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All too many couples who are struggling to start a family have been given the unhelpful advice that they should “just relax.” Many people end up blaming themselves for their fertility problems, as though they are subconsciously stopping their bodies from conceiving successfully.
Fertility problems often go together with anxiety, depression, high stress levels, or all the above. A number of studies have found that couples struggling to conceive have higher levels of depression and anxiety. But it's not clear if the participants’ state of mind caused their fertility issues, or vice versa.
A 2011 meta-analysis of 14 studies into IVF success and women’s emotional distress covered more than 3,500 women. It concluded that depression, anxiety, or other emotional distress did not have an impact on the outcome of treatment.
But this is a topic that’s very hard to explore scientifically. Most studies examine couples who are undergoing IVF treatment, but by this point, most people will have been struggling with fertility issues for a while. It’s hard to say whether their difficulty conceiving was caused by their state of mind, or if having trouble getting pregnant caused anxiety, depression, and distress.
When you’re having trouble starting a family, it can affect your state of mind in many ways. A lot of people become isolated, because they avoid friends who are pregnant or have young children, and that can have its own impact on mental health. Fertility treatments can be expensive and lead to financial challenges. Some men and women feel a lack of control over their lives or bleak about the prospect of being unable to raise a family.
One study found that women who were receiving fertility treatments saw their symptoms of depression and anxiety get worse as their treatment progressed, which indicates that the treatment caused them emotional distress, and not the other way around.
It’s worth pointing out that fertility drugs can also affect the hormonal balance and cause emotional distress. For example, clomiphene citrate, a synthetic estrogen that can cause mood swings, anxiety, and insomnia in women, is often prescribed to increase sperm production and control ovulation. Other fertility medications can provoke depression, irritability, and mania.
Additionally, some medical issues that cause infertility also raise the risk of emotional distress, like polycystic ovary syndrome (PCOS) which can cause higher rates of depression and anxiety.
Stress has been found to correlate closely with infertility, but the jury is out about the cause and effect.
When you’re stressed, your brain produces two hormones, alpha-amylase and cortisol, which can interfere with the production of gonadotropin releasing hormone (GnRH). GnRH controls the release of sex hormones which govern women’s menstrual cycle and ovulation, and men’s sperm count and quality. Men who are stressed might also produce more steroid hormones called glucocorticoids, which affect sperm production by controlling testosterone secretion.
According to one study, women with higher levels of stress were less likely to get pregnant during IVF treatment than those with lower signs of stress.
There are a number of ways that anxiety levels could affect fertility:
A 2004 study from Iran that followed 370 women receiving fertility treatments found that women with higher levels of anxiety also saw longer periods of infertility, but that anxiety didn’t appear to cause infertility. It also concluded that higher levels of depression affected both the cause and duration of infertility.
When scientists carried out a metaanalysis of studies on Cognitive Behavioral Therapy (CBT) training and fertility treatments, they found that couples receiving CBT or mindfulness therapy were more than twice as likely to conceive successfully than couples without any therapy. The more couples were able to lower their anxiety levels, the bigger the improvement in pregnancy rates.
Depression might affect fertility in a number of ways:
One study found that women who are struggling to conceive and women who are battling cancer have similar levels of depression, while another reported a 38% drop in conception rates among women with severe depressive symptoms, compared with women with no or low symptoms.
Another study concluded that women with infertility had higher rates of depression than women without any fertility issues, but it didn’t rule out the impact that infertility may have had on the women's depressive symptoms.
Although doctors are still not sure if depression, anxiety, stress, or other emotional distress can make it harder to get pregnant, they agree that the way that you deal with these disorders can be the most important factor.
People with mental or emotional health disorders can tend towards unhealthy habits which can provoke infertility and/or lower the sex drive, including:
Therapeutic treatments which help you relax, calm down, and improve your state of mind can improve fertility simply by helping you put an end to unhealthy habits that affect the reproductive system.
Some popular approaches to improving mental and emotional health as a way of increasing fertility include:
Your mental and emotional health always has a knock-on effect on your entire body, so it’s never a good idea to ignore it. Whether you’re trying to conceive naturally or beginning IVF, it’s clear that the more relaxed and positive you can be, the better. We hope you reach parenthood in an easy, smooth, and stress-free manner.
If you’re trying to get pregnant, whether you’re hoping to conceive naturally or starting IVF, it seems safe to say that the less stressed you are, the better your chances of conception. It’s never easy to relax, but take the time to do activities that calm you down. We hope your path to parenthood will be smooth and stress-free.
Anyone who’s struggling to conceive knows that the entire experience can be extremely stressful. It’s not surprising that anyone finding it difficult to start a family feels a lack of control that fosters anxiety and potential depression.
