pregnancy

When should you actually start thinking about your fertility? An explainer.

In the last couple of years, I have reached a scary age where all around me, people are getting married, buying houses, and starting families. 

My friends and acquaintance are getting pregnant. On purpose.

After spending my teens and twenties actively trying not to get pregnant, fertility is something I’ve never really been concerned about; I’ve just assumed everything is working fine. But what if it’s... not?

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While having kids isn’t a part of my life plan anytime soon (maybe ever), if I did decide that I wanted to have a baby in the future, I’d like to know whether falling pregnant would be easy, difficult, or impossible for me. 

And if it is going to be difficult, I think I’d want to know sooner rather than later.

So, do I need to be thinking about my fertility yet? Should I be getting tested? And how do you get tested?

I decided to do some digging, and here’s what I found out.

Does timing matter?

For many of us, there is no 'right time' to start a family. Everybody is different, and timelines vary depending on relationship status, financial situation, career goals, and/or travel plans.

When it comes to biology however, science says there is definitely a 'preferable' timeframe. There is a lot of confusing information out there, so I decided to ask an expert to help me make sense of it all.

Dr Clare Boothroyd is a gynecologist, endocrinologist, and fertility specialist. She also holds a Certificate of Reproductive Endocrinology and Infertility (CREI), and has dedicated her career to treating infertility. 

"Fertility starts to decline at the age of 30, and it’s a steady decline thereafter," Dr Boothroyd says.

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"So women over 30 need to be thinking about when is the right time, do I have a plan, should I be storing eggs, what is my egg reserve like, that sort of thing."

To find out about your egg reserve, women can take an Anti-Mullerian Hormone (AMH) blood test, also known as an egg timer test. An AMH test estimates the ovarian reserve, which is the term used to describe the number of eggs left within a woman's ovaries.

"If [the egg reserve] is low... that might help a woman or couple to decide to create a pregnancy sooner rather than later. Or for women who don’t have partners, somewhere between 30 and 34, they might look at storage of eggs.

"It’s not just a female issue though, that’s really important. If a man has had testicular cancer or family history of male factor infertility, these guys need to be evaluated early in the piece and be talking with their partners about it."

Image: Getty.

What if you want to get pregnant ASAP?

If you’re currently trying to get pregnant or if you're going to start trying soon, you’re probably already tracking your cycle and have some awareness around your ovulation and fertile window – or if you’re not, that’s a good place to start. 

But if you’ve been trying for a few months with no success, does that mean something is wrong?

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Not necessarily, according to Luk Rombauts, president of the Fertility Society of Australia and New Zealand (FSANZ). 

"A general rule of thumb is you should try with regular timed intercourse for 12 months before you seek assistance," he says. 

"If the woman is 35 or older, we recommend tests being done at six months, or if there is any other obvious reason to be checked, you are welcome to see a specialist earlier."

The frustration of struggling to fall pregnant is something Sally* and her husband are all too familiar with. 

The couple have been trying to conceive for almost a year, but as they are in their 20s and have no obvious health issues, they have had to wait months for an appointment with a fertility specialist.

"A few months before we started trying, I started tracking my ovulation with LH urine strips and it confirmed I am ovulating and my cycle is regular, which are good signs," she shared.

"My mum fell pregnant with twins in a few months of trying, and my husband’s mum had no troubles either. I certainly thought I wouldn’t have any trouble at 27 years old.

"I expected it to take some time, but after the six-month mark I started to worry and get anxious thinking something might be wrong. Now it’s at the point that each month when I get my period, I’m upset for a few days. It’s very disheartening."

After initial tests and analysis, all of which have appeared normal, the couple are finally booked in to see a specialist in the coming weeks. 

They have all the hope of getting some answers. 

Image: Getty.

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What are some of the factors that can impact fertility?

If your education was anything like mine, you were probably taught a bit about periods and to always use a condom and... not much else. Other than ageing, I was never really educated about the factors that can impact fertility. 

Turns out, there are a few. 

According to FSANZ, in addition to age, women’s fertility can be affected by endometriosis and polycystic ovarian syndrome (PCOS), as well as general lifestyle and environmental factors, such as smoking, weight, and stress. 

For men, fertility is primarily impacted by problems with sperm production or the transport process, with age and lifestyle also playing a part.

Professor Rombauts says while female age is the main cause of fertility issues, there can be numerous contributing factors.

"In a couple there is sometimes a small problem on the female side and a small problem on the male side, which together can make a big problem," he says. 

"Some women also just aren’t completely in tune with their menstrual cycle or have no in-depth knowledge of their fertile window. That is a small issue, but vital if you want to get pregnant.

"Sometimes there are big things people might not know about. Chlamydia, for example, if it’s not picked up or treated, we know it can lead to blockage of tubes and is significant enough that you could require IVF or surgery."

If you haven’t had an STI check in a while, this is your reminder to get one.

What are the chances of having fertility issues?

According to the FSANZ, roughly one in six couples will have trouble falling pregnant, which may be due to female issues, male issues, a combination of those, or sometimes unknown factors. 

Emma is currently 35, and was unaware of her fertility issues until she started trying to get pregnant.

She and her husband are now preparing for their fourth round of IVF. She found out she had a low egg reserve after deciding to get tests done, due to her husband working away and having limited opportunities to try to conceive.  

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"I had never had my fertility tested nor did I have any reason to; I had a very regular period and had never had any health concerns to make me think otherwise," she shared.

"I hadn’t taken any birth control for five years but I had spoken to a couple of health professionals in the past about cycles and ovulation and was aware that timing was everything, so I thought that was the reason I hadn’t got pregnant in the past... I was totally wrong.

"I feel like it’s still quite a taboo topic. I have only spoken to a handful of people about what I am going through because it’s hard to explain what is happening and I also don’t want people to feel sorry for us."

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So, should I get my fertility tested?

When it comes to fertility and family planning, there is no 'one size fits all' and no guarantees. I can’t tell you whether you’re fertile or not, and I definitely can’t tell you when you should have a baby. 

But, in short?

If you're over 35 or if you’ve been trying to conceive for a while with no success, it might be time to speak to either a GP with an interest in women’s health, or getting a referral to a fertility specialist. 

In terms of testing, an AMH test is often the starting point. An AMH test is not covered by Medicare and will generally set you back around $90. 

Further testing through a specialist involves things such as an STI check, antenatal blood check, hormone check, genetic carrier screening and vaginal ultrasound for women, and an STI check and semen analysis for men. Most of these are covered by Medicare, except for genetic screening and semen analysis.

It’s also worth noting that while the AMH test offers information about the quantity of eggs, it doesn’t provide details on egg quality, meaning that even if you have a high AMH, the quality might not necessarily be great (especially if you are over 40).

*Name has been changed for privacy.

Jessica is a content producer and writer based in Sydney, and has a keen interest in popular culture, environmental issues and lifestyle and content. Outside of work she spends most of her time reading, cooking, and scrolling through dog memes.

Feature Image: Getty.

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