Infertility impacts one in eight families. However, despite how common infertility is, the topic often feels shrouded in mystery and stigma.
When we’re in our twenties, we often don’t understand the limitations of their own fertility and therefore cannot make an educated decision about when, if, and how we want to build our family.
Here’s a short overview of what every woman should know in her twenties about fertility:
Typically, a woman’s fertility remains steady from the time she begins her period until 35. As she enters her late 30’s, she’ll remain fertile, but a marked decline has begun. By 40, a woman’s chance of getting pregnant each month is only 5%.
Men also experience a fertility decline, but it’s much slower. While it’s very uncommon for a woman to get pregnant naturally after the age of 45, it’s quite common to hear stories of men fathering children well into their 60’s.
Every woman deserves fertility diagnostics
If you’re interested in having biological children, simple fertility tests can be very helpful. ‘
For the best testing, visit a fertility clinic. Diagnostic blood tests measure your hormone levels and a fertility doctor can use an ultrasound to assess if anatomical issues may impact your fertility.
Simply by looking, a doctor gets a general sense of how many eggs you’ll be able to produce in an IVF cycle by counting the follicles on each ovary. These tests cost about $300, but many insurance companies will cover diagnostic testing.
You can also order an at-home test like Modern Fertility for $159. These tests look only at your hormone levels and don’t include the doctor’s interpretation that you can get in a clinic.
Hormone tests have their limits. While they can give you an idea of your egg quantity, there’s no test that can measure egg quality. And ultimately, egg quality matters a lot more than quantity.
Additionally, your doctor may do more in-depth tests to see if you have any anatomical barriers to pregnancy. Also, a semen analysis can test for male-factor infertility.
Egg freezing: a single woman’s choice
In 2012, the experimental label on elective egg freezing was removed, bringing this technology to the masses. Women can carry a baby in their 40’s and 50’s, but by their early 40’s they lack high quality eggs. So, if a woman freezes her eggs while they are still high quality (typically in her 30’s), she can use them at a later date when she’s ready.
Egg freezing is not an insurance policy. Eggs cannot be tested for quality, so there’s no guarantee that they’ll result in a live birth. If an egg is fertilized with sperm to become an embryo, that embryo can be tested for chromosomal abnormalities.
So, freezing embryos is an ideal option for a woman who wants more certainty about the future. However, embryos require sperm, so if a woman doesn’t yet know who she desires to be her child’s father, freezing eggs allows her freedom to make that decision in the future.
When should couples seek help?
In a heterosexual couple, if the woman is under 35 and has been trying to get pregnant for a year without success, they may be ready to get medical help. If a woman is over 35, they should try for 6 months and then seek help. If a woman is over 40, there may be value in getting help immediately from a fertility doctor.
What does intervention look like?
A fertility doctor offers a wide array of treatments, but the most common interventions are intrauterine insemination (IUI) or in vitro fertilization (IVF).
IUIs are simple and affordable, but only have a 10-20% success rate, so people aim to try 3-6 IUIs. A woman’s cycle is monitored and she takes a low round of hormones. Then, when she ovulates, sperm in a catheter is placed directly in her cervix. IUI is a non-invasive and intentional process which helps sperm overcome the distance it needs to travel to create an embryo.
IVF is a much more involved process, but also has a much higher success rate. The first half of IVF is identical to egg freezing. A woman takes a large amount of injectable hormones to grow as many eggs as possible. She’s closely monitored, going into her clinic every few days for several weeks.
Eventually, her doctor determines that she’s ready for egg retrieval, a minor surgery. If she’s freezing her eggs, the process stops here until she’s ready to use them.
After her eggs are retrieved, they’re fertilized with sperm to create embryos. After 5-7 days of growth, there will be a clear understanding of how many embryos have advanced and the doctor may run a test called PGT-A to see which embryos are chromosomally normal. At every step along the way, there will be loss; not every egg will become a chromosomally normal embryo.
After all that, the patient(s) will have a very clear understanding of how many healthy embryos they have. Next, a woman will take more medications and the embryo is transferred into her uterus. Then, everyone waits two weeks to see if she’s pregnant.
IVF success varies on a woman’s age, but if a PGT-A normal embryo is transferred, she has a 60-70% live birth rate regardless of age. Three PGT-A normal embryos have a cumulative 95% chance of pregnancy.
If a woman is older and wants more than one child, the doctor may recommend “embryo banking.” She may be successful having her first child, but then 1-2 years later when she’s ready for a second child, her fertility may have declined. If she freezes multiple healthy embryos through IVF before attempting pregnancy, she can use her younger embryos at a later date.
Options always remain
People who aspire to be parents may reach finite limitations to have biological children, but there are many beautiful non-traditional options. Loving relationships forged in families don’t require genetic ties.
Donor eggs and sperm can help in certain cases and are great resource for LGBTQ couples. Donor embryos may be another wonderful resource if a woman desires to carry a baby, but can’t use her own embryos. Surrogacy is another beautiful option for woman who cannot carry a baby or for gay couples.
Adoption is another powerful way to form a family. Children can be adopted via domestic infant adoption, international adoption, or through the foster system.
None of this is cheap and unfortunately financial limitations are a barrier for many. However, some support is available.
- Check your insurance. Most insurance will at least cover diagnostic testing. However, some plans offer amazing full coverage. Check out this list to see if your employer provides this. HR teams often may not realize that there’s a desire for this coverage, so have a conversation with HR if you feel comfortable.
- Get a temp job. Starbucks is famous for its amazing insurance for part-time workers. Employees who work 20 weekly hours can access remarkable fertility coverage after three months of employment.
- Shop doctors. Fertility prices vary wildly, but some clinics are positioning themselves to price-conscious patients. It may actually be cheaper to travel for care. CNY Fertility has a low-cost and travel-friendly model with locations in New York, Georgia, Colorado and Quebec.
- Fundraise. Your community loves you and wants to support you. It can feel awkward to ask for funds on a site like GoFundMe, but you may be blown away by the ways your loved ones rally to help.