How important is for adolescents, young adults and grown-up adults to understand all the biological issues related to fertility?
A recent large-scale survey of 1,215 Australian university students (ages 18 to 30) showed an underestimation of the impact of female and male age on fertility, where less than half could correctly identify the age when a woman’s fertility declines and even fewer knew when male fertility declines. Importantly, the study found that having children was equally important to male and female students; more than 90% of students wanted children at some point but also expected to achieve many other life goals before becoming parents. Women were more likely than men to rate completing their studies, advancing in their profession, having work that could be combined with parenthood and having access to childcare. As such they demonstrated an unrealistic expectation of what they would achieve prior to conception, whether that be in their career or financially. These data demonstrated that there is a critical need to educate young people about the limits of fertility and support them to become parents at a point that is ideal biologically, while balanced against the life goals they want to achieve.
Moreover, we know that the general female population will undergo accelerated loss of ovarian reserve leading to decline or loss of fertility from their mid-30s on until the pre-menopausal years by age 45. In the past, this was of minimal concern from a public health standpoint since most women had completed their family plans by their mid–30s. However, over the past 2 decades the average age of a mother at her first birth has steadily increased and is currently 30 years of age in the Western world, with a further 1 in 5 women not having commenced pregnancy attempt by 35 years of age. While some of these women have made a conscious decision not to have children, the majority still do want children but have simply not begun trying for a baby, often due to gaps of knowledge about age-related fertility decline. Importantly, recent studies have shown that information about one’s ovarian reserve would lead individuals to modify life choices. One study showed that among health care workers, if testing of the individual or individual’s partner indicated a diminished ovarian reserve, 48% would try to have a child sooner, 21% would opt for egg cryopreservation, 7% would try to find a partner sooner, 7% would pursue adoption, and 3% would select embryo cryopreservation. Only 14% would not actively pursue treatment or make lifestyle changes.
These facts highlight the need for better education on fertility facts at all ages. At Sher Fertility Institute New York we will give you honest advice that is evidence-based on your realistic chances to achieve a pregnancy, as well as which are the state-of-the-art therapeutic alternatives that exist. Consideration should be given to:
- Assess your ovarian reserve. Although there is currently no agreement on the use of AMH to screen for ovarian reserve in the general, non-infertile population, with proper guidance and discussion of all couple’s health and other reproductive parameters it may provide help in the decision-making process. Concerns raised by opponents of such testing are that a poor result does not definitively mean diminished chances of natural conception, while an abnormally low value may also lead to substantial anxiety with multiple potential negative consequences (e., premature termination of education and career development to have children, seeking motherhood outside of a stable relationship). However, contrary to this argument, a recent study showed that women that banked or did not bank eggs have a surprising congruent relational status and reproductive choices, indicating that freezing oocytes does not appear to influence their life choices. An important ethical consideration, however, is that oocyte banking is costly and may, as of now, not be affordable to some women identified as having low ovarian reserve by AMH screening.
- Complete a thorough infertility workup after a year of actively trying to conceive if you are under 37 years, and after 6 months of trying if you are over 37 years of age.
- If fertility issues are found you must undergo appropriate treatments without delay, always following evidence-based guidelines.
- Freeze your eggs as a means of fertility preservation or freeze embryos if you are married and committed to initiating a family later, to stop the impact of ticking of the ovarian clock for later use as personal and work-related factors become more stable.
Yes, it is not easy to balance the competing aspirations of study, career and other personal life goals with achieving parenthood at the age when you are most fertile. If you would like more information call (646) 792 7476 to schedule an appointment today. At Sher Fertility Institute New York, we recognize that time is of the essence and we are committed to making every effort to see you as soon as possible.