Fertility Ed 101

When we hear the word fertility, what do we think? How much were we ever taught? How do we manage our own personal fertility questions?

For most adults, the last formal education received on the topic of reproduction was in a middle school health class with a strong focus of knowing what to expect with puberty and how to avoid unintended pregnancy. What we are really missing is a college-based class, for all students, to learn the many facets of natural conception, and the many factors that could negatively impact this precious human endeavor.

Healthy adults in committed relationships may not have the biological information that they need to properly plan the time they need to conceive, carry, deliver, recover and breast feed for each baby. There is also a lack of understanding of the reality of miscarriages as a common aspect of human reproduction. But everyone is pretty knowledgeable about plan B if the condom breaks. Right?

Gathering reliable information on times to conception is difficult, but what information we do have over many decades is an approximately 20% per month chance of conceiving with regular unprotected intercourse….. if you are in the mid 30s or younger…..and if there are no known medical conditions. That means if you consider yourself young and healthy, there is an 80% chance you do not conceive in the first month of trying. Good to know. More importantly, there is a 10% chance that you do not conceive in the first year of trying. Yikes! There is not much we do in this fast-paced society that makes us wait a year or more to succeed. Once you do conceive, mother nature can still play tricks. Miscarriages, most of which occur in the first 8 to 10 weeks of pregnancy occur at a rate that is similar to one’s (female) age, 35% for 35 year-olds, 40% for 40 year-olds, and the majority of pregnancies for 44 year-olds. This can be a shock for those who look and feel young and have a most healthy lifestyle.

Why? Why? Why?

The main hurdle for all of us is age related aneuploidy. The precious egg cell has a lot of precision chromosomal work to do at the time of ovulation. It has to reduce its own chromosomal content by ¼ with egg maturation, and again reduce its chromosomal content by ¼ at the time of fertilization, while permitting a half set of chromosomes of the sperm to enter and match and blend with the remaining half set of chromosomes of the egg; and then replicate this new full set of chromosomes just before the first cell division. It is a miracle that this happens correctly as often as it does. When that happens correctly, the resulting embryo is Euploid (the good number) and more likely to implant and develop into a healthy pregnancy. When that does not happen correctly, the resulting embryo is Aneuploid (the wrong number of chromosomes) and will either fail implantation or contribute to a miscarriage. The chances of an aneuploid embryo occurring is directly related to female age. Because the egg cells never replicate or rejuvenate. They rest in a dormant state for 2, 3 or 4 decades before entering the active phases described above. The older the egg, the more likely that aneuploidy could occur.

Mother nature has a design flaw: Eggs have a limited supply, they do not renew, and they have the most complex microbiological responsibilities.

Definitely plan accordingly for extra time to conceive. Additionally, there are other factors: uterine, tubal, ovulatory, and sperm related that may contribute to a conception delay. It is best to start talking about your conception plans with your gynecologist years before trying to conceive. Think about whether there are any pelvic or period related symptoms that are not normal and warrant an evaluation early on. Consider fertility preserving strategies, with a reproductive endocrinologist like Dr. Moomjy. If life is such that you start trying to conceive in your mid 30s or later, do a basic evaluation of fertility ASAP and use this information as power.

Maureen O'Brien Moomjy, MD, FACOG

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