9 Things Every Woman Needs to Know About Her Fertility

1
What You Must Know About Your Fertility

Woman holding a positive pregnancy test and smiling, she understands her fertility
The more you know about your fertility, the more likely you'll be successful in having the family you want. Ezra Bailey / Getty Images

Whether you're trying to get pregnant now or only considering it for the future, there are certain things you must know about your fertility.

Sadly, the education most of us received didn’t talk about egg freezing, when you’re most likely to conceive, or age-related fertility decline. Most of us were never told how long it should take to get pregnant or what to do if you can't.

High school sex education focuses on preventing pregnancy. That's great for teenagers. Not so great for the rest of our reproductive lives.

Here are 9 things every woman should know about her fertility.

2
You're Fertile for Less than a Week Each Month

Couple in bed ready to have sex just before ovulation
If you want to get pregnant, you need to have sex before ovulation. Dimitri Otis / Taxi / Getty Images

High school sex ed leaves many of us believing we’ll get pregnant the second a boy kisses us!

Then, when we’re adults and we want to conceive, we’re shocked when it doesn’t happen so easily.

You’re not fertile all month long. In fact, you're only fertile for a week at most each cycle. And you’re very fertile for only two to three days, just before you ovulate.

When Do You Actually Ovulate?

Another thing people misunderstand about fertility is ovulation day.

Do you think that you’re most fertile day is Day 14 of your menstrual cycle? You could be wrong about that!

If you wait to have sex on Day 14, but ovulated on Day 12, you will have missed your chance to get pregnant.

If you ovulate on Day 18, you will have had sex a tad too early.

You can find out when you ovulate. There are a variety of methods to try:

Important side note: If you're thinking you can worry less about birth control, since you're only fertile for a few days each month, you're making a big mistake.

When women are most fertile, they also feel increased levels of sexual desire, and their partners find them more attractive. (Mother Nature is very smart!) Use some form of contraception - always! - if you don't want to get pregnant.

3
If Having Kids Is Important to You, Consider Your Biological Clock

Cracking egg with red clock hands, in white egg carton - metaphor for biological clock
Your fertility begins to rapidly decline after age 35. ICHIRO / Digital Vision

A number of surveys and research studies over the years have found that many women (and men) are not aware of how much female fertility declines with age.

People frequently overestimate their chances of conceiving at age 40 or 44. Or they assume IVF treatment alone can solve the issue. (It can't.)

Based on this false information, they plan their families, and sometimes wait too long to start trying to conceive.

If you have a choice in the matter, don't be one of these women.

When Is the Best Time to Start Having Kids?

A really interesting study looked at what age a couple should start trying to have a family, based on how many kids they eventually want to have and whether they are open to IVF treatment.

If you’re not open to IVF treatment, you should start trying to conceive...

  • By age 32, if you want a 90% chance of having one child
  • By age 27, if you want two children
  • By age 23, if you want three children

If you are open to IVF, the study suggests starting your family...

  • By age 35, if you want a 90% chance of having one child
  • By age 31, if you want two kids
  • By age 28, if you want three kids

Of course, even if you start young, you’re not guaranteed a baby. Young men and women can also experience infertility.

4
Egg Freezing Is Neither Risk-Free Nor Guaranteed

Frozen storage for egg freezing
Having your eggs on ice is no guarantee you'll actually get pregnant with those eggs in the future. Science Photo Library / Getty Images

Women delay motherhood for a variety of reasons, not all of them under their control. Many fertility clinics offer egg freezing services to young women concerned about their fertility future.

The idea is that you freeze your eggs when you’re young and your fertility is good. Then, later in life, those eggs can be used to get pregnant via IVF treatment. Maybe.

Egg freezing (and later, IVF) isn’t cheap. Some clinics encourage the young woman's parents to "pay to protect" their daughter's fertility (since few young women have the cash.) If you’re lucky, insurance may pay for egg freezing. But this is rare.

It’s costs around between $10,000 and 17,000 to freeze your eggs. Then, you will have to pay a yearly storage fee of about $500 to 800. After that, if you need IVF treatment (you may conceive on your own before), you’ll have to pay up to another $5,000 to use those eggs.

