Whether you’re actively trying to conceive, or just want to keep your options open to make sure you can have children later down the line, it's important to be as informed as possible about your fertility.
More and more of us are putting off having children until later in life – the average age of first-time mothers in the UK recently rose above 30 years old and the number of first-time mums over 40 is rising too.
But when does our biological clock actually start to tick, how can you know how fertile you are and how can you improve your chances of conceiving when the time comes?
Even if having children isn’t on your radar right now, you might still have a few burning questions you've been dying to know the answer to, but were too embarassed to ask.
1. How can you find out how fertile you are?
Doctors can perform a blood test to check on your egg reserve and you can get it anytime. This is something worth asking about if you’re considering putting off having kids for a few years. It’s just a simple blood test on day three of the menstrual cycle to allow a woman to know if she has time, or doesn’t have time, and needs to think about trying to conceive earlier, advises Dr. Jane Frederick, specialist in reproductive endocrinology and infertility and medical director of HRC Fertility in Orange County, California.
2. How do you know if you're infertile?
According to the CDC (Centre For Disease Control And Prevention) in America, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a six month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss (two or more spontaneous miscarriages). Pregnancy is the result of a process that has many steps. In order to get pregnant, a woman’s body must release an egg from one of her ovaries (ovulation), then the man's sperm must join with the egg along the way (fertilize), then the fertilized egg must go through a fallopian tube toward the uterus (womb), and finally, the fertilized egg must attach to the inside of the uterus (implantation). Infertility may result from a problem with any or several of these steps.
3. What's the 'normal' timeframe for getting pregnant?
In any given month, a healthy fertile couple has about a 20% chance of getting pregnant, according to Dr. Thomas Molinaro, a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey (RMANJ) in Eatontown. This means that for a young and healthy couple who have an active sex life, getting pregnant would take an average of five to six months.
4. At what age are you most fertile?
According to the American Society of Reproductive Medicine (ASRM), if you’re a woman, your fertility is expected to end roughly five to ten years before you hit menopause. After 35, the number of eggs you have, and the health of those eggs, starts to dramatically decline. To put it in perspective: A healthy 40-year-old woman has a 5% chance of getting pregnant each menstrual cycle, compared to the 20% odds of a woman ten years younger. This doesn’t mean that it’s impossible to get pregnant naturally in your late thirties or early forties, just that the odds become lower across the general population.
5. What day are you most fertile?
According to Netdoctor, you're most fertile before you ovulate. If your menstrual cycle is regular, say every 28 days, ovulation normally occurs around 14 days prior to the next period, in other words, around day 14. Day one is counted as the first day of bleeding and your most fertile time would therefore be from day 10-16 inclusive. Believe it or not, in addition to the day you actually ovulate, you’re most likely to get pregnant if you have sex in the five days or so before. Here’s why: Once the egg leaves your ovary, sperm has about 12 to 24 hours to reach the egg for conception to happen. But sperm can actually remain viable inside you for several days after you have sex. So to put it bluntly, the more swimmers you’ve got in there ahead of time, the higher your odds are of making a baby.
6. Is it really hard to conceive after 35?
According to Integrated Fertility Specialist Emma Cannon, at the age of 30 the chance of conceiving each month is 20%, when you're 35 this goes down to 15%, while at 40 this reduces to just 5%. But don't worry too much – according to Baby Centre, over 80 per cent of women aged under 40 who have regular sex without using contraceptives will get pregnant within a year, and over 90 per cent of couples conceive within two years.
7. At what age should you freeze your eggs?
If you’re going to freeze your eggs, the best time to do it is in your twenties or early thirties. The younger you are when you get your eggs frozen, the more likely it is that the eggs you’ve frozen are viable and high-quality. If you’re in your mid to late thirties when you freeze your eggs, though, you risk not having enough healthy eggs available for when you want to use them down the line.
8. How can you improve your fertility and increase your chances of getting pregnant?
Whether you're male or female, small changes to your lifestyle can potentially make a huge difference in your fertility. For women the biggest factors are smoking cigarettes or being exposed to secondhand cigarette smoke (it's best to avoid smoke altogether when trying to conceive), eating a poor diet and not getting enough excercise will also negatively impact your fertility, as well as chronic stress and drinking alcohol. For men, taking drugs damages sperm, taking testosterone to build muscles can reduce fertility and smoking, eating a poor diet and drinking alcohol excessively will also negatively impact his swimmers.
