Welcome to The V, our weeklong series devoted to all things sex and reproductive health. This is a safe space free from "taboos," because there's no reason women should feel awkward talking about their bodies. That said, we'll be clearing up misinformation on the subject, starting with this huge misnomer: The "V" in this case doesn't refer to the vagina, but the vulva, which is the anatomically correct term for external female genitalia (including the opening of the vagina). Stay tuned all week for need-to-know guides on birth control, tips for taking your orgasm to the next level, real-life stories about endometriosis, and everything in between.
At a recent breakfast with the Reproductive Medicine Associates of New Jersey, one of the fertility experts in attendance spoke about hating the term "biological clock," saying she denied it and its truth throughout medical school. Surprised by this, I waited for her to unleash the groundbreaking news that the term is just a scare tactic, but this moment never came. "The biological clock is a real thing," she said as all of our faces subsequently fell.
In fact, a woman reaches peak fertility in her early to mid-20s—sad news for those of us focused on our careers or just not ready or able to have a child in our 20s, which seems to be the norm for generations Y and Z: Since 2000, more women have been having children after age 35. But this isn't to say that you're doomed post-20s—women over 35 are certainly capable of birthing a healthy baby. However, the risks do heighten as you age, such as the likelihood of needing a C-section, increased blood pressure, and a greater possibility of having a premature birth or a miscarriage.
On the other end of the spectrum, a recent study did find a correlation between a higher maternal age and health of the baby: From 2001 to 2007, tens of thousands of UK children were evaluated up to age 5, and the older the mothers were at the time of birth, the less likely the child was to require medical attention or have health issues. In other words, there's some give-and-take when it comes to giving birth in your 30s and 40s.
Also, freezing your eggs is quite expensive—I learned at the breakfast that it can cost anywhere from $10,000 to $12,000 plus an annual storage fee of $600 to $800, and insurance doesn't cover it (unless the patient has cancer), so it's not always a feasible choice. Luckily we come bearing good news: Shefali Shastri, MD, gave us some insight on steps you can take, in terms of diet and lifestyle, to be more fertile. But first she shared some important information on infertility. Keep scrolling for more info.
What are the signs and symptoms of infertility?
The outward symptoms of infertility aren't always overtly apparent. Says Shastri, "You can have a young woman in her 20s with regular menses, in great shape with a major infertility issue. If a couple has been trying for over a year (if younger than age 35) or for over six months (if over age 35) without success, they should see an infertility specialist who can fully assess the patient and the partner.
"In some instances, there may be signs such as irregular or no menses, painful periods or pain with intercourse, or even a specific family history of miscarriages or early menopause [Ed. note: which can begin at age 35], which would be of concern and require additional evaluation." Shastri adds that a woman's fertility is not always to blame; her male partner may be infertile or have erectile dysfunction.
How do you test for infertility?
"The basic infertility evaluation for a woman focuses on ovarian reserve (which refers to the number of oocytes [Ed. note: the cells in an ovary] a woman has in her ovaries) and her reproductive organs," says Shastri. "Specifically, a woman's ovarian reserve is determined through a pelvic ultrasound and blood work to check hormone levels including her follicle stimulating hormone and anti-Mullerian hormone [Ed. note: the hormones necessary for reproduction]. These three markers give us the best information about a woman's egg reserve.
A hysterosalpingogram is a type of X-ray that can help best evaluate a woman's uterus and fallopian tubes. A pelvic sonogram or sonohysterogram (a type of sonogram) may also be done to get additional information about the pelvic anatomy."
What inhibits fertility?
Shastri tells us that there are many factors that could lower a woman's fertility, such as smoking, having an eating disorder like anorexia (which can interfere with ovulation), and having multiple sex partners (which could potentially increase your chance of contracting an STD if neither partner is tested). Another inhibitor is tubal disease in which the fallopian tubes are damaged by infection or other pelvic diseases. Obesity is another risk factor, as increased body mass index is a direct cause of infertility.
What can you do to improve your chances of being fertile?
Because obesity is a risk factor, Shastri explains that being in prime physical health is an excellent way to increase your chances of getting pregnant: "I recommend to my patients that they should aim to be in the best mental and physical shape they can be in and be cognizant that age plays a major role in lowering egg reserve and quality."
A healthy diet is also a bonus. Shastri tells me that following a high-antioxidant diet is advised: a lot of antioxidant-rich berries like blueberries and blackberries, leafy greens, fish, healthy fats like avocado and olive oil, no processed or sugary foods, and very little red meat—basically, a lean and clean diet.
One more very important factor Shastri urges is to be open about the topic of fertility with your family, friends, partner, and gynecologist. It's never too early to ask questions and seek advice, and waiting to research your own fertility could prove to be a major setback. If you're on birth control, you may not notice signs of infertility such as an irregular period, so getting tested sooner rather than later is advised.
This story was originally published on April 20, 2017.