Fertility is an emotive subject and headlines screaming about our biological clocks don’t help. Midwife and fertility expert, Zita West sees thousands of women a year at her clinic. Here she debunks some myths and talks us through the steps we can take to protect our fertility for when the time is right.
1. What are the most important indicators of fertility?
Age is the biggest factor. The sad reality is that the older you are the more chromosomally abnormal the eggs are that will go on to fertilise, implant, but sadly often miscarry. Though everyone is different and many women of course do get pregnant and have children in their forties. Genetics also plays a role and if your mother had an early menopause the chances are that you may too – not always but the likelihood is increased.
2. Is fertility predetermined or are we able to boost our fertility?
Yes it is predetermined, as a woman is born with all the eggs they will possess. Men on the other hand make sperm 24/7. However, I believe that you are able to influence the environment that those eggs grow in through your lifestyle choices and your diet. Living as healthy a life as you can and eating a good range of nutrients will allow the eggs to be in optimum health for fertilisation.
3. So, when does a woman’s fertility naturally start to decline?
It doesn't fall off a cliff at 35 that's for sure! Age is the biggest factor in fertility decline but some women are more fortunate than others in that they will have greater egg reserves, giving them more of a chance to conceive later in life.
4. What can women do to protect their fertility?
Check your sexual health. Chlamydia is a silent infection that can block the Fallopian tubes if left untreated. You can still get pregnant but if both tubes are blocked then IVF would be the next course of action. There is also a higher risk of ectopic pregnancy.
Don't smoke! Women who smoke have earlier menopause and smoking increases free radicals, which damage eggs. And it goes without saying, don’t take recreational drugs.
Manage your weight. Being overweight or underweight can affect fertility causing hormonal disruption, which impacts ovulation. A typical woman should have a Body Mass Index of between 18.5 and 24.5.
A healthy exercise regime. Exercise is a great way of keeping in shape, staying healthy and tackling stress but be careful as over exercise can stop ovulation and periods.
Watch what you eat. Try to avoid processed foods as many of these contain trans fats, which have been shown to interfere with ovulation. Try to eat foods that are as close to source as possible, using fresh ingredients wherever you can. Also make sure your diet consists of a good range of slow release carbohydrates, protein and fats (non transfats of course!)
5. Are there any supplements that women should take to boost / protect fertility?
Women very rarely eat a balanced diet. In addition, many lifestyle factors deplete the body of vital nutrients needed for fertility (smoking and stress being two key factors) so it often helps to build reserves by boosting intakes of certain key nutrients. It's not just about getting pregnant, it's having reserves for those early days of pregnancy when the foundations for developing healthy organs are being laid and a growing fetus relies on your reserves for a healthy pregnancy.
Folic acid is well known and many women do supplement their intake, but many women are also deficient in Vitamin D – the workhorse of the immune system - and need a good supply for the baby’s immune system once pregnant. Omega 3 is also an important nutrient required by every cell in the body for them to work at their best, including eggs and sperm cells. Typical signs of Omega 3 depletion are dry skin, forgetfulness, low energy and mood.
6. Does the pill impact fertility, once you have come off it?
Many women that I see have been on the pill for as long as 15 years, sometimes even more, and because of this they have no understanding of their natural cycle. Please, please, please, if you are thinking about having a baby don't wait for the pill to ‘come out of your system’. Studies have also shown that you have an increased chance of conceiving in those early months of coming straight off the pill Also, it's not unusual to have up to 7 months cycle disturbances when you first stop the pill so don’t be put off having lots of sex. However, if you find your period doesn't return seek help: you will still be able to get pregnant, but you may need medication to get your cycle going again.
7. What are the basics we need to know when it comes to conceiving?
It’s important to understand your natural cycle if you’ve spent years on the pill. The fertile window is 6 days in the lead up to ovulation so understanding this is so important. Women need to focus on the sperm too. It last longer than the eggs: eggs last around 24 hours, whilst sperm lasts 3 to 5 days. That means if you’re having sex 3 times a week and sperm last 3 to 5 days there will be a constant supply in the fallopian tubes ready to fertilise the egg.
8. What advice do you wish every woman was given?
Women generally don't understand that it can take up to a year to get pregnant so they often begin to worry after just a few months of trying. And if your aim is to have more than 2 children before you are 40 you really need to begin to try for your first in your early 30’s as it takes up to a year to get pregnant and then a further 18 months at least to go through pregnancy and breastfeeding. I see so many women with regrets due to delays with pregnancy, and although I know it is not always the right time or circumstances, it helps if women are aware of these timescales so that they can plan.
9. If women are worried or haven’t met the right partner yet are there any tests that they can take to measure their fertility?
Yes, there is a blood test called an AMH test, which we use at the clinic, but I don’t advise testing if you haven't found a partner. I have seen far too many women in my office distraught that they have received a poor fertility result and are terrified as a result. If they are in a relationship then knowing their egg reserves can help with planning and ensuring they look after their eggs with wise lifestyle and nutrition choices.
10. What would you say to younger women who are worried about the future of their fertility?
Things are changing. I am starting to see a younger group of women who want to check out their fertility. I think women are worrying more about fertility and I do think that in the past we have done disservice saying they can have it all. In my experience, contrary to what the press often say, women don’t leave it too late to conceive deliberately. Rather, life often gets in the way. Egg freezing has become increasingly popular: if you intend to freeze your eggs then you should have a test to check your egg reserves beforehand so that you are not freezing your eggs unnecessarily.