce female fertility but others state that low to moderate alcohol consumption may be associated with higher pregnancy rates than non-drinkers.  Once pregnant, excessive alcohol consumption may lead to birth defects and developmental delay.  The Royal College of Obstetricians and Gynaecologists and the Department of Health recommend that women trying to get pregnant should avoid alcohol because there is no ‘safe’ limit.

In men, excessive alcohol may lead to difficulties maintaining an erection, impaired ejaculation and reduced sperm quality.

Over-the-counter and recreational drugs - Non-steroidal anti-inflammatory drugs such as ibuprofen can interfere with ovulation.  Aspirin may interfere with implantation.  Recreational drugs such as marijuana and cocaine may interfere with ovulation and/or the function of the fallopian tube.  The fallopian tube is important for transporting the egg from the ovary where it is released, to the womb (uterus) where an embryo will hopefully implant.  Fertilisation occurs in the fallopian tube.  Anabolic steroids, which are abused by some body-builders, inhibit the production of sperm and this may be permanent even if the drug is stopped.

Medical Conditions - Some women may have medical conditions that can affect their fertility.  These may or may not be known about when starting to try for a family.  Some of these conditions may be more general, for example thyroid disease and vitamin D deficiency whilst others may be more specific, for example, polycystic ovary syndrome and endometriosis.

But should medical professionals and educationalists even be trying to influence women about when it is or isn’t the right time to start a family?

Shouldn’t we just trust women to decide for themselves. Women generally take motherhood extremely seriously - they know it involves driving along a road with no possibility of a U-turn. Each women is unique to her own circumstances, personality and desires and no-one else is in a better position to know what is right for her. But perhaps by providing women with a ‘fertility map’ it might make it easier to decide when and if they want to make that journey into motherhood.