• Dr Izzy Smith

Fertility Q and A with Dr Raelia

Being totally honest I always got irritated when I heard doctors talk about the importance of not leaving having children too late due to risk of infertility or other problems. It’s not as if women have a magical wand they can wave and find a partner, afford property or be at a time where taking time off work wouldn’t be really detrimental to their careers.

It also just seems so unfair that men don’t have to face the same set of issues as women☹ Furthermore, not everyone wants to have children and reiterating to all women that they should be thinking about having children seems patronising.

However recently I’ve had a few friends go through IVF, mainly for secondary infertility, who all said they wish they’d been better informed of the likelihood of fertility problems associated with trying to fall pregnant in the mid-30s or older.

Essentially, we have a culture-biology gap. Our culture has changed rapidly in the last few hundred years, but our DNA hasn’t has time to catch up and our biology is still wired to optimally reproduce in our late teens and 20s. I didn’t want to be the same Doctor that I got irritated by, but I’ve realised in the same way there’s nothing empowering about being lectured you should be focusing on having children, it’s also not empowering to not be fully informed about our health and bodies either and the impact this could have on our future decision making.

Consequently, I wanted to do some content on fertility, especially as I think there’s undue stigma around these issues (for men and women) when it should be discussed like any other health topic 😊

Here are a few facts on fertility which I discussed on recent insta live with Dr Realia;

1. In our 20s you have around a 20% chance of falling pregnant each cycle which then decreases approximately after 30.

2. Compared to the rest of the animal kingdom, human childbirth is quite dangerous and only a few hundred years ago, maternal mortality was around 10%. Humans relatively low fertility (single pregnancies and only 20% chance per month at best) was thought to be an evolutionary process in order to offer survival benefit 😊

3. Sperm can live for around 5 days in the female reproductive tract which means the fertile window is about 5 days before ovulation. If you are trying to fall pregnant, tracking your cycle and knowing roughly when you ovulate can be a useful tool to help increase your chance of conceiving 😊

4. As we age, our eggs develop problems with their DNA such as chromosome abnormalities or other errors that make it hard to fall or maintain a pregnancy. During our 20s most of our eggs are healthy with only about 10% having any major DNA issues but unfortunately this number starts to increase by around 30. By 35, approximately 50% of eggs gave a chromosomal abnormality, by 40 it’s around 90% and by the early 40s almost all eggs have DNA issues. This is essentially the major reason why despite still ovulating each month, fertility decreases as we age.

5. Unfortunately having the healthiest diet or excellent general health does not do anything to stop these age-related chromosomal abnormalities ☹

6. AMH or “anti-Mullerian” can help indicate egg reserve quantity but not quality. It does not predict your likelihood of falling pregnant and is just one piece of the puzzle when accessing someone’s fertility health. Consequently, this test should only really be ordered by an obstetrician or fertility specialist.

7. Freezing eggs are not a guarantee of future fertility but offer an extra option. The benefit of freezing eggs earlier, is that they remain the same age as when you froze them i.e. will have a low chance of genetic errors.

8. Endometriosis increases the risk of fertility problems and surgical management can improve fertility (as well as being an important aspect of pain relief). However, for minimal disease there isn’t evidence that excision of low-grade disease improves outcomes in IVF and the diathermy (heating elements used in surgery) can negatively impact egg reserve. Consequently, it’s important to discuss fertility preservation and a combination or surgical and non-surgical management options with your endometriosis specialist (if having children is something you may wish to do in the future 😊)

9. For couple struggling to get pregnant, it’s critical to remember that it takes two people to make a baby and 50% of fertility problems are related to the male side of things. Both people should get worked up for fertility issues after 6-12 months of unsuccessfully trying to conceive.

I hope this blog was informative and helpful. The statistics can feel a bit gloomy but I realised discussing this doesn’t mean I’m some type of anti-feminist who’s encouraging women to stop everything and have children (heck I’m definitely not), but instead is about empowering people through knowledge that allows informed decisions on what’s right for them and their future 😊

This was only part 1, and part 2 Dr Raelia and I will discuss all things egg-freezing, IVF and other fertility treatments. I think this is absolutely amazing technology that’s helping empower women with their fertility health so stay tuned for part 2 in the New Year!

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