I started thinking about my fertility around the age of 25.
Until then, children seemed like an inevitable part of my future—something to worry about later. But definitely a certainty I was planning for. And then, I had a conversation with a former friend who asked me if I planned to have kids. It was a simple enough question, but one that felt so out of place: I was single, young and healthy; of course I wasn’t considering my ovulation schedule right-that-very-second.
When I gave her a strange look, she matter of factly told me I was running out of time. After all, you ‘had’ to date someone for at least three years before you got engaged, take a year to plan a wedding, and wait two years to start your family. With that logic, I’d have to meet someone tomorrow to have a baby at the age of 31. And as she (not so kindly) added: who knows if you will be fertile in your 30s?
It was then that my rabbit hole into fertility began. At the time, I was also working for a digital brand for NBC, covering pregnancy and parenting, which genuinely, only fueled my anxiety. Fast forward to right now, and I’m happily engaged to the love of my life (we dated for 1.5 years before he popped the question, for the record), and we intend to start trying next summer.
Even so, I think about my fertility all the damn time. I track my periods religiously, exercise and eat clean to ensure I’m at a healthy weight … and have a monthly freak-out that I won’t get pregnant. Every time I visit my OB-GYN, I parade her with questions, and she tells me, ‘I have time.’ And yet, those three words give me little peace. When I express these fears to my calm, patient husband-to-be, he listens and reassures me that no matter what, we will find a way to have kids—whether through IVF, surrogacy, or adoption. He also reminds me that we have time, that I’m only 32, that the chances are high that I’ll have no issue conceiving.
But the truth of the matter is: there is no way to test if you can or cannot carry a child… until you try. And if you’re someone like me—an avid reader and a dedicated researcher of facts—it’s hard not to ignore the statistics. For most women, fertility starts to decline dramatically at the age of 35 and then takes a big ole jump off a cliff at 40. But, we’re still delaying having children to build careers, travel, and live a full, exciting life before spending 18 years taking care of another soul, 24/7.
Plus, we are less likely to settle than our mothers, grandmothers, and ancestors before us since we have been raised to be feminists and remember who we choose as our spouse is an incredible, poignant decision. Though my ex-friend saw marriage as a checkbox, I never did, and I didn’t meet the right guy for me until three months after I turned 30.
So what can a woman do when she feels like she has a ticking timebox in her uterus? How can we mentally and emotionally calm ourselves down? And how can we give our reproductive systems a fighting chance? Here, I asked the questions I’ve been dying to know:
Prioritize smart diet decisions
One of the easiest ways to prepare a woman’s body for pregnancy is quite simple: prioritizing our diets. Mary Jane Minkin, MD, a clinical professor in the department of obstetrics, gynecology, and reproductive sciences at Yale Medical School, says this habit is one you can start right now — even if you don’t intend to conceive for years. Being significantly over or underweight can decrease our ovulatory responses, so it’s best to be at your ideal body weight, as prescribed by your physician. Both men and women should minimize drinking and avoid smoking, since a heavy booze lifestyle doesn’t do wonders for sperm or ovaries. Once you are starting to have unprotected sex without birth control, Dr. Minkin says to take a daily folic acid supplementation. “Women who conceive while taking folic acid reduce their risk of having a child with a neural tube defect and other congenital disabilities,” she adds. (And psst: I’ve been taking folic acid for a year already, and my OBGYN says it’s fine to start taking even a few years before trying to conceive, so it has time to build up in your body.)
Rule out any underlying medical conditions.
What’s been helpful for me lately is realizing I’m not the only woman who frets over fertility without pinpointing reason. As board-certified OB-GYN and maternal-fetal medicine and perinatology specialist, Dr. Steve Rad explains, it’s incredibly common for females to stress about future fertility. “Some people dream of becoming a parent as early as childhood so the fear that it wouldn’t work out for them is a fear that I come across often on a daily basis,” he shares.
One way to tame some of those pestering thoughts is to keep regular doctor appointments and to remain in constant communication with your physician if you have questions. If something feels off, express your concern, ask for blood tests and don’t give up on answers. This helps to rule out any underlying medical conditions, according to Dr. Rad. No matter how large or small, prepping your body to be in the best shape, it can be will up your chances of conceiving.
