By Maeda Riaz • April 15, 2012•Writers in Residence
The Healthy Lawyer: Focus on Fertility
Making it through college, the LSAT, law school, and the bar exam requires a certain amount of preparation, research, and planning ahead. Perhaps you took a prep course before the LSAT or bar exam. I bet you researched law schools before you applied, right? You examined rankings, maybe talked to alumni or a career counselor? Maybe you had a list of backup schools or an alternative career path in mind in case you didn’t get into the school of your dreams. While interviewing and looking for a job, you probably researched firms and employers. In other words, you prepared, researched, and planned ahead to increase your chances of success in your chosen profession.
We plan ahead and try to prepare our educational and professional lives, so why not our personal lives? Most women certainly do think about when they want to start a family, but how many think about what they will do if they have problems conceiving? Fertility is usually only something people think about when it becomes an issue for them personally.
Have you been trying to conceive but been unsuccessful? Maybe you’re not trying to conceive but plan to start in the near future. Maybe you already have a child but want to wait a few years before you have another one. Maybe you want kids, but not now. Or maybe you’re not sure you even want kids. Whatever the case, fertility and family planning is something all women who may want to have children someday should think about.
Facts and Figures on Fertility and Childbearing
Women are delaying childbirth now more than ever before, often to pursue educational or professional goals. According to most recent figures available from the U.S. Census Bureau, not only has the average age of first-time mothers risen, but the number of first-time mothers aged 35 and older has risen eight-fold between 1970 to 2006, from 1 percent to 8 percent. Women are lucky to live in a time with so many more educational and professional opportunities available to them than previous generations, but Mother Nature hasn’t yet caught up to women’s changing roles in society. The biological clock still ticks on.
Most people assume they will be able to conceive no problem. Luckily, this is true for most couples. We all know fertility decreases as a woman gets older, so I won’t bore you with too many statistics. According to the Centers for Disease Control and Prevention, infertility is a common problem, affecting approximately 10 percent of women aged 15 to 44, which is approximately 6.1 million women. Infertility is the inability to conceive after twelve months of trying if you’re under 35. If you’re over 35, it’s after six months of trying.
This post focuses on women, but of course infertility also affects men. For a couple unable to get pregnant after twelve months of trying, 30 to 40 percent of the time the cause is male infertility; female infertility accounts for 40 to 50 percent, and the remaining 10 to 30 percent of infertility may be from both partners, or the cause cannot be identified. Approximately 10 to 20 percent of couples are unable to get pregnant after one year of trying.
Now here’s a fact that is frightening at first glance: by age 30, a woman has only 12 percent of her eggs left. In terms of numbers, however, that’s still 30,000 or so eggs. While you can’t control the number of eggs you have (it’s a finite number that you’re born with), there are lifestyle factors you can try to control which affect fertility.
By her mid-thirties (35 or so), a woman’s fertility drops significantly. Fertility in women peaks in her early 20’s. Over 35, a woman faces increased risk of miscarriage and having a baby with Autism or a chromosomal abnormality, like Down syndrome. Cedars-Sinai hospital cites a study on female lawyers that “showed that those who worked more than 40 hours per week had a greater risk of miscarriage.”
The Celeb Factor
It seems like more and more celebrities are having babies after the age of 40. There are even a couple of slideshows online showing these fit and fabulous new mommies. In fact, birth rates for women over 40 has been rising over the past few years and falling for all other age groups.
It’s great that there are more options for women who would like to have children later in life, but some in the medical community believe this trend gives women a false sense of security because it promotes the idea that women can easily have babies well into their forties. So how are these celebs doing it? They look so happy and smiley in photos, but no one really knows the private struggle many of them may have gone through. Some celebrities, however, have opened up about their infertility and have shared their stories. Take a look here, here, and here. The reality is that most women over forty, and even some in their late thirties, celebrity or not, probably used some form of assisted reproductive technology (ART) to help them get pregnant.
Factors Affecting Fertility
Although there is a long list of factors that affect fertility, the following list focuses on some of the more common ones.
Being either overweight or underweight can impede fertility. Overweight women may produce too much estrogen and being underweight can shut down a woman’s reproductive system. It’s important to maintain a normal BMI, or body mass index. You can calculate your BMI here.