One study found that women who are grappling with infertility show similar levels of depression to women who are fighting cancer. Another study found that women who were undergoing IVF treatments and had higher signs of stress (both self-reported and clinical) were less likely to get pregnant after their first IVF cycle.
It doesn’t help that some of the medications that are used to increase fertility, like clomiphene, leuprolide, and gonadotropins, have side effects that include increasing anxiety, depression, and irritability.
So it’s not surprising that stress and infertility go hand in hand. The big question is: does infertility cause stress, or does stress reduce fertility?
It’s not an easy question to answer.
The easiest way to measure stress is to ask the people involved to rate how stressed they feel (self-reported stress levels). The trouble is, this measure is not objective and could therefore be under- or over-reported.
It’s more scientific to measure levels of stress hormones. Stress triggers the release of two hormones:
The challenge here is that cortisol is released in pulses throughout the day, so levels can fluctuate significantly from hour to hour, making it tough to be sure of an individual’s long-term cortisol levels.
Alpha-amylase is more constant, but scientists still aren’t confident about its reliability in representing stress levels.
Most studies try to measure both self-reported stress levels, and at least one stress hormone level.
So far, studies haven’t been conclusive. 2010 saw the first study to find a link between stress levels and fertility outcomes. It tracked both cortisol and alpha-amylase levels and concluded that women with higher levels of alpha-amylase saw a 12% drop in their chances of becoming pregnant. However, this isn’t a statistically significant difference.
A later study in the US found that women with the highest levels of alpha-amylase took 29% longer to get pregnant than those with the lowest levels, but it didn’t take sufficient measurements to be confident of the results. Another one in China found that couples with higher levels of the enzyme had more difficulty conceiving than those with lower levels, but it didn’t rule out the impact of other factors on the delay in conception.
In case you might think that stress only affects women’s fertility, some studies have shown that stress could affect sperm production. The amount of sperm produced, their shape, and how fast they can swim all affect chances of conception. Unfortunately, however, the evidence isn’t clear cut for male fertility, either. A study from 2014 found that life stress affected the speed and shape of sperm, but not sperm concentration, while an earlier study found that men with 2 or more recent stressful life events showed lower sperm concentration and lower sperm motility (speed), but that sperm shape wasn’t affected.
An analysis of scientific studies from 1978-2014 discovered that couples undergoing fertility treatment who also received mindfulness training or Cognitive Behavioral Therapy were more than twice as likely to get pregnant than those receiving no such therapy. The study concluded that the more anxiety was reduced, the greater the improvement in pregnancy rates.
Although the jury is still out about whether stress really does affect fertility, it is thought that alpha-amylase and cortisol could interfere with the production of GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones.
In this way, it could affect the menstrual cycle and ovulation in women, and the quality and count of sperm in men. Stress may also increase amounts of steroid hormones called glucocorticoids, which control the secretion of testosterone and thus affect sperm production.
Many doctors agree that stress on its own isn’t likely to affect fertility levels. What matters is the ways that you respond to feeling stressed.
For a lot of people, high stress levels lead them to:
all of which can lower your chances of getting pregnant.
If you’re trying to get pregnant, whether you’re hoping to conceive naturally or starting IVF, it seems safe to say that the less stressed you are, the better your chances of conception. It’s never easy to relax, but take the time to do activities that calm you down. We hope your path to parenthood will be smooth and stress-free.
If you’re trying to start a family or hope to have more children, and you’re approaching (or passed) the big 4-0, you’re bound to have heard at least once that it’s a lot more risky to have a baby when you’re the other side of 40.
Actually, you’ve probably heard it many, many times. It pushes your stress and anxiety levels sky high, but is there any real truth to it? And if so, just how much risk are you facing if you get pregnant after the “big 40 deadline”?
Many IVF clinics won’t treat women over the age of 50, because the risks are simply too high. The Ethics Committee of the American Society for Reproductive Medicine advises doctors against IVF for women over age 50. But if you’re aged between 40 and 50, and you’re eager to have a family, how safe is it to do so? No one can give you a definitive answer, but here are the main risks to consider.
First of all, your background health makes a huge difference to the risks you and your baby could face. If you’re healthy, have no chronic conditions like high blood pressure, and conceived naturally, there’s no reason why your pregnancy should be higher risk than if you were a decade younger. Women who have some background health issues and conceived with the help of IVF could have a very different experience.
The older you are, the higher your risks of developing certain common complications of pregnancy, including preeclampsia, gestational diabetes, and placenta previa.
Preeclampsia is a serious pregnancy condition that is caused by high blood pressure. It can cause permanent organ damage and is potentially fatal for both the mother and the fetus. The only way to treat it is to deliver your baby, but that poses its own dangers for a baby that hasn’t yet reached full term.
Blood pressure (hypertension) generally rises with age, and many women have borderline hypertension without being aware of it.