Ask your doctor, not Google.
When your period is late or never shows up, when you have abnormal spotting, or when you have any down-there concern, stay far, far away from Google. Not only will nearly every search result in the infamous ‘C’ word (aka: cancer), but it will only intensify your emotions around fertility. Or, if like me, you keep reading article after article and only become more afraid, it’s time to see your OB-GYN ASAP.
As reproductive endocrinologist and infertility specialist Dr. Lucky Sekhon explains, it’s vital to speak to a professional with trainer and experience specific to female fertility. “If your future or current fertility is stressing you out—it is better to talk about it and confront why this is a source of stress rather than ignoring it,” she continues. “Most often, once the facts are discussed, and a preliminary evaluation is done, patients feel better and less anxious, either because the test results are reassuring or we identify a specific problem and can then discuss potential solutions and what it means, alleviating the suspense and anxiety of the unknown.”
Schedule a reproductive check-up with a specialist.
Sometimes, a general OB-GYN won’t entertain any testing until you are actively trying to conceive and not finding any luck. However, if you want to understand right now what’s going on downstairs, Dr. Sekhon suggests booking an appointment with a reproductive endocrinology and infertility (REI) specialist. Though it’s worthwhile noting that not all insurance plans cover the visit, if you have the funds, it’s a worthwhile investment. As an REI doctor herself, Dr. Sekhon sees many women for reproductive check-ups who are seeking a deeper understanding of how age and time will impact their unique biology. Typically, this consultation includes a thorough medical history, blood work and/or imaging studies (via ultrasound or x-ray). You can expect the following in your session, according to Dr. Sekhon:
Abdominal and vaginal ultrasound: to look at the ovaries and to get a sense of how many eggs a woman has a particular snapshot in time.
AMH and FSH testing: These include measuring the anti-mullerian hormone (AMH), which indicates egg quantity. And, estrogen and follicle-stimulating hormones (FSH), which also test egg quantity.
Thyroid testing: REI doctors will also test the thyroid hormones since the fetus does not make its own thyroid hormone until the end of the first trimester. Thus, it depends on the mother’s thyroid until its own gland becomes functional. If a woman’s thyroid is underactive, it could require hormone supplementation.
Prolactin testing: This is a hormone from the pituitary gland, which can make periods/ovulation irregular if it’s secreted in excess, usually from a benign tumor. Dr. Sekhon says this is checked if someone reports a history of irregular or absent periods.
Hysterosalpingogram: This is an x-ray of the pelvis which allows doctors to visualize the uterine cavity and fallopian tubes to rule out any scarring or blockages. “I usually only recommend doing this test if someone is trying to conceive—since things can change over time—having open fallopian tubes at one point in time doesn’t mean they can’t be blocked in the future,” she explains.
Saline sonogram: This is a test used to get a more accurate look at the uterine cavity’s inner lining. “A woman with a history of fibroids or multiple uterine procedures could have scarring. This type of saline sonogram can help to determine whether the uterine cavity lining is smooth and healthy or if it could be structurally abnormal, making it more difficult to conceive in the future or safely carry a pregnancy,” she explains.
Don’t put yourself in the horror stories.
The hardest hurdle for me to overcome mentally is not thinking of all of the women I know (or have written about) who have had intense fertility battles. I often try to remind myself—albeit, sometimes unsuccessfully — that typically, we only hear about the bad stories. It’s rare to focus on the good ones since well; those don’t warrant as much of a discussion or offer an educational opportunity. That’s why it’s important to remember that every single woman and couple have their own journey toward parenthood, says Michelle Tham Metz, MD, an assistant clinical professor of OB-GYN at Mount Sinai Hospital. Just hearing about those who have spent thousands of dollars on fertility treatments or those who have had several miscarriages can cause intense worries. “I think that the internet and some of these Facebook groups can lead women down a black hole of fear and misplaced anxiety,” she continues. “Remember: each woman is an individual with a remarkably different capacity for fertility.”