Because I serve a pretty diverse group of women (you’d be surprised who finds their way to the mythic land of Beverly Hills medicine!) I’m not always sure exactly where my ladies get their info about fertility—friends, colleagues, Aunt Rose, social media, Google news. But I’ve gotten pretty good at predicting the source based on the emotional tone of their inquiries, and there is nearly ALWAYS an emotional tone to these inquiries.
So let me just get to it. What do I WISH you all knew before you started to worry?
Here are 10 things I wish everyone knew about fertility before age 35:
1. You're never gonna have more eggs than when you were a half-baked fetus in your own momma's uterus.
That's correct: it’s been a downhill slide ever since you were at 20 weeks gestation. So get over it. I say this NOT to be mean, but rather to build some perspective on my favorite topic: surrender.
2. You'll have to surrender to the process.
While it's true that you're probably more fertile in your teenage years than you'll ever be again, do I really need to say that that doesn’t mean it’s the optimal time for most of us to enter parenthood? You can't change the past, all you can do is accept the present. Let go of any regrets about what you didn’t do up until the point that you're sitting in my office, lamenting how many children your mom had when she was your age.
3. Are you really interested in motherhood or is it something that has been expected of you?
What about your partner? This is a huge question that I ALWAYS ask the ones who come to me year after year with the same questions about fertility but absolutely no forward motion—especially if they tell me they're in stable, loving relationships. Motherhood is NOT a requirement of adulthood.
4. Are you OK with the fact that having a child will change (and in fact, disrupt) your life?
Despite what I've said above, fooling yourself into thinking it won’t matter later on if you're still involved with your current career/lifestyle/free-spirited-boyfriend or girlfriend is a huge mistake. I don’t have an easy answer here.
Do some soul searching, will ya?
5. It's not fair, but it's the truth: If you're in a same sex relationship, it's just gonna be more complicated.
Sorry. What we cis/heteros don’t even need to think about (but really probably should) is going to take some advance planning and possibly some extra cash. Get advice sooner rather than later on this one to reduce stress. There are many knowledgeable and supportive docs out there—find us!
6. Get serious about your health before you get pregnant.
Remember everything you learned about the immutable power of DNA in middle school science? Turns out its not quite the case. For instance, scientific evidence now indicates that optimal levels of folic acid, vitamin D, and even omega 3 fatty acids found in fish oil in you, the pre-pregnant woman, has impact on the health of your future kids. I am NOT going to shame you about starting pre-natal vitamins as soon as you got that positive pregnancy test, but honestly, you should have been getting healthy way way before then. It actually matters.
And here is where lifestyle choices, (and not just the obvious ones like avoiding substance use), can impact positively: yoga, meditation, and mindfulness WORK.
7. There's a lot of controversy about age and fertility.
Fertility has always been a popular battleground for feminists of all stripes and of course, for our more conservative sisters and brothers. (If you think I’m going there, you're wrong.) But, I will say this: data on age and fertility has been well-established for decades but even some of my Fertility Doc colleagues have had a difficult time validating the sources of this data. The validity of this has been questioned quite a bit lately in particular, online.
What is NOT in dispute is healthy, live birth rates. SO even if the fertility rates are better than we thought at 35, 40 or even 42, that's doesn't mean we're encouraging you to wait as long as possible to get pregnant. You want a baby at the end of the journey, not a miscarriage.
And by the way, it's not just the woman's age that matters. Male partner age also affects birth outcomes, but that's another post.
8. Something else to consider: how many kids do you want?
That’s going to take more time/years. Nuf said
9. Please don’t freak out because your boss took 3 years and spent $300,000 getting pregnant.
You may not know everything about her painful saga- medical history, including male partners’ are critical components to achieving a healthy pregnancy
10. Know the truth about egg freezing.
Just be aware of what this is and is not. Originally developed as a “rescue therapy” for patients undergoing potentially fertility destroying but life saving treatments like chemotherapy it has now entered the mainstream. The process is very similar to the first part of in vitro fertilization – stimulation with hormones to make many eggs at once and then surgical retrieval of the eggs. The eggs are then frozen and will need to be thawed for later use in IVF once you have a partner or sperm donor. The science is getting better but thaw rates are about 50% and of course the egg quality (how good a job will these eggs do at making a healthy embryo) isn’t clear until later on when you try to use them. This is by no means a sure thing but it’s worth educating yourself about it.