Timely ad­vice on your bi­o­log­i­cal clock

The Dominion Post - - Well & Good -

re­cently re­ceived a ques­tion from a 30-year-old reader who was wor­ried about her fer­til­ity. In my ex­pe­ri­ence, this is an ex­tremely com­mon cause of con­cern for pa­tients, es­pe­cially in the cur­rent era where ca­reers and travel of­ten take prece­dence over meet­ing a life part­ner and start­ing a fam­ily.

Look­ing back just four decades, the aver­age age of a first preg­nancy in parts of the de­vel­oped world was around 24 years – it has now risen to about 30 years, mak­ing this a valid ques­tion for many mod­ern women.

So should you be con­cerned about your fer­til­ity as you ap­proach 30, and if so what tests are avail­able that might help ease your mind?

Dr An­drew Mur­ray, who is the med­i­cal di­rec­tor of Fer­til­ity As­so­ci­ates Welling­ton, says: ‘‘Thirty-year-old women don’t need to be wor­ried about their fer­til­ity, but should be thinking about it’’. This is great ad­vice – if you think you would like chil­dren, but haven’t started try­ing to con­ceive yet, for whatever rea­son, use this mile­stone as an op­por­tu­nity to be proac­tive and op­ti­mise your fu­ture chances. We all know that our chances of get­ting preg­nant fall as we age – in fact the chance of suc­cess­fully con­ceiv­ing each cy­cle drops from 22 per cent to a mere 6 per cent be­tween 30 and 40 years of age.

This steep drop off in suc­cess rates is due to a com­bi­na­tion of fac­tors, the most im­por­tant of which is age­ing eggs. Women are born with a mas­sive, but fi­nite, num­ber of eggs – around one mil­lion in fact.

By pu­berty this store has dropped to around 300,000 and by mid-thir­ties to a mere 25,000. This may still sound a large supply, but un­for­tu­nately our ‘‘best eggs’’ tend to be used up when we are young, mean­ing that age­ing eggs have a much higher risk of ge­netic prob­lems, and mis­car­riage.

The rate our egg supply di­min­ishes is in­di­vid­ual, and this is some­thing you can get checked – a sim­ple blood test known as AMH can be done at any point dur­ing your men­strual cy­cle.

It can pre­dict how many eggs you have in re­serve, and hence how many fer­tile years you may have left. It is not 100 per cent perfect and won’t help peo­ple whose ovaries are ‘‘poly­cys­tic’’, or who have above aver­age fer­til­ity. This test is not avail­able on the pub­lic health sys­tem, and costs be­tween $85-110 de­pend­ing on where you are in the coun­try.

Mur­ray feels it is worth the in­vest­ment. ‘‘This sim­ple test done every year for women in their 30s, can be very re­as­sur­ing; it can also high­light when time may be run­ning out and en­able those women to make in­formed choices about their fer­til­ity. If the test in­di­cates their egg supply is low, they should see a spe­cial­ist for ad­vice on their op­tions.’’

How­ever, it’s not just the women who con­trib­ute to this equa­tion – around a third of cou­ples who strug­gle to con­ceive do so be­cause of an is­sue with the male part­ner.

Hav­ing a sperm test is re­ally worth­while, and sim­ple – and can high­light some po­ten­tially big prob­lems early on, en­abling you to look at al­ter­na­tives with­out more valu­able time pass­ing by.

So if you and your part­ner are hop­ing to con­ceive, you should talk to your doc­tor about get­ting a sperm sam­ple tested, just to check ev­ery­thing is work­ing as it should be.

If you know you do want to con­ceive at some point, but you ei­ther don’t have a part­ner or aren’t in a po­si­tion to start try­ing yet, Mur­ray says that look­ing at storing your eggs can be a good op­tion for some women. It is possible to store your ‘‘young’’ eggs, which can then be fer­tilised at a later date, and im­planted in to your older womb, in­creas­ing the like­li­hood of a suc­cess­ful preg­nancy later on.

So if you’re in your late 20s or early 30s, the ad­vice seems to be start thinking about your fer­til­ity and plan ahead, be­fore it’s po­ten­tially too late.

Try to track your cy­cles for a few months – if they are roughly reg­u­lar (be­tween 21 and 35 day cy­cles), the chances are you are reg­u­larly ovu­lat­ing which is a good sign. You can opt to pay for an AMH test if you would like to know more about your egg re­serves, and even talk to a spe­cial­ist about storing some eggs if de­lay­ing preg­nancy for a few years is on the agenda.

Once you’ve done all that and you’re ready to start try­ing, en­sure you’re hav­ing ‘‘reg­u­lar’’ sex, every two to three days, es­pe­cially around the time of ovu­la­tion, to max­imise your chances, and give it a few months – even with­out any un­der­ly­ing fer­til­ity issues, it will take many cou­ples sev­eral months to con­ceive, and stress and worry will only com­pound this.

PHOTO: 123RF

Women over 30 don’t need to be wor­ried about fer­til­ity but they need to start thinking about it.

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