1. Getting pregnant
  2. Planning for pregnancy
  3. Preconception planning

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I Want to Have a Baby: Fertility Specialist Answers 5 Most Disturbing Questions on Preconception Planning

If you are thinking about becoming a parent, it is never too soon to start taking healthy steps for you and your baby-to-be. In this article, Lubna Pal, Professor of Obstetrics, Gynecology & Reproductive Sciences, answers the most disturbing preconception planning questions.

Is age an important factor to start planning a family and what is the best age to conceive naturally without additional assistance?

Age is a profoundly important factor, a critically important factor, which determines not only success for a pregnancy but also the health of that pregnancy. 

Women who are at extremes of ages – young women, teenagers as well as older women, specifically those 40 and above – their pregnancies can be burdensome. They are burdensome for the mom, they are burdensome for the baby.

Teenage pregnancies are more likely to have complications such as preterm birth and preeclampsia, whereas older moms are much more likely to have problems like preeclampsia and gestational diabetes. 

Planning for a pregnancy in your early 30s is a great strategy.

Extremes of age have implications for both ability to become pregnant, and for the health of the mother and baby. Therefore, it is critical that information is made available to all reproductive age women.   

As we age, our reproductive success goes down. The shift starts to happen in mid-thirties. 

Ages of 35, 36, 37 is the time when – at the population level – it takes a bit longer to get pregnant, a little bit more instances of miscarriages happen, a little bit more incidents of genetic abnormalities such as Down Syndrome start to happen.

Planning for a pregnancy in your early 30s is a great strategy. 

I also want to highlight that no one size fits all. There are many women who in their 40s get pregnant and have a healthy pregnancy. However, the point is not to wait until then to plan.

Planning a pregnancy should still be at a much earlier age with the goal of achieving a healthy baby by a healthy mom. Aging is important for fertility success. And it’s also important to put your personal story, family history in perspective. 

If I’m a woman who is 28 years old and who comes from a family where my mother experienced early menopause (say, in her 30’s) or if there is a history of fibroids or endometriosis in women in my immediate family, etc., in this case, I too may be susceptible to gynecological problems that may impact my fertility at an earlier age than the population norms described above. 

If I am made aware of this possibility early in my reproductive life, I am more likely plan family building at a younger age than I would if I remained unaware of this concern.

From my perspective as a gynecologist reproductive specialist, I believe fertility planning involves both planning to avoid an unwanted and unplanned pregnancy, and planning when to get pregnant.

The whole point of planning is to optimize one’s chances of achieving a healthy pregnancy in the shortest possible time.

Unplanned pregnancies, and multiple pregnancy terminations, particularly when surgical approaches are utilized, have their own risks and can be harmful to your physical and psychological wellbeing. Planning a pregnancy should be about when it is right, recognizing that aging is a very important consideration. 

Fertility is a team sport. There are two players and a playing field. And it’s easy for someone to say, ‘Plan a pregnancy’. But sometimes a woman hasn’t found the right partner. Societal perceptions are shifting with increasing recognition of the unique needs of certain populations to achieve family building. For example, same gender couples and transgender people require special considerations.

There is no single strategy that is right for all women.

If I’m a woman in a same-gender relationship, then I and my partner will need access to donor sperm to achieve a pregnancy. Regardless of sperm availability, I still need to be aware that my age can and will impact on my ability to conceive and that, if possible, I should not delay attempting pregnancy beyond my mid- 30’s.

If I’m a single woman by age 34-35 and I haven’t found a partner, but hope to have a child of my own, I now have an option of choosing to freeze my eggs for future use.

There is no single strategy that is right for all women. Women must be aware that the pace of reproductive aging is much faster than chronological aging.

Forty-year-old is a young person chronologically, but reproductively, the best years are well past by the time a woman reaches age 40, in terms of egg quality as well as egg quantity. Reproductive planning requires this understanding: If I don’t have access to the right partner to create a pregnancy, my options are either freezing my own eggs for future use, or attempting pregnancy with use of donor sperm. 