Why Doesn't the ASRM Recommend Egg Freezing to Extend Fertility?

While the American Society of Reproductive Medicine does consider egg freezing to be an appropriate step when medically indicated, they don't currently endorse the technique for extending fertility in healthy women.

Why not? There is a lack of research on women without fertility problems using egg freezing to extend their childbearing years.

The egg freezing procedure is invasive and costly. There are risks to ovarian stimulation and the egg retrieval procedure.

On top of all this, egg freezing is also not guaranteed to work.

Just like with IVF, under the very best circumstances, the pregnancy success rate is around 40% per cycle, and that will be lower if there are any fertility factors -- male or female -- involved.

How many cycles you can try will depend on how many eggs you freeze, how many survive the freezing process, and then later, how many good quality embryos you'll have for potential transfer.

If You Want to Freeze Your Eggs, When Should You Do It?

If you do decide to freeze your eggs, keep in mind that the older you are, the less likely it is that this procedure will benefit you.

One study found that freezing your eggs before 38 may be the most cost effective option if you plan on trying to have a baby after 40. (The younger you are when you freeze them, the better.)

Freezing your eggs after 38, however, may no longer be worth the cost.

5
Irregular Cycles Are Not Normal, and Neither Are Painful Periods

Woman holding her abdomen with period cramps
If your period cramps keep you from going about your life, they are not normal. Talk to your doctor about your symptoms. PhotoAlto/Laurence Mouton / Getty Images

When menstruation begins, having irregular cycles or strong menstrual cramps can be normal. It takes the body awhile to get regulated. (However, even if you’re a teen, if your cycles are irregular or your cramps are really bad, you should see a gynecologist. Just in case.)

Once you’ve passed your teenage years, your cycles should be regular. And period cramps shouldn’t prevent you from living an active life.

Menstrual cramps that interfere with your daily life can be a symptom of endometriosis or pelvic inflammatory disease, both of which can cause infertility. Also, both of these diseases get worse with time.

The sooner you get diagnosed and treated, the better.

What if Your Cycles Are Irregular? 

There are a variety of causes for irregular periods. Polycystic ovarian syndrome (PCOS) is one of the most common causes of irregular cycles and of ovulation-related infertility.

If your cycles are irregular, you should see your doctor now. Don’t wait until you’re trying to get pregnant.

6
You Can Be Healthy, Have Regular Cycles, And Still Be Infertile

Woman practicing yoga, a healthy lifestyle choice
A healthy lifestyle will increase your odds of pregnancy success -- but it doesn't mean you won't experience infertility. The young, healthy, and fit also face fertility problems. Hero Images / Getty Images

What if you have regular cycles? And you’re healthy and fit? Certainly you won’t have trouble getting pregnant, right?

Unfortunately, it’s no guarantee.

Not every cause of infertility has noticeable symptoms. For example, you can have blocked fallopian tubes and have zero symptoms that anything is wrong.

Also, male infertility is frequently symptomless.

Are Regular Cycles a Sign of Good Fertility After Age 40?

Some women over 40 assume that as long as they are having regular cycles, their fertility is still great.

They figure that age-related infertility won’t hit until perimenopause starts to mess with their periods.

The truth is that your fertility declines years before your cycles slow or stop. 

7
An Unhealthy Lifestyle Can Harm Your Fertility

Woman breaking cigarette in half, quitting smoking to improve her fertility
Smoking can harm your fertility and speed up age-related fertility declines. But if you quit, you could reverse some of that damage. JGI/Tom Grill / Getty Images

Living a healthy life doesn’t protect you 100% from infertility. But unhealthy habits can have a negative effect on your fertility.

Here are a few big health habits to watch out for:

Smoking harms your fertility: You've probably guessed that smoking isn't good for fertility, but did you know it can speed up age-related infertility, bringing on earlier menopause?

The good news is that if you quit early enough, you may be able to reverse the negative effects.

Risky sexual activity may lead to contracting a sexually transmitted infection: STDs can lead to infertility.

Many sexually transmitted infections are symptomless in women. You may feel fine while the infection silently wreaks havoc on your reproductive organs

Practicing safe sex, and seeing your gynecologist for regular testing, is important if you're at risk.