Being pregnant puts a huge strain on your heart, far more than even strenuous exercise. At the same time, your body produces more of the reproductive hormone progesterone, which raises your blood pressure and cholesterol. If your blood pressure is already borderline or high, or you have heart issues, this can be enough to push you into preeclampsia.
If you’re aged 40+, your risk of developing preeclampsia jumps from 1.5% to 4.6%. However, if you’re otherwise healthy and your blood pressure is good or low, your age only slightly increases your chances of developing preeclampsia.
Gestational diabetes is a form of diabetes that only affects pregnant women. Although you can develop it at any age, even when you eat a healthy diet, you’re four times more likely to experience it when you’re over 40 than when you’re in your 20s or early 30s.
During pregnancy, your uterus has to expand massively to accommodate the fetus, which requires a healthy and effective blood (vascular) system. The older you are, the greater your risk of vascular disease, which affects major organs like the uterus, as well as your heart.
If your vascular system isn’t operating at full power, you might develop placenta praevia, which is when the placenta doesn’t move up and away from the opening of the uterus. As it tries to expand, it can rupture, causing severe bleeding and bringing on premature labor.
Women over 40 have a seriously increased risk of placenta praevia, compared with women under 30.
Anything that affects your health, as the gestating mother, can also affect the health of your unborn child. Preeclampsia, gestational diabetes, and placenta praevia can all bring on preterm labor, which could harm your baby.
Studies have also found that if you’re giving birth for the first time at age 40 or over, the baby’s birth weight is likely to be significantly lower.
Overall, one study found that babies born to mothers aged over 40 were 35% more likely to need to spend time in intensive care, and 70% more likely to be born with some medical anomaly.
As you get older, your eggs get older too. That makes it harder for you to conceive, because there are fewer follicles left to develop into eggs, but it also affects the quality of the eggs that remain. Lower quality eggs are less likely to divide correctly during gestation, increasing the risk of chromosomal defects.
Down’s syndrome, or trisomy 21, is the best known and most common type of chromosomal defect. It happens when the 21st chromosome divides into three copies instead of just two, in every cell. When you’re aged 25, the risk of giving birth to a baby with Down’s syndrome is just 1 in 1,250, but that rises to 1 in 400 at age 35 and 1 in 100 at age 40. By the time you’re 42, you have a 1 in 60 chance of giving birth to a baby with Down’s syndrome, and a 1 in 12 chance at age 49.
Other less-common chromosomal defects include trisomy 13, or Patau’s syndrome, and the even rarer Edward’s syndrome or trisomy 18.
Older women are far more likely to suffer a miscarriage than younger women.
If you’re aged 30, the risk that your pregnancy will end in miscarriage is around 18%, but it rises to 38% if you’re 40, and almost doubles to 70% for women aged 45.
It’s not always clear why this happens. Chromosomal defects often trigger a miscarriage, and those are more common among mothers aged 40+. Another issue is that the older you are,
the more likely it is that you’ve developed a chronic condition such as high blood pressure, diabetes, or thyroid disease, which can complicate your pregnancy and increase the risk of pregnancy loss.
The risks of stillbirth also rise, especially once you pass your due date.
Up until 39 weeks of gestation, a 40-year old woman has a similar stillbirth rate to that of a woman in her 20s at 41 weeks. But once you pass week 39, your risks of stillbirth spike to double those of a woman aged 35. That’s why it’s better to induce labour in women aged 40+ once they reach their due date.
For a variety of reasons, women aged over 40 are more likely to experience complicated birth that requires interventions like forceps, vacuum, or a caesarean section. Some of the reasons include:
You’re approximately twice as likely to need a c-section if you’re over 40.
Although c-sections and assisted deliveries usually bring favorable birth outcomes, it’s worth remembering that it takes longer to recover from a c-section than from a vaginal birth, and that assisted deliveries like forceps increase your risk of tearing.
Oddly enough, yes. When you’re over 40, you’re naturally more likely to have a multiple pregnancy, although scientists aren’t sure why.
A multiple pregnancy can increase your risk of miscarriage. Multiple pregnancies are also more likely to be born with a low birth weight, which is associated with complications like cerebral palsy and learning difficulties, and 5% more likely to develop congenital anomalies.
In general, maternal mortality is 2.5 times higher for multiple births than when you give birth to a singleton baby.
There’s some evidence that women who have a baby aged over 40 are more likely to develop certain health complications after giving birth. If you’ve had gestational diabetes, you’re at higher risk of developing type 2 diabetes postpartum.
That said, although the higher risks of having a baby when you’re over 40 are real and serious, celebrating your 40th birthday isn’t in itself a reason to decide not to start or add to your family.
If you’re trying to get pregnant, either naturally or through IVF, it’s best to have a thorough screening first so that you’ll be prepared to deal with the impact of any health risks on your pregnancy and birth. And if you’re already pregnant, do take all the health checks and screenings recommended by your doctor. We wish that your pregnancy and birth experience is as smooth and healthy as possible.