We, as reproductive specialists, often see single women in their early 40’s, who seek our assistance for egg freezing. Although we can still perform egg freezing, it is important for women to know that the chances of eggs collected from women in their 40’s to result in a healthy pregnancy are highly reduced compared to if the eggs are frozen at younger ages, preferably under 35.  

Fertility planning should take into consideration

  • the process of aging,
  • personal journey,
  • personal story,
  • woman’s life perspectives,
  • her access to a partner who she would like to make a baby with,
  • the knowledge of what choices are available to her,
  • financial implications related to those options. 

From the perspective of fertility planning, I would not recommend egg freezing to a healthy 22-year-old heterosexual single woman as her chances of finding the right partner and getting pregnant without any assistance over the next few years are quite high! 

Chances of successful pregnancy are much higher when you’re young, in your 20s. When you reach your early 30s and you haven’t found a right partner and are getting worried about declining chances of pregnancy with aging, that’s the time when considering fertility preservation by eggs freezing may be worth the cost involved.  

When is it time to apply for fertility care? 

By definition, inability to conceive despite trying for 1 year is consistent with infertility

However, for women who are 35 or older, the time duration is reduced to 6 months. So, couples who have not been able to achieve pregnancy despite trying for 6 months (if female partner is 35 or older) or 12 months (if female partner is younger than 35) should consider seeking consultation with a fertility specialist. 

I see patients all the time who have been trying but they are really not aware of the importance of the timing of intercourse to the timing of ovulation.

This definition requires that the couple understands that this is the time to try to get pregnant. Older couples, with women aged 35 and older, should recognize this time is lesser – six months, at least in the United States. Not being able to achieve conception despite trying for six months is counted as infertility. These are the definitions. 

My perspective as a clinician is that if I have a patient, a woman, who has irregular menstrual cycle, she’s ovulating irregularly. I don’t have to make her wait for one year before I’ll say ‘You need help’. 

Women should be aware of this relationship between regularity of menses and timely ovulation. 

I see patients all the time who have been trying but they are really not aware of the importance of the timing of intercourse to the timing of ovulation. 

Ideal time, if you are trying to conceive, is to aim for intercourse happening two to three days before actual ovulation happens so that the sperm are available in the territory before ovulation actually happens, as this way, the chance of the egg meeting with the sperm in a timely manner gets optimized.  

If you wait for ovulation to happen before you actually attempt intercourse, your chances of success go down slightly. If you wait for your body temperature to go up before having sex, your likelihood of fertility becomes very slim because the unfertilized egg is likely dead by the time the body temperature starts to rise due to progesterone levels going up.

So step 1 is: If a young couple (under 35 years of age) is attempting to get pregnant, and are unable to achieve pregnancy despite one year of attempting, that is time enough to consider seeking assistance. 

For older couples, definitely six months of failed attempts is enough. But, regardless of age, if menses are irregular, there’s no need to wait that long, and a conversation with a health care provider about fertility can be begun sooner because the worst thing is when emotional stress builds up, stressing the individual as well as the couple. 

There’s no point in adding to the frustration of the couple by trying this long before any conversation with a healthcare provider will happen.

Young people under 30 with regular cycles, nonsmokers, without health problems, and without any family history of early menopause, endometriosis, fibroids, should be reassured that it is quite normal for it to take up to 12 months of trying before a successful ongoing pregnancy is achieved. And if you find yourself stressing, then initiate a conversation with your healthcare provider.

Does smoking affect the ability to get pregnant?

Whether passive or active, tobacco exposure is harmful to fertility, and harmful to both eggs and sperm. Even if I may not smoke but if I’m with a smoker partner or I’m in a workforce where everybody smokes, this passive exposure to tobacco still is harmful to my ovarian biology, amongst other things. 

And then there are epidemiological data that identify higher stress levels in certain life choices situations. And smoking is one of them. 

People who smoke, if they stop smoking, they get stressed out much more. For some, smoking is a stress-release strategy, but smoking itself is bad for reproductive physiology. 

As for the amount of smoking, any amount of smoking is considered harmful for reproductive biology. 

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