Michal Schonbrun, MPH, CHES,<\/span><\/p>\n It\u2019s a fact. More and more women are delaying pregnancy and first birth until their late thirties\u2019 and early forties. Most are educated, independent, invested in career goals and building financial stability.\u00a0 Some have potential partners; some have ambivalent partners and some have no partner. These women describe themselves as healthy, fit, and with regular menstrual cycles, so they assume there is nothing to worry about, until the body tells a different story.\u00a0 For many, there\u2019s a huge disconnect between what they know about their biology and fertility clock in general, and how that clock applies to them personally.<\/span><\/p>\n For every young female under <\/span>35<\/span> who hopes one day of having children \u2013 this post is for you.\u00a0 You are not deciding today to get pregnant- but there is a lot you can do, learn and prepare for between now and then.<\/span><\/p>\n Picture from: Freepik<\/a><\/p>\n 1. Follow your heart<\/strong><\/span> and desire.<\/span>\u00a0<\/span><\/strong> Start to imagine what a future family might look and feel like, even if the pieces are not yet in place. It is an ongoing meditation and process.\u00a0 Just because you don\u2019t have a partner or ideal conditions for having a child \u2013 do not throw away the dream.\u00a0 Having a vision, a reproductive plan, a tentative timeline will help energize your intentions and feed your spirit.\u00a0 Open-up to the people in your life and express your intentions.\u00a0 Collect information. Build your social, family and financial networks so you\u2019ll have support in place when you need it. You can revisit and adjust your plan. But start the process.\u00a0 If you need a \u201cfertility\u201d guide, there are fertility awareness educators (FAE\u2019s) all over the world, like myself, that you can locate<\/span> here<\/span><\/a>. If you feel stuck, and need emotional support, there are therapists who specialize in parenthood clarity and even online<\/span> courses<\/span><\/a>.\u00a0\u00a0<\/span><\/p>\n 2. Befriend and listen to your body<\/strong><\/span>.<\/span>\u00a0<\/span><\/strong> It\u2019s the place you live that is \u201chome\u201d for the rest of your life.\u00a0 Become more knowledgeable and savvier about what and how your body communicates. \u00a0 Befriending your body means tuning in, making peace with who you are and cultivating self-acceptance and self-love. It means prioritizing your health and lifestyle. Be aware of how you gain and lose balance.\u00a0 Be aware of what connects and disconnects you from your body.\u00a0 What happens when you\u2019re overworked, tired and sleep-deprived?\u00a0 What happens when eating habits spiral or when on-going stress depletes your energy and immune system?\u00a0 We are all sensitive to different things. Your early thirties are the years to establish good health and lifestyle habits and find ways to practice and maximize self-care.<\/span><\/p>\n 3. Pay attention to your menstrual cycle<\/strong>.<\/span>\u00a0 Your cycle is your number one ally when it comes to gauging your fertility and overall health. Your cycle is your body\u2019s \u201c5th vital sign,\u201d as important as heart rate, body temperature, blood pressure and respiratory rate.\u00a0 How regular are your cycles? Do you ovulate?\u00a0 Have bad period pain or heavy bleeding?\u00a0 Did you know that regular ovulation is a sign of overall health and not just fertility potential?<\/p>\n If you are a long-time user of hormonal birth control (HBC), taken for regulating an irregular cycle or treating bad period pain or other issues- there\u2019s a good chance that when you stop these methods, an underlying problem is going to resurface.\u00a0 Instead of attending to the symptoms of a deeper problem, you can often fix the problem with natural medicine ( naturopathy and nutrition, Chinese Medicine, functional medicine doctor). HBC creates \u201cartificial\u201d cycles that mask conditions like endometriosis (pain) or polycystic ovarian syndrome (PCOS-irregularity).\u00a0 Making lifestyle changes around diet, exercise, stress and sleep can go a long way to strengthen your health and fertility.<\/p>\n 4. Become body-literate<\/strong><\/span>.<\/strong><\/span>\u00a0 Learn fertility awareness (FA) with a<\/span> certified teacher<\/span><\/a>.