We’ve all been bombarded with messages about the dangers of smoking for several decades, but there’s one issue that tends to fly under the radar: the impact that smoking has on your fertility.
It’s estimated that over 1 billion people worldwide regularly smoke tobacco every year, but many people aren’t aware that it can harm their chances of conceiving and giving birth to a healthy baby.
Most couples who have regular, unprotected sex will succeed in getting pregnant within one year. But for people who smoke, it can take approximately twice as long to get pregnant. Another study found that women who smoke are less fertile than non-smokers.
Contrary to popular myth, low-tar and low-nicotine cigarettes pose the same danger to fertility as traditional cigarettes.
There’s no amount of cigarette smoke that is safe for women who want to start a family.
Even if you smoke only one to five cigarettes a day, you’re still at risk of ectopic pregnancies or premature birth. Secondhand smoke also harms your fertility, such as if your partner smokes, or if you work in smoke-filled conditions.
When you smoke, the toxins in the cigarettes enter your body and pervade every part of your system. As a result, smoking affects your fertility in a number of different ways.
Poor quality eggs
The nicotine, cyanide, carbon monoxide, and other chemicals in cigarette smoke can harm the ovaries, producing poor quality eggs that are less likely to be fertilized and develop into a healthy fetus.
Early menopause
Every woman is born with a finite number of follicles, which develop into eggs. These are your ovarian reserve. Eggs die naturally throughout your life, and once they have been used up, you enter menopause. Women who have completed menopause can no longer become pregnant.
A number of studies have found that women who smoke have a significantly lower ovarian reserve than non-smokers, because the toxins in cigarette smoke cause the eggs to age and die off faster than normal. On average, smokers enter menopause more than 1 year earlier than non-smokers.
Disruption of the hormonal balance
The chemicals present in cigarette smoke also interfere with your endocrine function, which is the part of your brain which is responsible for producing and releasing sex hormones. Oestrogen, progesterone, testosterone, and follicle stimulating hormone (FSH) govern your menstrual cycle, ovulation times, and uterine development in order for you to become pregnant.
Damage to the fallopian tubes
There is also evidence that smoking affects the fallopian tubes, increasing the risk of lesions. It’s thought that this is why smoking raises the incidence of ectopic pregnancy, which is when an embryo implants in the tubes rather than the womb.
Ectopic pregnancy can be life-threatening, or permanently damage the fallopian tubes to the extent that future conception is impossible.
Lower embryo implantation rate
Cigarette smoke and the toxins that it contains can affect the behavior of the cilia, which are tiny “hairs” that line the fallopian tubes and transport the egg and embryo to the uterus. When the embryo settles in the uterus, it’s “implanted,” and can continue to grow and develop into a healthy baby. In women who smoke, implantation rate drops by over 20%.
For women who smoke or who spend a lot of time in a smoke-filled environment, cigarettes can continue to cause harm even after conception.
It’s not just women who need to stop smoking before starting a family. Male fertility is also affected by cigarette smoke. Out of the 8.75 million men in the UK aged 20-39, 120,000 of them are infertile because of smoking.
Cigarette toxins like cadmium and cotinine damage sperm DNA, which can then cause problems with fertilization, embryo development, and embryo implantation, hampering attempts to become pregnant and increasing miscarriage rates.
Cigarette smoke negatively affects semen and sperm quality, causing:
Surprisingly, all these effects have been spotted in men whose mothers smoked half a pack of cigarettes or more every day while pregnant and/or breastfeeding, even if the men themselves didn’t smoke, which shows just how far the effects of smoke can reach.
As well as reducing your ability to conceive naturally, smoking also harms your chances of getting pregnant through IVF.
It’s been found that smokers need twice as many cycles as non-smokers before they can conceive. Women who smoke need more ovary-stimulating medication, and still see 30% lower pregnancy rates.
Even when women stopped smoking many years before receiving IVF, there’s some evidence that the difference may still be noticeable. There’s also a recent study that found that smoking at any point in your life can harm your placenta, which can affect your ability to carry a baby to term as well as harming the health of the fetus.
Men who smoke see much lower success rates in assisted reproductive technologies like IVF or intracytoplasmic sperm injection.
As a result, in the UK couples who smoke, or where one partner smokes, aren’t entitled to any free IVF cycles.
The good news is that when you stop smoking, your fertility can recover very quickly, although you can’t undo all the damage. Sperm and egg DNA improve, sperm quality rises, and female hormonal balance returns, although some aspects of harm, like your reduced egg supply, can’t be fixed.
If you’re thinking of starting a family, it’s best to stop smoking as soon as possible. Women who have stopped smoking don’t see any significant drop in their fertility compared with women who have never smoked.
