You're 28; You're single; You're having fun. Should you have your fertility checked? If you hope to one day have children, the answer is: yes.
The medical community has become increasingly concerned about the number of women facing age-related infertility. One of the big questions being asked is how we get information about the risks of delaying childbearing into public consciousness? As an infertility counsellor, I do see my fair share of single women and couples who are blindsided by the bleak statistics for getting pregnant after age 35. Many are unaware of how steeply fertility declines for women after that point, and others are shocked to discover, that not even the most advanced assisted reproductive technologies (ART), can guarantee success for them.
At the Canadian Fertility and Andrology Conference in Ottawa this past September, research was presented demonstrating that the number one reason women delay childbearing is because they have not yet found a stable relationship or life partner. Some researchers and practitioners suggested that the situation is so dire, we should simply start telling unattached women to run to the nearest clinic and use sperm donors. I couldn't agree less, though.
Yes, I believe it is extremely important to educate the public about age-related infertility. But I do not think this should be done so that women who are not yet emotionally, financially or psychologically ready to become a parent should rush off and get pregnant. The reality is, that while our culture and society has changed significantly over the past several generations (both women and men stay in school longer, few families can live on a single income so both partners must work, etc.), our biology has not. It is simply no longer feasible nor wise for most women to start having children in their early 20s.
But understanding the risks of delaying child bearing is important, as is knowing the details of your own particular fertility health. This goes for both men and women. I see too many couples who start trying to get pregnant in their mid-30s, only to discover after many months or trying, that one of them has a medical problem that interferes with infertility. By your mid-30s, time is already of the essence when it comes to fertility, and these couples then find themselves in a race against the clock. At least if you know what you may be facing, once you are ready to conceive, you can go into it with an action plan. Skip the wasted months of trying on your own and get medical intervention as soon as possible.
Infertility is defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse. One in six couples experience infertility over their lifetime. While fertility for women starts to significantly decline after age 35, it begins to do so for men after age 50.
There are a variety of health conditions that can negatively affect fertility, many of which are not identified until a couple has difficulty conceiving. Genetic disorders (cystic fibrosis, Kleinfelter syndrome, etc.) can cause male-factor infertility. Autoimmune diseases (lupus, thyroid disease, etc.), Polycystic Ovarian Syndrome (PCOS), endometriosis, Type II diabetes can all interfere with fertility. Speak to your doctor about what disease screening and medical tests may be appropriate for you.
If you have been diagnosed with a chronic illness or disease, make sure you are being treated and monitored by your physician and follow your treatment regimen that you have been prescribed. Speak to your physician about whether any medications you take should be continued or treatments should be modified while undergoing fertility treatment.
If you have about $600 to burn, private medical clinics, such as Medcan, offer fertility testing programs. If not, you may be able to ask your family doctor to order a few of the most basic tests, such as examining your egg reserve, or a semen analysis for men.
It is also never too early to begin making lifestyle changes to improve your fertility health. Here are a few tips:
• Disruption of circadian rhythms may negatively affect fertility. There is an association between sleep disturbances caused by shift work and menstrual irregularities and delayed conception.
• Sleep apnea is associated with decreased testosterone levels in men.
Recommendation: If possible, develop optimal sleep hygiene habits to ensure you are getting adequate rest and are working with your inherent circadian rhythm. Aim for seven to eight hours of sleep every night and try to wake up and turn in at the same time each day. Sleep in a dark, cool environment. Avoid excessive stimulation prior to bedtime (i.e. television, computers, exercise, etc.). If you suspect you may suffer from a sleep disorder, get an evaluation from a specialist to receive proper treatment.
Too little or too much body fat can interfere with fertility.
• Low body fat is associated with hypothalamic amenorrhoea (an absence of menstrual cycle) as well as anovulatory cycles and a shortened luteal phase.
• Women seeking treatment for infertility have greater levels of eating disorders than women in the general population. Eating disorders are associated with a greater chance of low birth weight, miscarriage and birth defects.
• Being overweight and obese is also associated with amenorrheoea and anovulation as well as poorer fertility treatment outcomes, and greater risk of miscarriage and congenital anomalies.
• Small decreases in weight (such as 5 per cent of body weight) among obese women can dramatically improve fertility outcomes.
• Obesity is associated with infertility among men because of disruptions to the endocrine system and decreased sperm quality.
• Try to maintain a healthy weight. If you are at a healthy weight, avoid making drastic changes to your lifestyle during fertility treatment that may cause undue weight loss or gain.
• If you are struggling to lose weight and your weight may be related to your infertility or you want to begin infertility treatment, speak to your doctor about what weight-loss treatments may be appropriate and/or seek out counselling to support your weight-loss efforts.
• If you are struggling with an eating disorder, seek help from a mental health professional.
• Depression and distress can lead to poorer fertility treatment outcomes.
Recommendations: If you have been diagnosed with depression, make sure you are monitored closely during your fertility treatments. Speak to your doctor about whether or not you may continue with your medication regimen and/or if you may benefit from counselling. Try to manage tension and stress throughout your treatment process through counselling, relaxation techniques, yoga, meditation, etc.
• Smoking has a negative impact on fertility health for both men and women.
• Consumption of more than two alcoholic drinks per day can impair fertility.
• Caffeine consumption should be limited to 250mg or less per day.
• Use of recreational drugs has a significant negative impact on fertility.
• Moderate daily exercise may be helpful for overweight/obese women who are trying to lose weight, but high intensity exercise should be avoided during fertility treatment.
• Greater consumption of dairy and meat products, and lower consumption of nutrients from fruits and vegetables (vitamin C , lycopene, fibre and folate) is associated with poorer sperm quality.
• Quit smoking/avoid second hand smoke.
• Limit alcohol and caffeine consumption.
• Limit red meat and high-fat dairy products and focus on eating a wide variety of fresh fruits and vegetables.
• Speak to your doctor about whether or not a dietary supplement may be appropriate for you. Tell your doctor about any prescription drugs, over-the-counter medications and/or herbal supplements you are taking as some may affect fertility or be unsafe to take during fertility treatments.
• Speak to your doctor about what type of exercise regimen may be appropriate for you. Stick with low intensity activity during fertility treatments. Women who are underweight and/or have hypothalamic amenorrhoea may want to avoid any activity beyond walking and/or mind-body exercise such as yoga.
• Tell your doctor about any prescription, over-the-counter and herbal/natural remedies you are taking.
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