In terms of actually making a baby, the Baby Centre recommends trying to have sex every two to three days. Then sperm with good motility will be in the right place whenever you ovulate. Regular sex throughout your cycle gives you the best chance of conceiving. Also, having sex when your cervical mucus is wet, slippery and most receptive to sperm will also increase your chances of conception.
Other things you can try include acupuncture (it is said to increase the blood flow to the ovaries and this has a regulating and protective effect on both your maturing eggs and hormones). Taking multivitamins and omega 3s have also been shown to benefit fertility.
9. At what point should you start seeking fertility help, like IVF?
According to the CDC, if you’re a woman under 35 and trying to get pregnant, you and your partner should try for a year before going to see a specialist for help. If you’re 35 or over, seek help from a specialist after six months. This is because it becomes harder to get pregnant, there’s an increased risk of miscarriage and an increased risk of genetic problems. About a third of couples where the woman is over 35 have fertility problems.
10. How can polycystic ovary syndrome (PCOS) affect your fertility?
According to Netdoctor, polycystic ovary syndrome is characterised by irregular periods starting within two years of puberty usually leading to very scanty or even absent periods. In 50 per cent of cases there will also be weight gain and unwanted body hair and infertility is a possible problem. It is caused by an imbalance of hormones released by the pituitary gland, which sits at the base of the brain. Ovulation fails to occur, there is a high level of circulating oestrogen in the bloodstream and a relative increase in the male-type hormone, testosterone. Tests to assess the severity of your PCOS and to see whether you are ovulating and therefore fertile include a simple blood test, an ultrasound scan of your ovaries and possibly a laparoscopy procedure where a narrow telescope is inserted just below the belly button to look directly at the ovaries from the inside. If you have polycystic ovaries it would be a good idea to visit a gynaecology clinic sooner rather than later to see if any measures can be taken now to maximise your chance of having children in the future. Treatments would include the medication clomiphene to stimulate ovulation, a hormone known as LH-RH, the oral contraceptive pill and surgical removal of a small wedge of ovarian tissue to restore ovarian function.
11. How common is having a miscarriage?
According to Netdoctor, miscarriages are the most common form of pregnancy loss, affecting one in four pregnancies.
12. How can I maximise my chances of a healthy pregnancy?
There is no way to guarantee a healthy pregnancy, but Netdoctor suggest that there are a few things that you can do to try to minimise the risk of problems, which include stop smoking, limit alcohol consumption, avoid taking unnecessary medication, eat a balanced diet, avoid eating unpasturised cheeses, pâté, or raw eggs, as well as liver and foods fortified with vitamin A. Regular moderate exercise such as walking or swimming is also beneficial and meditation, yoga and rest can all be good for you and your baby.
13. Can a history of using the contraceptive pill affect fertility?
Yes – in a good way! In fact, having been on the pill could actually help you get pregnant. Aside from regulating your period, the pill can lower your risk of uterine and ovarian cancers, making you much more likely to conceive without complications when you decide to try. Some forms of contraceptive pill prevent you from releasing an egg each month, which some consultants claim actually preserves fertility.
14. How long should you be off contraception before trying to conceive?
There is no right answer and the amount of time varies, but according to Integrated Fertility Specialist Emma Cannon, it is normal to take up to a year to conceive.
15. Can having an abortion affect fertility?
According to Emma Cannon, terminations can impact your fertility by causing scarring to the uterus, which can incidentally also happen after miscarriage. An abortion can also damage the womb to the extent that implantation is affected. If you notice any change to your periods following a termination, you should return to your hospital or doctor.
16. Does smoking affect fertility?
Yes. According to the ASRM, women who smoke go through menopause roughly four years earlier than women who don’t. Infertility rates among smokers are also about twice as high as non-smokers! For help and advice on how to stop, visit our Stoptober page.
17. Should you give up alcohol when trying to conceive?
Yes. According to Netdoctor, the negative effects of excessive alcohol consumption on fertility are widespread, including increased time to conception, poor or abnormal embryo development and even early menopause. Consuming no more than two units per week is likely to be the best tactic, although some women (or couples) do decide to abstain completely.
18. What is the best sexual position for conceiving?
Position doesn't generally make all that much difference, but choosing the right one can be a bit of a help if you're having trouble conceiving. According to Netdoctor, for most women the best chance of getting pregnant is to make love flat on your back with your knees bent (which tilts the pelvis a bit) and to stay like that for 5 to 10 minutes afterwards. But there is no need to raise your legs in the air! For the minority of women who have retroverted wombs (any doctor who has examined you internally should be able to tell you if you're retroverted or not), it's thought that the best chance of conception is achieved by making love 'doggy-style', and then staying like that for 5-10 minutes afterwards.