Whether you’re hoping to conceive naturally or thinking or starting IVF, quitting smoking will give you the best shot at growing a healthy family. We hope that your path to parenthood will be easy and worry-free.
You’ve probably heard a lot about the risks of delaying starting a family until after you’ve become stable within your career, since trying for a baby later in life can potentially limit your chances of a successful pregnancy and birth. But you might not realize that the work you do or your workplace conditions themselves could also be affecting your chances of conceiving and giving birth to healthy children.
There are at least six ways that your work could affect your fertility:
It’s hard to say exactly how many chemicals women are exposed to daily, because they are all around us - in our makeup, our sanitary products, and in both our water and our food. One study found that every pregnant American woman is exposed to at least 43 different chemicals during her pregnancy.
But the workplace can be particularly hazardous. More than 1,000 common workplace chemicals have been shown to affect reproduction in animals, but millions more have never even been studied. The European Chemicals Agency (ECHA) registered over 21,000 substances since 2008, and that’s just for substance manufactured in amounts of more than 1 ton. It’s impossible to know which ones might affect fertility.
That said, there are some chemicals that scientists already know can make it hard to get pregnant, and it’s so easy to be exposed to them. Some of the main hazardous chemicals affecting fertility include:
As you can see, this includes a large number of workplaces and job types, including working in nail salons, factories, healthcare, farming, art, and garages.
These chemicals can disrupt the balance between your pituitary gland in your brain, (which controls your hormones) and your ovaries.
Estrogen and progesterone are the hormones that govern your menstrual cycle and prepare the uterus for a fertilized egg. If your pituitary gland doesn’t produce them at the right time and in the right amounts, it can alter your ovulation timing, damage egg production, and lower egg quality. It’s more likely that you’ll struggle to conceive with damaged eggs. Further, when egg quality is lower, the risk that it won’t divide correctly is higher, leading to a greater chance of chromosomal defects.
Chemotherapy drugs, X-rays, and fluoroscopy procedures all produce ionizing radiation, which we usually just call radiation. They affect the fertility of patients who have to undergo the treatments, but they can also affect medical staff who carry out the procedures or care for people after they receive treatment.
Direct radiation can damage the ovaries, and leaked radiation can harm the DNA in cells. Today’s workplace safety practices usually keep the amount of leaked radiation well below harmful levels, but it’s important to follow the rules and make sure your employers keep to them as well. Even a low dose of radiation can bring on early menopause.
Any profession that causes a lot of stress can impact your fertility.
We’re talking high-powered executive roles, jobs that include a lot of last-minute deadlines, and exposure to a toxic boss or stressful work environment.
That’s because stress produces a hormonal response (the “fight or flight” response) which affects the hormonal balance in the body, which can affect the production of reproductive hormones.
When you travel regularly or work night shifts, early morning, or late evening shifts, it can disturb your biological clock and cause jet lag. When your internal clock isn’t functioning properly, it can have an effect on hormone production, disrupting your menstrual cycle and ovulation window.
That includes:
Only around 24% of Europeans work a regular 8-hour day, five days a week, during daylight hours. 17% work shifts, and 14% work for 10 hours or more on a regular basis.
A large number of women work at jobs that involve too much bending at the waist or lifting, and it’s been found that these activities can affect your egg quality and egg production. The CDC defines “too much” bending and lifting as bending at the waist more than 20 times per day, or lifting heavy objects more than once every five minutes.
A study published in the Journal of Occupational & Environmental Medicine found that women engaged in physically demanding jobs had a 9% lower reserve of eggs, and 14.5% fewer mature eggs, than those whose jobs don’t include heavy lifting.
Women working in restaurants or bars, as childcare providers, in factories and distribution warehouses, in retail environments, and in a number of other industries could all have to carry out “too much” physical activity, according to the study.
Workplace environments can also affect male fertility, so it’s something to think about if you’re struggling to conceive.
Heat is a significant risk factor for male infertility.
The ideal temperature for sperm production is a couple of degrees below body temperature, but many men work in hot environments that raise the temperature inside the testicles. When that happens, it changes the shape of the sperm, so they can’t swim well enough to reach the egg and fertilize it.
Heat can be an issue for:
Exposure to chemicals like pesticides, DDE, diesel fumes, lead, and paint thinners can impact:
Before you panic, consider that not every chemical is going to affect your reproductive health.
Issues that make a difference include:
Scientists still don’t know all the ways that your work could affect your fertility, so it’s important to do all you can to create a healthy workplace environment.
That includes:
Whatever path you take to building a family, we hope that your experience is as smooth as possible.
If you’re trying to start a family, you are probably vaguely aware of the onset of menopause as you consider your timing. It’s like a huge “end” sign in the race to have children. For most women, menopause occurs between 45 and 55 (on average at 51), but some women find that it appears much earlier than expected, which could potentially throw a wrench into your family planning preferences.
