A 37-year-old friend of mine recently came to the egg freezing clinic where I work and found out that her AMH (or anti-Müllerian hormone) level was unusually low. This meant she might have a harder-than-average time having kids. It would be harder still if she waited much longer. Not ready for kids, she decided to freeze her eggs. But because of her low AMH and somewhat late timing (optimal age for egg freezing is under 35; under 30 is much better), she had less-than-stellar results. She’d have to do the procedure a couple of times in order to produce the recommended number of eggs for a good chance of pregnancy later on. That wasn’t really what she’d bargained for.
The question is: Why was my friend in this position in the first place? And what, if anything, could have been done to prevent it?
There is a lot of secrecy and shame surrounding discussions of women’s fertility, even among women. Funny, isn’t it? It’s just another aspect of our reproductive health. We women are generally comfortable with the subject of pregnancy prevention, and vocal when advocating for our rights to information and healthcare access. Since the election, my Instagram feed has been silently shouting at me to get an IUD, and almost every woman I know has found a way to support Planned Parenthood through donations, volunteering, or posting messages of support. We’ve even managed in the last few years to break the “taboos” of talking about periods, menstrual products, and vaginas themselves. Cheers to that!
But we rarely broach the subject of fertility until we’re ready to get pregnant. Have you talked to your mom about her experience trying to conceive? Do you know which of your friends has had trouble getting pregnant? Does your primary care physician or gynecologist ask whether you plan to have children, or let you know that fertility declines with age? The earlier you get your hands on accurate information, the better position you’ll be in to chart your own reproductive future.
So let’s crack open the door to this conversation with a quick fertility lesson, shall we?
Fertility is at its peak when you’re about 18 years old and headed off to college. It declines steadily from there, though most women in their 20s won’t have much trouble getting pregnant. At about age 30 (the average age of a woman in the wedding announcements section of The New York Times in 2016), age-related fertility decline becomes a meaningful phenomenon. At age 35, only 6% of a woman’s egg supply is left (you’re born with all the eggs you’ll ever have, and you lose hundreds every month), and fertility follows a dramatic decline in the years after. By age 40, the chance of getting pregnant on your own is quite low. Menopause occurs at age 51, on average. (Fun fact: a woman’s salary peaks at age 39. Thanks, biology.)
I’m not saying any of this to scare you. Many women get pregnant easily in their late 30s, and some women struggle in their early 20s. Every individual’s biology is different, and you can’t paint a precise picture of your future from general statistics like this. But knowledge of biology is certainly helpful when making choices about your health, so unless you’ve gotten some fertility testing, this is the best information you have to go on.
One of the few things you can do to be more informed about your own fertility potential is to get a basic fertility assessment, which includes an AMH test and a transvaginal ultrasound to determine the number of eggs in your ovaries primed for maturity in any given month. This information, together with your age and health history, will help a reproductive endocrinologist (that’s long for “fertility doc”) give you a good picture of your fertility health. I encourage you to get a fertility assessment this year as part of maintaining your overall health. If it turns out that your ovarian reserve is not where you want it to be, consider your options: freeze your eggs if you’re not ready to have a baby, or make plans to have a child sooner if that’s feasible for you.
At the very least, know that you are not alone in thinking that this subject is important, and that you might not have the information you need.
And know, too, that despite the silence, people you know are seeking fertility treatment. One of the women I spoke to after she froze her eggs said, “Once you start going through it, a lot of people start telling you they’ve done it too. The big secret is that the place to be in NYC on a Sunday morning isn’t brunch: it’s the fertility clinic.”
The number of women freezing their eggs has grown 1600% since 2009. “Don’t wait,” cautions another woman I interviewed. Know that if you do freeze your eggs, your chance of pregnancy using them later on will be the same as it was in the year you froze—so if 40-year-old you tries to have a baby with your 30-year-old eggs, you’ll be turning the clock back a decade.
If having a family that includes your own genetic children is important to you, and you are serious about protecting and preserving your fertility, then go get your AMH checked and speak with a fertility doctor or educator about your fertility health. Ask your mom and grandmother how old they were when they went through menopause. Read up on female fertility and ways to preserve your fertility options for the future. Inform yourself about your fertility and you may end up making life decisions that change the path of your family-building future. Just don’t sit around in the dark and wait for the opportunity to pass you by.
Kristen Mancinelli is a public health professional and educator.
She is currently Director of Education at Extend Fertility in NYC.
Hand block printed textiles that give back to the community in Bagru, India