Being overweight can cause infertility: Your weight also plays an important role in your fertility. Being overweight -- or underweight -- can lead to trouble conceiving.

In fact, obesity may be one of the most common causes of preventable subfertility. If you are obese, research has found that losing 5 to 10% of your weight can jump start ovulation. 

More on lifestyle and fertility:

8
Seek Help if You Don't Conceive After One Year

Couple talking to a doctor after their fertility problems
If you don't get pregnant after one year of trying, you should see your doctor. If you're age 35 or older, see your doctor after just six months. Portra Images / Getty Images

About 80% of couples will conceive after six months of well-timed unprotected sex, and about 90% will be pregnant after a year.

If you don’t get pregnant after one year of trying, you should see your doctor. If you’re 35 years old or older, then you should see your doctor after six months of trying.

Don’t wait longer!

Many couples don't follow this advice. They put off seeing their doctor for much longer.

This is a really bad idea, as some causes of infertility worsen over time.

Putting off a fertility evaluation may lower your chances for successful treatment later.

9
You Can Experience Infertility Even If You Already Have a Child

Couple with one child on the beach
Just because you got pregnant easily in the past doesn't guarantee it'll be easy the next time. Jasper James / Getty Images

If you got pregnant quickly with your first, second, or even third child, you should have no problems conceiving another, right?

Wrong.

Getting pregnant easily in the past doesn’t guarantee your fertility for the next time.

In fact, of all the couples currently struggling to conceive, half of them have at least one child.

Don’t use the fact that you conceived easily in the past to delay getting help now.

Just like those trying for their first child, if you don’t conceive after a year (or after six months if you’re 35 years of age or older), see your doctor. 

10
Infertility Isn't Only a Female Thing

Man speaking with male doctor about fertility
Infertility isn't only a female problem. Half of all infertility cases involve male infertility. Make sure your partner is tested, too. JGI/Jamie Grill / Getty Images

If you're having trouble conceiving, the first doctor you'll probably see is your gynecologist.

But you’ve got to make sure your partner's fertility is tested as well. Male infertility is involved in almost half of all infertility cases.

If your doctor tests and treats only you, but your partner is also infertile, the treatments can't succeed. You will have gone through the physical and emotional stress of treatment for no reason.

I can’t tell you how many stories I’ve been told where the male partner wasn’t tested, the female took fertility drugs and didn't conceive, only to find out it was never possible – because he was infertile.

Make sure his fertility is tested, too.

Sources:

Age and Fertility: A Guide for Patients. American Society of Reproductive Medicine. Accessed April 14th 2013.

Berger, Amanda, Ph.D; Manlove, Jennifer, Ph.D.; Wildsmith, Elizabeth, Ph.D. "What Young Adults Know - and Don't Know - About Fertility Patterns: Implications for Reducing Unintended Pregnancies." Child Trends Research Brief. September 2012.

Cottrell BH. "An updated review of evidence to discourage douching." MCN Am J Matern Child Nurs. 2010 Mar-Apr;35(2):102-7; quiz 108-9. doi: 10.1097/NMC.0b013e3181cae9da.

Devine K1, Mumford SL2, Goldman KN3, Hodes-Wertz B3, Druckenmiller S3, Propst AM4, Noyes N3. “Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth.” Fertil Steril. 2015 Jun;103(6):1446-53.e1-2. doi: 10.1016/j.fertnstert.2015.02.029. Epub 2015 Mar 23. http://www.fertstert.org/article/S0015-0282(15)00159-4/abstract

Habbema JD1, Eijkemans MJ2, Leridon H3, Te Velde ER4. “Realizing a desired family size: when should couples start?” Hum Reprod. 2015 Sep;30(9):2215-21. doi: 10.1093/humrep/dev148. Epub 2015 Jul 15. http://www.ncbi.nlm.nih.gov/pubmed/26185187

K. Mac Dougall, Y. Beyene, R.D. Nachtigall. "Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40." Human Reproduction. (2012) doi: 10.1093/humrep/des409 First published online: November 30, 2012.

Mature oocyte cryopreservation: a guideline. American Society of Reproductive Medicine. Accessed April 14th, 2013.

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