Doctors distinguish between early menopause, which happens between the ages of 40 and 45, and premature menopause, also called premature ovarian failure (POF) or premature ovarian insufficiency (POI), which occurs before the age of forty.
Studies have found that around 5% of women experience early menopause, and another 1% experience premature menopause.
For many women, early or premature menopause is idiopathic, which means that there’s no known medical cause. That said, there are a number of issues that can lead to early menopause or POI:
Chemotherapy and radiotherapy often bring on menopause because the treatment can damage your ovaries and stop them from ovulating. In these situations, it’s possible for your body to recover and begin ovulating again, although you might still struggle to get pregnant because of other ways that the treatment impacted your reproductive organs.
Genetic and chromosomal disorders, like Turner’s syndrome, can affect the ovaries from birth and bring on early or premature menopause.
Autoimmune diseases like diabetes, rheumatoid arthritis, and thyroid diseases are signs that your immune system has malfunctioned in some way and is attacking your body instead of the disease. In these cases, your immune system could also attack your ovaries and prevent them from working properly.
Infections, like mumps, malaria, and tuberculosis, can damage the ovaries, but this is very rare. HIV and AIDS that are not controlled properly with medication can also bring on menopause.
Surgery to remove the ovaries inevitably causes menopause.
Smoking can speed up the degeneration of follicles (premature eggs). A woman is born with one million follicles on average, and these slowly dwindle over time. Follicles aren’t just used up through ovulation and menstruation; they go through a process called atresia, which means that the egg follicles simply degenerate and die. If you smoke, you speed up this process.
A Danish study found that there’s a link between your mother’s age at menopause, and your own ovarian reserve, which means the number of eggs that remain in your body. If you have a family history of early menopause, you’re likely to have a lower ovarian reserve than average, have trouble conceiving at a younger age than average, and experience menopause yourself at an earlier age than average.
It’s rare for menopause to occur completely overnight (in fact, that would only happen if your ovaries were surgically removed). Women go through a period called perimenopause, which is when you’re still ovulating, but far less frequently. During this time, your periods become irregular and spaced further apart.
Perimenopause can last as long as six years or more, and during this time it is still possible to get pregnant, but it’s far more difficult.. One study found that between 2.2% and 14.2% of the women involved conceived naturally and gave birth to a healthy baby.
If your periods become noticeably longer or shorter than usual, or stop entirely for three cycles, you could be entering perimenopause. You might also see some of the symptoms of menopause, such as hot flashes, vaginal dryness, insomnia, headaches, anxiety, and joint pains.
Once you’ve gone through menopause, you won’t be able to conceive naturally, but you can still successfully start a family by using IVF with either donor eggs, or your own eggs that you froze at an earlier point in life.
You might have heard about hormone replacement therapy, or HRT, which is often recommended for women who experience early menopause. However, HRT is only prescribed to address various other health issues associated with menopause, like osteoporosis and an increased risk of cancer, in addition to managing its symptoms. It doesn’t improve your fertility.
If you:
it’s wise to consider freezing your eggs as soon as possible.
When you freeze your eggs in your 20s or 30s, egg quality is higher, which improves your chances of success when you use them later to get pregnant via IVF. Egg quality can drop well before menopause, which means that even if you do get pregnant during perimenopause, you’ll have a higher risk of miscarriage and of the egg failing to divide properly, resulting in the wrong number of chromosomes in each cell in the embryo.
The chances of going through early or premature menopause is something that you should bear in mind when you think about your path to growing a family. We hope that whatever you choose, your journey to parenthood is smooth and successful.
We all know that carrying too much weight can affect many areas of our health, but research has found that being overweight can also have a significant impact on your fertility. There are at least 3 ways that your weight affects your chances of becoming pregnant:
íWhen it comes to fertility, your weight is measured according to your BMI, or body mass index. In general:
The main way that extra weight affects fertility is by potentially disrupting your menstrual cycle.
Your menstrual cycle is regulated by a delicate balance of hormones produced by the pituitary gland and hypothalamus, and those glands stimulate your ovaries. The most important hormone is gonadotropin releasing hormone, or GnRH. It stimulates the production of follicle stimulating hormone (FSH), which starts egg development within the ovaries and raises your oestrogen levels, and leutinizing hormone (LH), which helps mature those eggs and release them on time.
Normally, the hypothalamus releases GnRH every one to two hours in a steady rhythm, but when you are overweight, the extra fatty tissue produces its own hormone, called leptin, which interrupts GnRH production and disrupts the entire menstrual cycle. The more extra fat you carry, especially when it’s around your abdomen, the more leptin your body produces.
Obesity also causes a drop in the production of sex hormone-binding globulin (SHBG) and growth hormone (GH), both of which are also involved in stimulating your ovaries to produce the right levels of androgen and oestrogen. According to one study, women who are obese are far less likely to conceive naturally within one year than women who are in the normal weight range.