\u00a0 Charting your basal body temperature and natural secretion changes can give you vital information about your cycle and fertility. You can only get pregnant during a few days of your cycle and you can easily learn to identify these days. This is stuff your gynecologist hasn\u2019t learned.\u00a0 This isn\u2019t just knowledge, but power, control and peace of mind that comes with mastering your fertility, literally.\u00a0 Having a tool for gauging hormonal health is life-changing and will change your relationship to your body.\u00a0 FA<\/span>\u00a0can also help you conceive sooner rather than later.<\/span><\/p>\n From App: readyourbody<\/p>\n 5. Investigate<\/strong><\/span>.<\/strong><\/span> If you don\u2019t have regular cycles now or didn\u2019t have them in the past- you may have a hormonal or nutritional imbalance. There are far too many invisible women out there who are \u201csub-fertile,\u201d meaning they have an undiagnosed problem which is reversible and make it difficult to conceive, until they take care of the problem.\u00a0 Sub-fertility affects those with a history of overweight or underweight (low or high BMI), restrictive diets and eating disorders, chronic stress, over-exercise, iron deficient anemia, hypothyroidism, and low B12.\u00a0 While known to disrupt reproduction, few women (or their doctors) are aware that these lead to sub-fertility so please, connect the dots.<\/span><\/p>\n 6. <\/strong><\/span>Remember<\/strong><\/span>:<\/strong><\/span> Age is the number one, preventable risk factor leading to infertility.\u00a0 Despite what you might think,\u00a0 \u201cforty is not the new thirty\u201d.\u00a0 Stop believing the stories you read in trendy magazines and on fertility clinic website ads that say \u201call is chill, you can take your time and wait, even until 40.\u201d\u00a0 Just because some rich and famous celebs can have \u201chi-tech\u201d babies in their late 40\u2019s \u2013 doesn\u2019t mean that you can too. This is a cynical and insidious lie that infertility doctors and clinics profit from because the longer you wait, the harder it becomes. These clinics are waiting to greet you with open arms\u2026 when you need hi-tech treatment.<\/span><\/p>\n 7. Test<\/strong><\/span>.<\/strong><\/span> If you\u2019re in your early 30\u2019s, regardless of relationship status, the most proactive thing you can do is to learn about and check your fertility status or ovarian reserve (AMH, AFC, FSH).<\/a><\/span>\u00a0 Our eggs are ageing from year to year, and when we pass our mid-30\u2019s our fertility potential has already declined. By the time we reach 40, our reserve is seriously depleted.\u00a0 Again, it bears repeating- just because you have a \u201cregular\u201d cycle doesn\u2019t mean you have good ovulation or that your egg quality will guarantee a healthy pregnancy and baby.\u00a0 Results from these tests provide a baseline for future comparison and how fast your biological clock is ticking.\u00a0 \u00a0They can predict how many years of fertility you still have; how your fertility compares to women your age and if you will be a good candidate for reproductive technologies like IVF<\/a> in the future.\u00a0<\/span><\/p>\n Having said this, multiple studies have found no definitive link between AMH levels and the likelihood of pregnancy. There are cases of women with high AMH who are not able to conceive and women with low AMH who do. A recent article in the BMJ<\/a><\/span> warns of corporate interests invested in fertility treatments who are using feminist language around control and empowerment to sell non-evidenced based health interventions like\u00a0 DIY AMH testing at home.\u00a0<\/span><\/p>\n CBC (complete blood count) is another way to gauge your overall health, by checking your blood biochemistry. This simple test can often detect health issues which could impair your fertility.<\/p>\n 8. Freeze<\/strong><\/span>. <\/strong><\/span>Collect information and consider freezing your eggs (or embryos with a partner or donor sperm).\u00a0 While this is not guaranteed \u201cfertility insurance\u201d to bank on for the future, it can give you pause in postponing a big decision. Just remember- your chances of conceiving with frozen eggs or embryos will be dependent on the age that you froze them (spoiler alert- best by or <\/span>before <\/span>35<\/span>)<\/span>, the number of eggs harvested (best to have 15-20), and the age at which you will carry a pregnancy.