Timely advice on your biological clock
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.