Obesity can even lead to anovulation, which means that your ovaries simply stop producing eggs entirely because of the disruption to the hormonal balance. Women with a BMI over 27 are three times more likely to have stopped ovulating than women with a normal BMI.
Researchers are still investigating a link between obesity and a drop in egg quality, but it seems likely that even if you’re still ovulating, obesity decreases the quality of your eggs. As the egg divides repeatedly, it’s more likely to divide abnormally, generating eggs with the wrong number of chromosomes, and/or to fail to fertilize correctly.
A different study discovered that for every extra BMI point you have above 29, your chances of getting pregnant within 1 year drops by around 5%.
Scientists have also found that once you become pregnant, obesity can affect your chances of completing the pregnancy and giving birth to a healthy baby. According to the NHS, women who are obese have higher rates of miscarriage, higher risk of developing gestational diabetes, high blood pressure, and preeclampsia, and are more likely to experience complications when giving birth. The higher your BMI, the greater the risk.
A study found that even a little extra weight can have a surprising impact on miscarriages during IVF. Thirty-eight percent of women with a BMI of 25 or above miscarried during the first trimester, compared with 20% of women with a healthy BMI.
One more thing to bear in mind is that weight gain can cause infertility in men, too. Research indicates that men who are overweight, with a BMI above 25, have a 22% drop in sperm count and 24% drop in sperm concentrations. On top of that, testosterone levels fall when your BMI increases, which reduces the sex drive.
Weight isn’t the only thing that affects your fertility, and fibroids may complicate the process of conceiving, but if you’re struggling to conceive, and you have ruled out any other issues that could be preventing you from getting pregnant, you might want to consider losing weight.
We hope that your journey to pregnancy and parenthood goes smoothly and well.
If you’re trying to start a family, or you hope to have children one day but you’re not currently in a position to do so, you’ve probably had people tell you that you need to start before you’re 35, because once you’re over that age you’ll seriously struggle.
It increases your stress and anxiety to hear that, but is there any truth in it? Exactly how hard is it to get pregnant after the age of 35, and should you keep your hopes up?
Like many things, the answer is more complicated than people make it sound.
It’s impossible to draw a line in time and say that after this date, your fertility plummets. Instead, what happens is that your fertility begins to drop gradually from your late 20s. The rate of decline speeds up once you get to 32, and then it speeds up again at about age 37.
By the time you reach the age of 40, your fertility has dropped significantly. It’s still possible to get pregnant, but it might take a lot longer than you expected.
Here are some statistics to explain things more clearly. One large study looked at pregnancy rates for women if they have sexual intercourse on their most fertile day. It found that:
To put it another away, you have a 25% chance of conceiving each month when you’re in your 20s, but only a 5% chance each month when you’re in your 40s.
That doesn’t mean it’s impossible, only that it’s less likely.
Another way of calculating fertility is by tracking how long it takes for a woman to conceive and give birth. Using this method, it was estimated that:
Given these statistics, the American Society of Reproductive Medicine (ASRM) recommends that you should begin evaluation for infertility if you haven’t become pregnant within 12 months of unprotected sex if you’re under 35, or six months if you’re older than 35.
When we talk about the difficulty of getting pregnant over the age of 35, it’s important to remember that it’s not just about conception rates.
The older you are, the higher your chances of miscarriage or stillbirth.
The risk of a baby with serious birth defects, which might lead you to consider an abortion, also rises over the age of 35. According to one study, 10% of pregnancies end in miscarriage for women in their early 20s, but that rises to 18% for women over 35, and 34% for women in their early 40s.
That means that you have a 40% risk of losing your baby when you’re 40, but only a 15% risk when you’re in your 20s. This is mainly because as you age, the quality of your eggs drops as well as the quantity. With a drop in egg quality comes a higher risk that a fertilized egg won’t divide correctly, leading to chromosomal defects.
The main reason why your fertility drops by around this age is because you don’t have very many eggs left. Women are born with around 1 million eggs, but by the time you reach puberty there are only about 300,000-400,000 remaining. This number gradually drops, and by the time you’re 35 there are only a few dozen that could be suitable for fertilization. You could begin to have menstrual cycles where no egg is released.
When you’re older, there’s also a greater chance that you’ve had some kind of surgery or infection that could have affected your fertility by leaving scars around the cervix or fallopian tubes. You’re also more likely to have developed conditions such as endometriosis or uterine fibroids, which make it much harder to become pregnant.
As you age, you also experience a natural decline in cervical mucus, which plays a key role in conception by helping sperm through the cervix and into the uterus and fallopian tubes so that it can fertilize the egg.
