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January 31, 2009

Fertility 101

Suddenly, women in their 20s are flocking to fertility centers, hoping to increase their odds of one day getting pregnant. Here's what they — and you — need to know.

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Photo Credit: Kenji Toma

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When it comes to fertility, 25 is the new 35. Women once waited until their biological clocks had almost popped a spring before bringing out the big guns, but smart young women today aren't leaving anything to chance. Just consider that the number of women 24 years old and younger who reported trouble conceiving or maintaining a pregnancy has almost doubled. Or the fact that 44 percent of those signing up for reproductive assistance now are under 35, according to the CDC's National Survey of Family Growth. From when to have sex to what not to eat, this comprehensive guide reveals the latest ways to plan for pregnancy — five, even 10 years in advance.

THE AGE GAME
Like it or not, age remains the biggest determinant of fertility. "No matter how much you take care of yourself, you can't slow down ovarian aging," says Dr. Kutluk Oktay, medical director at the Institute for Fertility Preservation at the Center for Human Reproduction in New York City. Here's why you shouldn't wait until your 40s to hit the baby panic button:

Your ovaries have a life span. Making a baby requires a healthy egg, but eggs become more scarce as you age. You're born with about a million eggs, but most of them never mature. By the time you reach puberty, you're down to half your original supply, and the number continues to fall each year. And not every egg that survives can make a baby. Even in your prime, about half of all eggs have chromosomal abnormalities, and the proportion of eggs with genetic problems increases as you age, explains Dr. David Adamson, president of the American Society for Reproductive Medicine. Eventually, you simply run out of viable eggs. "As of today, we have no way of changing that," he says. "It's the natural course of human life."

Fertility peaks in your 20s. Most women hit their fertile peak between the ages of 23 and 31, though the rate at which women conceive begins to dip slightly in their late 20s. Around age 31, fertility starts to drop more quickly — by about 3 percent per year — until you hit 35 or so. From there, the decline accelerates. "The average 39-year-old woman has half the fertility she had at 31, and between 39 and 42, the chances of conceiving drop by half again," says Adamson. Approximately one in four women age 35 or older have trouble getting pregnant.

The average woman can have a baby until age 41, but that's no guarantee. Your ability to naturally conceive a child ends about 10 years before menopause, but "we do not have good tests to predict when that life change will occur," says Adamson. While the average age at which women deliver their last child is 41, for some women it's 30; for others, 45. Currently, doctors can measure a few markers of fertility, such as the hormone FSH, but "these only tell us the bad news," says Oktay. "Even if FSH is normal, that doesn't tell us how many reproductive years this woman has left. Once it's elevated, we know it's too late."

Fertility patterns can run in families. "But it's not something to plan by," Adamson says. "While your mother may have had her last baby at 43 years old, you can't count on that being your destiny."

It's not you, it's him About half of infertility cases involve an issue with the guy. Though many men can father children past their 70s, sperm quality declines with age. Boost his swimmers by nixing things that overheat the scrotum, including laptops held on laps, prolonged hot-tub soaks, and too-tighty whities. Smoking, drinking, and crotch-numbing bike seats are other no-nos, says Dr. Kutluk Oktay. Frequent sex? Perhaps a good thing — an Australian study suggests that daily ejaculation can increase sperm quality. (But the more he expels, the fewer the sperm in each release.)

MAXIMIZE YOUR FERTILITY NOW
You can't push fertility beyond its natural limits, but you can do things to raise your odds of conceiving. Here's how:

1. Control stress. Stress alone will not make you infertile, says Alice Domar, Ph.D., of the Boston IVF clinic and author of Conquering Infertility. But for women especially sensitive to stress, it can throw off their cycle and may make it more difficult to get pregnant. Given that a new baby will invariably introduce new stresses into your life, Domar recommends that you devise a tranquility plan before you try to conceive.

2. Take folic acid early and often. It's widely known that folic acid (vitamin B9) reduces the risk of birth defects once you're pregnant, but some studies have also shown that women who take folic-acid supplements before becoming pregnant conceive at a higher rate. Jorge Chavarro, an instructor of medicine at Harvard Medical School, hypothesizes that folic acid may increase your body's sensitivity to FSH, the hormone that tells the ovary to kick out an egg in the middle of your cycle. He recommends taking at least 400 micrograms per day.

3. Quit smoking. Smoking is one of the worst things you can do if you're trying to get pregnant, says Shanna Swan, director of the Center for Reproductive Epidemiology at the University of Rochester School of Medicine & Dentistry. You're exposing yourself to tons of chemicals that accumulate in your body — and these chemicals interfere with your estrogen levels and can damage ovaries and your eggs along with them. Furthermore, smokers hit menopause about two to three years sooner than nonsmokers, says Oktay. If you do manage to get pregnant, smoking increases your risk of miscarriage and of delivering an underweight baby.

4. Don't overexercise. Moderate exercise is nothing but healthy. But work out too much or too intensely, and you're at risk for developing menstrual irregularities that make it difficult to get pregnant. If your periods become irregular, you should back off the marathon prep and endurance cross-training sessions.

5. Drink conservatively. There's no question that heavy drinking — the kind that throws your cycles off-kilter and leaves you chronically hungover — impairs your ability to conceive, says Oktay (even if it can enhance libido for a few hours). But what constitutes moderate drinking is an open question, as different studies have yielded conflicting results. Best to play it safe and have no more than one drink every other day.

6. Maintain a healthy weight. About 12 percent of infertility cases result from the woman being over- or underweight. Fat cells secrete hormones, and having too much or too little fat can throw your hormones off balance. A body mass index (BMI) between 20 and 25 seems to be optimal. (Calculate yours at nhlbisupport.com/bmi.) A recent Dutch study found that fertility dropped about 4 percent per BMI unit above 29.

NEXT PAGE: Truth or Myth: What Really Affects Your Fertility?


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