Understatement on fertility: “If it happens it happens…”

It is unfortunately my job to remind and educate patients of their current behaviors, health status, and what that means for their future…”you are morbidly obese and your weight puts you at risk for developing serious health conditions like diabetes, hypertension, and even breast and endometrial cancer…let’s talk about some things we can do to work on your diet and exercise.”
The same goes for a woman’s fertility.  I often have to remind women that there is a optimal time for child bearing and I always try to preface the conversation by letting them know that I as a woman hate having to be reminded of this “reproductive responsibility”.
However, as an ob/gyn I do feel it is my job to inform my patients of this very real decrease in fertility and increase in reproductive risk that occurs after a certain age especially if the woman is interested in having children.
I usually reserve this conversation for women in their 30’s and especially for woman in the “35 and over” bracket, since this is the advanced maternal age group and it is they that are at most risk for infertility issues.
The biggest understatement I have heard recently was a 38 year old patient answer…”well, If it happens, it happens…” after I asked her about starting a family.
The reality is that it may not just “happen” for her.
More concerning is that it is not just this patient that I hear this from.   I get this response quite often from women in that critical window period who assure me that they do want to have children but are just leaving it up to chance.  Initially, this seems ok, until a year later and we are still “not really trying, but ok if it happens.”
Then I take a deep breath…
If you were to ask these same women about any other subject including a job promotion, their kids kindergarten application, their house hunting, their pinterest account…none of these topics would elicit nearly half as little commitment as the “if it happens, it happens” response does to starting a family.
Most women “kind-of” know that in our late 30’s our fertility starts to decline and our pregnancy risk begins to rise…right?
We all know we wouldn’t leave that promotion or school application to chance so why our fertility at a point when every month counts?  We are so aggressive in every other aspect of our life and yet we decide to “sera, sera” our way past the window of opportunity to have children or in some cases have more than one child.
Maybe, it is because we don’t know enough about the process of infertility until we are faced with that problem.  We grow up hearing all about this “clock ticking” but where the hell is this clock and can someone tell us exactly when does the alarm go off!?
Sadly, sometimes there is no alarm, no warning.  Some women struggle with their fertility much earlier on in life and are faced with a roller coaster of emotions, procedures, injections, and losses… all to get that prized gem at the end of their long journey…BABY.
There are many different diagnoses for infertility and it is not all about the woman.  The male sperm obviously plays a big role and can also be a culprit when in comes to difficulties conceiving.
The next few blogs will be about helping you understand your fertility and know when its time to seek help from your gynecologist or an infertility specialist.
In an effort to change your resigned attitude to one of educated empowerment (because that’s what we do here!) I am bringing in Dr. Jennifer Hirshfeld-Cytron, a reproductive endocrinologist with Fertility Centers of Illinois, to discuss common infertility issues and diagnosis as well as treatment.  She will be our featured specialist for up coming blogs.
But first, I thought I would give you the basics of why our fertility diminishes in our 30’s and what should be our first steps from “if it happens, it happens” to “let’s make it happen!”
We are born with all of the eggs or oocytes we will have in our life time so our eggs, which live in our ovaries, are just as old as we are.  Since prime reproductive years for women are in their 20’s, a 35 year old oocyte is approaching retirement.  This is not to say it is not working–don’t get me wrong.  But there are factors that make it less efficient.
First of all, our fertility decreases significantly in our 30’s.
A healthy 30 year old woman has a 20% chance of getting pregnant each month, so out of 100  thirty year old women trying each month 20 will get pregnant and 80 will have to try again, by age 40 that number drops to 5% per cycle.
In addition, the egg quality also diminishes.
An oocyte contains a copy of our genetic information, it has 23 chromosomes.  As it ages it tends to have more errors occur within those chromosomes called aneuploidy.  This means the oocyte can have either too little or too many copies of the chromosomes and sometimes end up with genetic conditions like Down Syndrome, an extra copy of chromosome 21.  Because our body has it’s own checks and balances it can detect some of these errors very early on in a pregnancy and stop it from going any further–ending up in a miscarriage.  This explains why there is an increased rate of miscarriages in women of advanced maternal age.
As I said earlier, we are born with a finite number of eggs and eventually that supply runs out.  As we get older and approach 40 the quantity of oocytes diminishes.  This is called ovarian reserve.  Some young women may also have a diminished ovarian reserve without risk factors or warning, which is why it is important to see your ob/gyn if you have irregular or no menses.  There are many blood tests that can be done to measure ovarian reserve, but these test may not predict your success at becoming pregnant.
So, now that we understand why it’s much more difficult to not only become pregnant but to stay pregnant in our 30’s…How do we get started?
Well, first things first: Have a lot of SEX!
Husbands, you can send me the thanks on the “comments” section.
An understanding of the reproductive cycle is necessary to know that there are only around 2 days in our cycle that we are “fertile” and able to get pregnant.  Those 2 days are the days when we ovulate and are usually in the middle of our cycle.
The first day of your cycle is the first day of your menses.  Most woman have a menses every 28-30 days, the first half of your cycle is focused on “fattening up” your eggs.  Come the middle of your cycle the biggest egg “wins” and gets selected as the “dominant” egg.  At the same time your brain secretes a hormone called Luteinizing Hormone (LH) that triggers the release of the egg from the ovary. As the egg is released it is picked up by the fallopian tube and will wait there for the sperm to come up to fertilize it.  This process is called ovulation.  It usually gives the sperm around 2 days before it checks out.
You should invest in some ovulation or LH predictor kits so that you can actually determine exactly when those 2 days of your cycle are.  The kits come with instructions but pretty much you start checking your first morning urine on day 10 of your cycle until it is positive.  Once the test is positive this means that in the next 24-48 hours you will be ovulating and thus should have lots of sex.
If the ovulation kits never turn positive, this is an indicator that you are not ovulating and need to see your ob/gyn asap.
If you are under the age of 35 and attempting pregnancy for 12 months or 35 and over and have been trying for 6 months with no success, this qualifies as infertility and you should get in to see your ob/gyn for a panel of tests to assess the problem.
Anyone attempting pregnancy should start taking prenatal vitamins with folic acid 6 months prior to conception to help reduce the risk of neural tube defects like spina bifida and start a healthy diet and exercise.
Obesity increases the risk of infertility, miscarriage, and the risk of diabetes, hypertension, preeclampsia, and cesarean section once pregnant.
As always, these are only general guidelines and not meant to diagnose or treat infertility.  Always see your doctor for specific questions or concerns.
Don’t miss Dr. Jennifer Hirshfeld-Cytron, a reproductive endocrinologist with Fertility Centers of Illinois. 
Our featured specialist to discuss common infertility issues for the next few blogs!