Once you’re over 35, every year can affect your chances of success in becoming a parent, so it’s important to seek medical assistance as soon as you see that you’re having difficulty conceiving. Whether you continue your path to building your family through IVF, donor eggs/sperm, or natural conception, we hope that your experience is as smooth as possible.
It’s not just the woman’s age that affects your chances of conceiving a baby naturally. The age of the man also plays a role.
Male fertility doesn’t decline as quickly as female fertility, but the time men are in their late 30s it has dropped noticeably. One study found that women aged 35-39 with a partner in the same age bracket have a conception rate of 29%, but if her partner is five or more years older, their conception rate is only 18%.
People will tell you to attempt conception before the “magic” age. As we’ve shown, there is no predetermined number where your fertility (or your partner’s) will drop. That said, the chance to conceive and carry a healthy baby to term drops as you age, as your partner ages, as you have less viable eggs available, as the chances of miscarriage and stillbirth increase. It’s best to attempt conception earlier, but there’s no magic formula - or age - to ensure success.
We all know that younger women, as a whole, have an easier time getting pregnant and giving birth to healthy babies. But understanding why that’s the case is more complicated.
There are at least two different factors that make successful pregnancy trickier for older women:
Let’s take a look at the impact of each on successful pregnancy. Then we’ll ask the question: which matters more - the uterus or the egg?
A baby girl is born with 1 to 2 million egg cells. That egg supply steadily decreases, giving the average adolescent 400,000 eggs and the average 37-year old 25,000 eggs.
Eggs don’t just decrease in quantity; they also decrease in quality, for several reasons. First, your body tends to pick the best quality eggs for use first - when you’re in your teens, 20s and early 30s. By the time you get to your later 30s and 40s, the remaining eggs are less likely to be as high quality.
Additionally, when the egg cell matures in the ovaries during the part of your cycle prior to ovulation, it needs to divide several times. Older egg cells are more likely to divide abnormally, leaving the cell with the wrong number of chromosomes. The result is an egg that will not fertilize, or - even if it does fertilize - will not develop correctly and will not lead to a successful pregnancy or a healthy birth.
Who hasn’t felt that her body at 40+ just isn’t the same as it was at 20+? (There’s a reason why women who don’t want to share their age often respond to “How old are you?” with the facetious answer, “21.”)
Women who get pregnant after 35 are more likely to experience pregnancy complications such as:
Gestational diabetes
High blood pressure
Pre-eclampsia
Complications during childbirth, including prolonged labour, need for a Caesarian section, or stillbirth
Any of those complications can decrease the chances of a healthy pregnancy and birth.
Before we ask that question, maybe we should ask: Why does it matter which matters more? If you’re over 35, both your eggs and the rest of your body is over 35 - so who cares?
While you can’t change the age of your body (unless you’ve invented a time machine), when you’re using IVF you can potentially change the age of your eggs. This can be done either by using donor eggs from a younger woman, or by using your own eggs, if they were frozen when you were younger.
So, it makes sense to care about and to find out which matters more. Let’s take a look.
The UK’s HFEA (Human Fertilisation and Embryology Authority) presents some very telling numbers in their most recent report, using data from 2017.
The numbers tell about the live birth rate per embryo transferred (PET). For women using their own eggs, the birth rate steadily decreases, from 27-30% (depending on whether the eggs were fresh or frozen) for women under 35, to 2-4% for women over 44.
For women using donor eggs, however, the decrease is much less significant (where there even is a decrease). Birth rate per embryo transferred is 28-33% for women under 35 - not too different from the numbers for that age group who use their own eggs. But birth rate for women over 44 is 22-26%. What a significant difference from the 2-4% for women who use their own eggs!
Why is this the case?
Donor eggs are almost exclusively from women under the age of 35. When they use these younger eggs, even women in their mid-40s have a significant chance of having a successful pregnancy and birth. True, it’s still not as high as the success rate of those in their mid-30s, showing that the older body and uterus do have an impact, but it’s far higher than women who are using their own mid-40-year-old eggs, showing the much greater impact of the egg’s age.
Another support for the egg’s age having a greater influence than the body’s age is seen by difference in success rate between women using their own frozen vs. fresh eggs. For those under 35, the IVF success rate is comparable when using their own fresh eggs. All older age groups, however, have a higher success rate for frozen eggs. The eggs, frozen at a younger age, boost their chances of success.
The same boost is seen when performing IVF using embryos frozen at an earlier age.
No, we don’t know of any miraculous source that will make you 21 again (if that’s even what you want). Your body is stuck at the age that it’s at. Period.
But the numbers given by the HFEA point the way to a potential fountain of fertility. Using younger eggs - whether your own frozen eggs or a donor’s eggs - can give you a higher IVF success rate. Additionally, the earlier you freeze your eggs (especially if you freeze them before 35), the greater your chances of a successful IVF pregnancy and birth.
We wish you much success in your fertility choices and in having the family you want, when you want.