Environmental toxins can also affect a woman’s fertility. Pesticides, radiation, lead, and chemicals such as BPA (found in many consumer plastics) have been linked to impaired fertility.
A diagnosis of endometriosis can be devastating enough, and in addition to the physical pain of the disease, endometriosis often contributes to a woman’s infertility. Thirty to 50 percent of women with endometriosis experience infertility. Additionally, other diseases that affect the reproductive system can affect fertility, such as fallopian tube disease, the endocrine disorder polycystic ovarian syndrome (PCOS), and sexually transmitted diseases like Gonorrhea and Chlamydia, which can cause scarring and Pelvic Inflammatory Disease (PID) if left untreated.
Poor nutrition can affect a woman’s ability to conceive. Avoid saturated fats, processed food and refined carbohydrates. Basically, the same things to cut down on to live a healthier lifestyle, regardless of whether or not you’re trying to get pregnant.
There are a lot of resources and books available out there and theories regarding how nutrition affects fertility. Some advocate wheat-free, or sugar-free, while others advocate the macrobiotic diet followed by Ms. Goop herself, Gwyneth Paltrow. Be wary, however, of any diet that seems like a fad diet or that is too restrictive. Whatever nutrition plan you follow, doctors recommend all women take a multivitamin with folic acid, which helps prevent birth defects.
Alcohol & Caffeine
While it’s common knowledge that alcohol consumption during pregnancy can harm a developing fetus, it is also true that drinking alcohol while trying to get pregnant can hinder conception. Caffeine in moderation is generally considered acceptable.
Smoking: everyone knows it’s bad. No need to preach about it here. If you smoke, even occasionally, stop - if not to improve your chances for conception, then for your own health and longevity.
A study published in Fertility and Sterility confirms the link between exercise and pregnancy. Though slight in effect, according to the study, moderate exercise helps women of all BMI’s get pregnant. Vigorous exercise, however, slows the time to conception for all but overweight and obese women, for whom vigorous exercise has no effect. The simple takeaway: exercise, but not too much.
Stress management is also vital for women trying to conceive. There have been studies that show that women who engaged in techniques to decrease their stress versus those that did not were more successful at getting pregnant. Check out my post from last month for some stress management techniques.
While improving diet, nutrition and lifestyle is no guarantee you’ll get pregnant, taking charge of these areas of your life can be empowering for women facing infertility who may otherwise feel powerless.
Ready For Kids: Improve Your Chances of Conception
The reality is that even couples in their twenties trying to conceive only have about a 25% chance of conception each month. This number of course goes down the older you get. In addition to managing the lifestyle factors discussed above such as eating well, cutting down on alcohol and caffeine, exercising regularly, and managing stress, there are other things you can do to improve your chances of getting pregnant.
At Home Diagnostics
Since women are only fertile right before and right after ovulation, timing is everything when it comes to conception. At home ovulation kits can be used to find out the optimal times for conception and take the guesswork out of determining when a woman is most fertile. Sounds kind of gross, but an important part of ensuring pregnancy is having the right cervical mucus consistency, which can be examined at home along with basal body temperature if you opt for a more natural way of family planning.
If you suspect something is off with your hormones, your doctor can run a battery of blood tests to evaluate them. The litany of acronyms and hormone names can be overwhelming: LH, FSH, estradiol, progesterone, prolactin, and testosterone are the hormones most commonly tested. More in-depth info here.
For women who aren’t producing eggs or aren’t producing enough eggs, the oral medication Clomiphene (brand name Clomid) can be prescribed to promote ovulation, (i.e., egg production) and regulate hormonal imbalances. It is the most commonly prescribed fertility drug in the United States. There are also a plethora of other medications a doctor can put a woman on depending on her individual needs.
Some people swear by acupuncture as a means to improving fertility. Women will commonly undergo specialized acupuncture treatments in the months before fertility treatment, in addition to right before and right after a procedure such as in vitro fertilization. Although research is not conclusive, it is believed that acupuncture can promote relaxation, increase blood flow to the uterus, and regulate reproductive hormones and improve the lining of the uterus.
Assisted Reproductive Technology (ART)
If the egg and sperm are shy about getting together, artificial insemination can help things along. Artificial insemination involves injecting sperm directly into the cervix or uterus. Artificial insemination is less invasive and less costly than in vitro fertilization, discussed below. Artificial insemination can cost anywhere from $300 to upwards of a few thousand dollars, depending on the clinic and the treatment received.