\u00a0 Even if you have good eggs in the freezer, once you hit 40, there are much lower rates of success and higher rates of complications including pregnancy loss, premature birth, genetic-chromosomal abnormalities and more.\u00a0 And the little-big fact that your doctor may forget to mention: there\u2019s a lot we don\u2019t know yet, statistically, about egg thawing success because the eggs that most women in the world have frozen- are still frozen.<\/span><\/p>\n While technology makes this \u201cpause\u201d possible, we need to acknowledge the downsides of egg-freezing (EF). Celebs and social media influencers are creating trends that are driving more and more young women to freeze their eggs. Some of these influencers are partnering with IVF clinics with targeted ads about the biological clock. Some are documenting the actual EF process to hundreds of thousands of their followers. This raises serious ethical questions about the necessity of EF and the ability to make informed choices about it.\u00a0 Furthermore, EF in those under 30 carries the risk of ovarian hyper-stimulation<\/a>, which could be life-threatening.\u00a0<\/span><\/p>\n Picture from: Freepik<\/a><\/p>\n 9. Develop critical thinking<\/strong><\/span> about the panaceas of <\/span>IVF, which is <\/span>expensive, invasive, carries risks and side effects \u2013 and can yield disappointing outcomes. Yes, there are always outliers, but IVF statistics are not particularly promising for those over 35.\u00a0 IVF success (having a live birth) in women between 35 and 37 is approximately 32% per each egg retrieval cycle.\u00a0 Success for women aged 41-42- is less than 10%.\u00a0 If you\u2019re under 35, the success rate approaches 50%.\u00a0 \u00a0\u00a0<\/span><\/p>\n 10. Consider family history. <\/strong><\/span>Are there cases of infertility, miscarriage or problems conceiving?\u00a0 Talk to relatives on both sides.\u00a0 A history of blood clotting disorders, diabetes, endometriosis, uterine fibroids or poly-cystic ovarian syndrome (PCOS) <\/span>can be<\/span> hereditary.\u00a0 The earlier you know, the more time you gain to figure out your risk factors and how to manage them.\u00a0 And speaking of risk factors- if you have a history of <\/span>STI\/STD\u2019s<\/span><\/a>, autoimmune disease, or cancer, these conditions could interfere with the ability to conceive naturally, or delay the time to childbirth with assisted reproductive technology (ART).<\/span><\/p>\n 11. <\/strong>The bottom line<\/strong><\/span> is this:<\/strong> <\/span>We cannot afford to take our fertility for granted. It\u2019s OK to delay but know the facts so you can act. Despite the cultural pressures around us, we have to face the dilemmas and meet our own needs. As strong and independent women, we have the autonomy and responsibility to ourselves to make the decisions that are right for us \u2013 on our own terms and at our own pace.<\/p>\n \u00a0Age matters \u2013 even when we are healthy and with regular cycles.\u00a0 Awareness and knowledge about our biology and cycles have the potential to reduce infertility among people who choose to delay.\u00a0 Personal empowerment is about being proactive, taking responsibility and making informed decisions.\u00a0 When it comes to pregnancy, child birth and parenthood- having this knowledge and a personal vision to navigate the dream is not just awesome but critical.\u00a0 It is in your control.\u00a0 May every young person (under 35) manifest this power \u2013 sooner rather than later.<\/span>\u00a0\u00a0<\/span><\/p>\n Henderson-Jack, Lisa. <\/span>The Fifth Vital Sign<\/span>, Fertility Friday Publishing, 2019<\/span><\/p>\n Weschler, Toni. <\/span>Taking Charge of Your Fertility, 20<\/span>th<\/span> Anniversary Edition<\/span>, Harper-Collins, 2015<\/span><\/p>\n Briden, Lara. <\/span>Period Repair Manual, 2<\/span>nd<\/span> Edition<\/span>, 2018<\/span><\/p>\n Romm, Aviva. <\/span>Hormone Intelligence<\/span>, HarperOne, 2021<\/span><\/p>\n How a parenthood therapist helps women navigate the big decision<\/span><\/a><\/p>\n Should I have children?<\/span><\/a><\/p>\n How aging affects fertility and pregnancy<\/span><\/a><\/p>\n![\"\"](\"https:\/\/poriutivit.com\/staging2\/wp-content\/uploads\/2024\/02\/pensive-woman-with-question-marks-1-300x200.jpg\")
<\/span><\/p>\nHere are ten action steps that you can take today.\u00a0\u00a0<\/strong><\/span><\/h4>\n
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<\/p>\nRecommended resources:<\/strong><\/span><\/h6>\n