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What Every Woman Should Know About Her Fertility

Amy Klein
Written by Amy Klein

I know you: Your eyes glaze over when you see the word “fertility.” You blithely skip any articles mentioning “egg freezing” popping up in your news feed or sent to you by well-meaning (read: worried) relatives (Hi, Mom!).

You’re a woman in your late 20s or early to mid-30s and you might want kids, you might not; you’re not sure. One way or another, you don’t really want to think about it.

But hear me out, just this once. You’ll thank me later.

I know you because I was you. I was 32 years old, still not sure what I wanted to do with my life (and for that matter, how I wanted to live, if I’d ever marry, “settle down” with kids, or travel the world on some amazing gig that hadn’t yet made an appearance), and was meeting an old high school friend for brunch.

Back then I wasn't thinking about my biological clock. I could hardly decide what to wear in the morning — how could I create another person?

“Did you ever think of freezing your eggs?” she said. I looked down at my omelet, confused for a second. What was she talking about? The year was 2002. No one was talking about fertility struggles or IVF and especially egg freezing, which then was still an experimental procedure with extremely low success rates. Not that I knew anything about it then.

Is this really a topic for polite catch-up-on-life conversation? I thought, looking up at my friend blankly. I thought she’d be grilling me about my dating life, if there was anyone with “potential” — an annoying term that only valued the bottom line (marriage) and not life experiences.

Back then, the only eggs I was thinking about were in my breakfast.

“No,” I said to her as I took a bite.

“Well you should,” she said, ignoring my attempt to shut the conversation down. “I have this friend who …” blah blah blah, I tuned her out and ate my fries. This discussion was like the metric system — useful information to someone. Just not me.

This is the part where I should fast-forward a few years and tell you about how, after helping raise nieces and going to therapy, I finally decided I wanted to have kids but not on my own, about how I met my husband at 39 but didn’t marry him until I was 41, and then had four years of fertility troubles before I had a kid. This is the part where I’d morph into my annoying high school friend, and ruin your breakfast by telling you to freeze your eggs.

But guess what? I don’t care if you freeze your eggs.

We learn so much about how to not get pregnant — use a condom, avoid STDs — we were never taught how to get pregnant.”

Frankly, it doesn’t matter to me if you have kids of your own, if you decide to adopt, use a donor egg, be a stepparent, or be child-free. Any of those paths could have been my own at some point. But as a woman, it DOES matter that you at least understand your fertility and all that goes into it, no matter what your goals are.

We women know so much about so many things (OK, everything!) — travel, food, money, careers, technology, fashion, fitness, beauty, psychology — why shouldn’t we know about our own fertility?

Like, for example, how chlamydia and gonorrhea — even if you have no symptoms — can lead to difficulty conceiving in women, according to the CDC, which recommends “annual chlamydia and gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.”

Or how a family history of early menopause could mean the same for you. Likewise, if you’ve had irregular cycles or “woman” problems, like endometriosis, PCOS, or fibroids, you might have trouble conceiving … if and when you want to. This could mean you may not ovulate or you may have thyroid or other issues you need to fix.

Talk with your doctor about your family history. Check your plumbing and if you have something that needs to be taken care of, like cysts or fibroids, do it now, rather than later.

Even though it seems like we’re bombarded about our fertility, so many women are ignorant about their own bodies.

Most importantly: Did you know you could only get pregnant a few days out of the month? God, I spent so much of my 20s in crisis — when the condom broke or, believe it or not, got lost (it was still inside of me) or when I missed a birth control pill or three with my boyfriend — and I wasted hundreds of woman hours worrying, when I could have been out partying, because I didn’t know that it’s really, really hard to get pregnant until I started trying. (And if you think “trying” to get pregnant doesn’t sound sexy, you’re right.)

“My theory is we learn so much about how to not get pregnant — use a condom, avoid STDs — we were never taught how to get pregnant,” says Jay Palumbo, vice president of patient care at Eggbanxx, a company that provides support, financing, and exclusive pricing for egg freezing. “But if you stop a woman on the street they don’t have a clue about FSH and AMH,” she said, referring to two hormones that can help assess a woman’s fertility.

WAIT! Before you tune out because I’m getting technical, hear me out.

Don’t worry, I’m not gonna bore you with statistics about a woman’s declining fertility. We all get it. The clock is ticking. I’m not even going to talk about the success rates of egg freezing, how they’re no guarantee for a live baby, or the details of the two-week hormone taking and egg extraction process.

What I am going to tell you is that just as we know our height, our weight, our cholesterol, and the calorie count of Every. Single. Thing. that goes into our mouths (and how many hours on the treadmill it will take to burn them off), we can also know about our fertility potential — with a simple blood test.

