The question of fertility isn’t usually asked until people feel they’re ready to start a family. But what many people don’t know is that fertility should be an early consideration. With fertility naturally declining with age, it’s better to know sooner rather than later if you’ll need help with family planning.
Considering there’s a fair amount of confusion and misinformation around fertility, we collaborated with Dr. Meredith Brower, a physician at Kindbody, to answer a few questions and shed some light on the facts.
What is a Fertility Assessment?
Fertility assessments typically happen before any fertility services (think egg-freezing and IVF), and are designed to give an indication of an individuals’ overall fertility by using a number of tests to assess the various aspects of reproductive health.
One popular test is a blood test for the anti-mullerian hormone (AMH), which gives an indication of the number of eggs a woman has. In addition to ultrasounds and consulting with a doctor to discuss personal health and family history, other measures might be taken during a fertility assessment.
“The first part of a fertility assessment is obtaining a complete history,” said Dr. Brower. “It is important to understand the details of an individual's reproductive history, medical and surgical history and social history, in addition to knowing their reproductive goals."
Dr. Brower added that ovarian reserve—a woman’s remaining egg supply—can be assessed with an ultrasound and blood work, AMH, and follicle-stimulating hormones (FSH). Sperm can be evaluated with a semen analysis. The fallopian tubes can be evaluated with a hysterosalpingogram.
“We also do blood tests to assess an individual's overall health. Additional testing would be based on a person's own history,” she said.
At What Age Does Fertility Start Declining?
While fertility tends to steadily decline for women as they get older, Dr. Brower verified there’s no specific year at which fertility begins to decline.
“There is no golden age,” she said. “Fertility declines gradually with age.” In general, the process likely starts around the age of 32, though Dr. Brower noted that most women in their early 30's are still fertile and the decline is more significant after the age of 40.
What are Common Fertility Treatments?
Some fertility treatments, like in vitro fertilization (IVF) or surrogacy, are more widely known due to their popularity. Other familiar fertility treatments include intrauterine insemination (IUI) and fertility preservation, or cryopreservation (freezing eggs, sperm, or embryos). Egg donation and embryo adoption are other options.
What is Embryo Adoption?
It’s important to understand that embryo adoption is quite different from the adoption of a child. Dr. Brower explained that, when a woman adopts an embryo, the embryo is transferred to her uterus and she carries the pregnancy.
While this might sound like surrogacy, Dr. Brower confirmed that surrogacy differs from embryo adoption. Surrogacy, she said, involves a woman who carries a pregnancy for another individual or couple. The embryo, either one made from the egg and sperm of the intended parents, or even an adopted embryo, is transferred to the surrogate who carries the baby to term.
When is Intrauterine Insemination Used?
Intrauterine Insemination, or IUI, places sperm directly into the uterus at or near peak ovulation, mimicking the natural conception process and increasing the chances of sperm successfully reaching and fertilizing an egg. This is an option if the underlying problem behind the struggle to conceive is a male issue like low sperm count or decreased sperm mobility.
“Inseminations are also helpful in the setting of unexplained infertility,” Dr. Brower noted.
She also explained that the insemination procedure isn’t typically painful for patients. “Mild cramping can be experienced,” she said, adding that complications are extremely rare, but include infection.
How Does Fertility Preservation Work?
Also known as cryopreservation, fertility preservation is the process of freezing healthy sperm, eggs, or embryos so they can be used to conceive in the future. This may be a good option for anyone who has reason to believe that their fertility might be compromised in the future (underlying medical issues or a family history with infertility are common causes).
While she said every female considering fertility preservation has the option to freeze eggs or embryos, Dr. Brower noted partners play a role in the options available. “Freezing sperm requires a sperm source. Women without partners are more likely to freeze eggs.”
She went on to explain that women with partners are more likely to freeze embryos or freeze a combination of eggs and embryos. Dr. Brower did note that sperm freezing is not commonly done outside the setting of fertility preservation prior to cancer treatments.
How Are IVF Injections Given?
With IVF being one of the most common fertility treatments, many people have at least heard it mentioned. IVF is a form of assisted reproductive technology in which an egg is artificially fertilized outside of the body and then subsequently placed back inside a woman’s uterus by a doctor.
The first step when undergoing IVF is taking a medication for a period of time—typically a few months—which will help your eggs to quickly mature and become ready for fertilization. Once ready, a doctor will remove your eggs and fertilize them with donated sperm. Lastly, one or more of the embryos (i.e, successfully fertilized eggs) will be returned to the uterus. If successful, a fetus will then be able to naturally grow and be carried to term.
Toward the beginning of the process, patients are responsible for self-administering nightly ‘trigger shots’ that will artificially stimulate the body’s ovulation cycle.
If the thought of giving yourself injections is difficult to grapple with, you’re not alone. “Prior to starting injections we do a lot of teaching with our patients to assure they are comfortable doing them,” Dr. Brower explained. “We have videos demonstrating how to use the injections. Many people will watch the videos while they are doing the injections."
“Patients can contact us anytime if they feel uncertain if they are doing them correctly,” she continued. If somebody feels like they can't give themself the injections, Dr. Brower said Kindbody can hire a nurse to come to their home to do them.
Are Fertility Treatments for Me?
One of the most common questions people have around fertility is if and when they should talk to a doctor about their fertility.
“Everybody is a candidate to learn more about their bodies and options for treatment,” Dr. Brower said. “If somebody is willing to consider all of the options for treatment, most often we achieve the goal of a pregnancy.”
As you can see, there’s so much more to fertility than just pregnancy tests and check-ups. If you’re interested in taking a deeper dive into the world of fertility, check out our full course on fertility through The Guidepost. Sign up to receive daily emails that delve further into fertility, family planning, and what that means for you.
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This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.