In Vitro Fertilization (IVF)
Everyone’s heard of “test-tube” babies created through the use of in vitro fertilization (IVF). IVF is usually used after oral medication and artificial insemination efforts fail. Some things to consider are cost and success rate. You should do your homework and research the doctor and fertility clinic. Ask questions regarding success rate in achieving live births (not just pregnancy) for women similar in age to you and with your type of infertility. If you thought law school loans were burdensome wait until you hear how expensive IVF can be: $12,000 to $15,000 per cycle.
IVF can be an involved process. Typically, the woman takes hormone injections to hyperstimulate her ovaries to increase the release of eggs (usually only one egg is released each month during menstruation). The eggs are then removed through a surgical outpatient procedure, and then typically fertilized outside the woman’s body. The fertilized embryo is then implanted back into the woman. The woman is monitored to see whether she gets pregnant.
Technology has advanced so rapidly, in addition to testing the embryos for genetic disorders before implantation, it’s also possible to check for gender, which enables those couples that wish to engage in sex selection. For better or for worse, I guess the age of Gattaca is upon us.
Not Ready For Kids…Yet
You may not think you can be proactive about your fertility at this stage in your life, but to a certain degree you can. Embryo freezing involves steps similar to IVF, except there is no implantation. The woman is given injections to stimulate ovulation, and then the eggs are extracted and fertilized with the sperm in a lab, creating embryos that are frozen for later use during IVF.
Here’s an interesting side note I’m sure Ms. JD readers will have an opinion on: in Oklahoma a bill granting embryos full rights of personhood has passed in the Oklahoma Senate and is likely to pass the Oklahoma House in the coming weeks. This topic intersects with ART practices because oftentimes a couple will have remaining unused embryos left after undergoing IVF. Usually the couple decides what to do with the remaining embryos: donate to another infertile couple, donate to research, destroy, or freeze indefinitely. What will happen to these embryos if this bill passes in Oklahoma, and how will this change what say the couple has in the matter?
Egg freezing was and is still typically used by women undergoing treatment for cancer to preserve their fertility after destructive radiation and chemotherapy. The procedure, although still considered experimental, is becoming more mainstream, however. TV personality Maria Menounos has been public about her decision to freeze her eggs and embryos. The 33 year-old and her partner have decided to wait to have children and so have opted for the procedure as a type of insurance policy. Here’s an interesting account of a woman in her late thirties who underwent egg freezing. She shares her emotional journey and gives an informative account of the physical discomfort involved in the process.
Like with IVF or embryo freezing, anyone weighing this option should consider cost and success rate. The method is similar to IVF, minus the fertilization and implantation. Like embryo freezing, the woman would only undergo one surgery instead of two (no surgical implantation). Another thing to consider is the freezing methodology: slow freezing versus fast freezing (vitrification). Vitrification is a newer procedure but reportedly better preserves the eggs. Egg freezing typically costs around $10,000.
If you don’t want to take any of the above routes, which can be costly and painful, but are still curious about your ability to conceive, you should consider finding out your ovarian reserve. Your ovarian reserve is the number of eggs you have left and the quality of those eggs. Some women, even those in their twenties, may have a low ovarian reserve. Perhaps knowing ahead of time that you had a low ovarian reserve would factor into if, when, or how you decide to have children in the future.
The results of a fascinating study were published earlier this year on research conducted by scientists from Harvard and Japan. They were able to isolate human ovarian stem cells that were then used to grow new eggs in a lab. Pretty amazing, huh? This shatters the belief that woman are born with all the eggs they will ever produce without any way of making new ones. Just imagine the impact this would have on women and society in general.
Some lawmakers in Washington have proposed a tax credit under the Family Act of 2011 for those undergoing fertility treatments of up to 50% of the cost of qualified treatments, which will make treatments more affordable for many couples.
The information in this post is meant as a general primer intended to get people thinking about fertility. Consult your physician for advice on any of the medical topics and procedures discussed above. He or she is the best person with whom to discuss your individual needs and none of the information provided here is intended to substitute for medical advice.
Dear readers, do you have any personal experience or thoughts on fertility, motherhood, or becoming a mother you’d be willing to share?