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Ask Dr. Emma
So you’ve chosen the perfect wedding dress, found the perfect venue, and elected the perfect bridal party. But what about life after the big day? This month, our readers are asking Dr Emma Amoafo-Mensah, our resident doctor, key questions about fertility and health considerations you shouldn’t ignore.
I’m 25, should I be thinking about freezing my eggs?
Egg-freezing is becoming more and more popular, and is now the fastest growing fertility treatment in the UK. Before we try to answer the question, let’s talk through the science, and why it’s even a question in the first place.
Females are born with around 2 million eggs and don’t make any more; in contrast to males who are constantly producing sperm. By the time a girl reaches adolescence, the number of eggs left has reduced to about 400,000. This number continues to decrease, and by age 37, 90% of the eggs are gone, leaving around 25,000. This sounds dramatic and like you won’t be left with enough, but actually only about 500 eggs ovulate within a woman’s life time (if you have periods from the age of 13 until 51, that’s 38 years of ovulation, releasing on average 1 egg per month: 12x38 = 456).
The quality of these eggs decreases over time, and that’s one single (of many) reasons why women’s fertility decreases with age. According to the NHS, 92% of women having regular sex between the age of 19-26 will get pregnant within two years, but that number drops to 82% between the ages of 35-39. In a nutshell, once a woman reaches their mid-thirties, their fertility starts to decrease each year.
Now, let’s talk about egg freezing. This is the process of obtaining a woman’s eggs, freezing them, and thawing them later to be used for IVF. Women are given medications to make them produce more eggs and to help them to mature, then under sedation, the eggs are collected. Usually around 15 are collected and frozen. When the woman is ready, the eggs that survived will be thawed and injected with a donor’s sperm, and then implanted. The Human Fertilisation & Embryology Authority states that on average, the process costs £3350 for egg collection and freezing, £500-£1500 for the medication, and an extra £125-£350 per year for storage costs. Then to thaw the eggs and transfer them to the womb will cost another £2500 or so. It’s really difficult to find a reliable success rate for egg freezing, but the technology is improving year or year, so we would expect the rates to increase. It’s important to state here that the processes and costs are different in many countries, and in fact egg freezing is still illegal in many nations.
So, would I encourage a 25 year old woman to freeze her eggs? Of course, I could never answer this question with a single blanket answer, but I can highlight things that I believe need to be taken into consideration. The vast majority of women will get pregnant when they want to, so the first question is, why is the woman considering egg freezing? Is there a medical condition that means she is less fertile than average? Does she have plans for her life that means she is planning to conceive at an older age? Is she worried she won’t be able to fulfil certain social or cultural expectations in the future?
I would always implore the woman to look at herself from a holistic point of view, and ascertain where these thoughts are coming from. It’s no secret that women are increasingly under more pressure to “have it all”; that’s the career, the perfect relationship and the constantly well-dressed and wide-eyed child on her hip. If a woman is 25 and is thinking about freezing her eggs, my number one question will always be “why?”, especially since at the age of 25 she still has a decade of peak fertility years left (disclaimer: data shows that if eggs are obtained from a woman when she is younger, the likelihood of a successful pregnancy with these eggs is greater than if the eggs are obtained when she is older, so I am not devaluing this thought in any way).
It’s also important to know that the process of IVF can be both physically and emotionally strenuous. The medications are mostly safe, but they can be associated with side effects such as hot flushes, headaches and irritability. A very rare side effect known as ovarian hyperstimulation syndrome can be fatal. Emotionally, the uncertainty of whether each cycle will work can cause a great deal of anxiety and stress.
Overall, I would strongly advise women to think about all the steps involved in conceiving using any additional technology. It’s imperative to be sure that we don’t make decisions out of fear of a tomorrow that may never come, but empower ourselves with all the necessary information, to make a decision with a level head.
I’ve been trying for a baby for a while, and nothing is working, what now?
The first question I would ask is, what do you mean by “a while”. Many factors will affect a couple’s chance of getting pregnant, including age, general health, and how often you’re having sex. Statistics show that 84% of couples in the UK get pregnant within a year, if having regular unprotected sex (regularly, meaning every 2-3 days). After two years, that figure rises to 92%, and after 3 years, it rises to 93%. As explained above, women become less fertile with age, so it may take older women longer to get pregnant.
Problems with fertility affect 1 in 7 couples in the UK, this means in these couples, the issue may lie with either the man or the woman. In around 40% of infertile couples, both the man and the woman are affected. Conditions that can contribute to fertility problems include hormonal disorders such as polycystic ovarian syndrome, disorders of the reproductive system such as endometriosis and low sperm count, and modifiable risk factors such as anorexia, obesity, excessive alcohol use and drug use.
If you have been unable to conceive after 1-2 years of regular sex, you should seek advice from your GP in the first instance, who will arrange some investigations. Both parties need to attend, as male infertility accounts for 30% of cases. After initial review with your GP, you may be referred to a specialist service if more input is required. It’s worth saying here that in 25% of couples, no cause will be found.
There are both medical and surgical treatments available for infertility, as well as assisted contraceptive techniques such as IVF and intrauterine insemination. Investigating and treating infertility can be psychologically taxing and anxiety-inducing. Annoyingly, being stressed will also reduce your chances of falling pregnant naturally.
I’d like to emphasise again that as per the statistics above, the vast majority of couples will conceive when they want to, but it can take time. It’s so important not to compare yourself to other couples; it can sometimes look like everyone else gets pregnant quickly, without much effort. The truth is, you may not know what their journey was like, and the challenges they had to overcome themselves. Staying positive and keeping a cool-head will make the whole process beautiful and enjoyable, but if nothing has happened after a year, you should seek medical attention.
What considerations should I be thinking about before the big day?
This is a very broad question, and could cover many aspects. Speaking from my own personal experience, I would definitely say my top piece of advice would be to have sincere, forward-thinking conversations with your partner sooner rather than later. For example, my husband and I decided we wouldn’t want to try for a baby until at least two years after being married. This would give us time to get to know each other properly, as well as work on some meaningful projects. Because we had both agreed and were happy with this decision, it protected us from external pressures from others. I know of some couples who didn’t have this conversation, but had made assumptions about their other half; only to be shocked to hear that the wife wanted a child straight away and the husband wanted to wait, or vice-versa. I would always advocate open dialogue about this topic, which will promote understanding and avoid awkward situations down the line. You may want to talk about how many children you want too, but I know opinions regarding that often change after the first!
Secondly, you could think about asking about your partner’s family’s medical history, and your own too! Genetic disorders such as sickle cell disease, cystic fibrosis and many more are inherited in a predictable fashion, so it would be worth knowing if there is a history of these. Some people argue, actually, that they don’t want to know, as it can add complexity to the relationship and thoughts about the future. This is fine too, but you’ll need to decide together how much you want to know, and to what level you would want to investigate if either of you carry specific genes.
Another thing I must mention is screening for sexually transmitted infections (STIs). Many couples will have a sexual past before deciding to settle down and get married. The extent to which you want to discuss this with your partner is up to you, but each party has a right to know if they are at risk of contracting any STIs. Screening is done very easily these days, and in some boroughs in the UK, you can even test yourself at home. A test kit can be sent to your house, you take samples yourself, and then send them back for analysis. It’s important to get tested because STIs such as chlamydia and gonorrhoea can be completely asymptomatic. Many people also don’t know that undiscovered STIs can cause infertility if left untreated. It’s important to have an open conversation about it, and ensure there are no unwanted hidden surprises. You could decide to get tested together, and the whole thing could even bring you closer together.