You can get tested at your gynecologist or a fertility specialist on Day 2 or 3 or your menstrual cycle, assessing follicle-stimulating hormone (FSH), which approximates the quality of your eggs (how healthy your eggs are and likely to produce a child), especially compared with other women in your age group; and anti-Müllerian hormone (AMh), a protein that assesses your ovarian reserve (how many eggs you have left) and your potential response to hormonal stimulation. (AMh can be done any day of the cycle.) You can ask your ob/gyn to run these tests, although a fertility doctor may be better able to assess them.

We women were told we could have it all — there were no limits to what we could do. I don't think we realized that there were actual time limits imposed by our bodies.

There has been a recent controversy over how accurate these tests are. The NPR article "Women Find a Fertility Test Isn’t As Reliable As They’d Like" said, “The worst-case scenario of using an inaccurate test is that a woman might feel pressured to freeze her eggs because of ominous results when she actually has plenty of eggs left, while another woman might perceive a rosy outlook when she actually may be nearing the end of her egg supply.”

While there is a debate in the fertility world about exactly how accurate these (and other) tests are, that article is missing the point. “That is doing such a disservice to women,” said Dr. Aimee Eyvazzadeh, who calls herself the “Egg Whisperer” and offers blood work and consultations to women looking to assess their fertility (for $110). “These are tests that can guide you to what your future might hold,” she said.

In addition to the standard tests, there's a new patented diagnostic test at What', which can predict whether a woman will have Premature Ovarian Aging (POA) — a low number of good-quality eggs — in women as young as 18.

“Fertility is not skin deep,” she said, noting how women today think that if they’re in good shape, eat healthy, exercise, and generally take care of themselves, they won't be infertile.

So although it seems like we’re constantly being bombarded about our fertility ("A Woman’s Fertility Is Her Own Business," a recent op-ed in The Guardian exhorted to lay off), so many women are so ignorant about their own particular bodies.

We women were told we could have it all — there were no limits to what we could do. I don't think we realized that there were actual time limits imposed by our bodies.

Dr. Aimee told me about a 44-year-old woman who complained to her she’d “been trying for two months” to get pregnant and was perplexed that it wasn’t happening. A friend only discovered she has endometriosis at 40 and had to have surgery before she could start trying to get pregnant.

I recently met a 46-year-old who casually mentioned to me she’d be “starting to try” soon.

“Good luck with that!” I said. Who knows? Maybe she was particularly fertile and would have no problems despite statistics that generally say a woman's baby making is done at 44 (especially for first-timers, and people with problems).

Know thyself. Know thy thyroid, thy ovaries, thy fallopian tubes, thy eggs, and thy hormones.

But that’s the thing. Why wait until you're in your 40s to find out? Why not have a better understanding of where you fall on the spectrum by the time you’re 35?

These blood tests for FSH and AMH, as well as an antral follicle count (AFC), which assess your fertility potential, are far from foolproof — they may predict a problem when there’s none — but wouldn’t you want some information, however imperfect, sooner rather than later? (And if there’s no problem, that may be just the time to freeze — younger eggs always being better than older ones.)

You might want to take these tests to avoid what happened to L.A. actress and writer Sarah Fizeli, who wrote last year on XO Jane “I Went to Freeze My Eggs and They Told Me I Don’t Have Any Left.” Her AMh at 40, was, undetectable. “If only I’d frozen my eggs at age 30, when I was ready but my husband wasn’t. Or age 33. Or 35.”

“There’s very few things that can predict the future,” said Dr. Jamie Grifo, program director for the Department of Obstetrics and Gynecology at NYU Langone’s Fertility Center, which has done about 2,500 egg-freezing cycles, thawing 250, resulting in 100 babies so far. Dr. Grifo said the tests can predict trends, not whether someone will have a baby. When it comes to freezing your eggs, “there is no right answer.”

But getting the information is key. Some women are fatalistic, choosing not to, saying “It’s in God’s hands; we’ll see what happens,” but it’s better to be proactive.

“They think about their life and their options and consider what they want to do,” — given the information they have about their own possible fertility future — “and if you’re paying attention and making choices, you’ll have better outcomes than someone who doesn’t.”

So, ladies, I won’t bore you with all my fertility woes, and how much I wish I knew about reproduction when I was your age. I won't tell you about how I might have gotten pregnant with my boyfriend at 39 and not waiting to get married at 41, I won't take you through our nine rounds of IVF with ten doctors over four years, finally getting pregnant (but not with my own eggs). I have a beautiful baby now, so I have to try not to have too many regrets about how I should have done it differently.

Instead I’ll just say this one last time: Know thyself. Know thy thyroid, thy ovaries, thy fallopian tubes, thy eggs, and thy hormones.

Then make the appropriate decision, whether it’s marrying your boyfriend or kicking him to the curb, or stopping to date narcissist studs who will waste your time, or curtailing your long work hours to find the one, or getting pregnant this very second, or starting the egg freezing process, or deciding to never have kids and finding that wonderful travel gig that will take you on wonderful life adventures.

We women have so many options in life. It's good to know what they are.

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