A Simple Guide to Getting Proactive About Your Fertility

Last week, as part of The Well virtual event series, we heard from Dr. Jenn Conti, MD, MS, MSc and the team from Modern Fertility about the proactive steps one can take when it comes to fertility—even before actively trying to conceive. Here, in a guest post for Blood & Milk, Dr. Conti recaps last week’s presentation.

Fertility is more complicated than sex ed might have led you to believe. There are a lot of factors (from the biological to the modifiable) that can affect your fertility hormones and reproductive health. As an OB-GYN, many patients ask me what they can do today to prepare for pregnancy in the future — and while there’s a lot we can’t control when it comes to fertility, there are a few actionable things you can do to prepare yourself for kids. 

Here’s a quick rundown of my favorite ways to get proactive about your fertility — whether you’re ready to start trying for kids, a few years out from being ready, or still not sure about what your future holds. 

Get acquainted with some of the biological realities around fertility

Fertility naturally declines for everyone over time, but the rate at which that happens is totally unique to the individual. As we get older, our ovaries slow production of fertility hormones and the number and quality of eggs we have goes down. By menopause, our cycles come to a complete stop. One example in how this plays out: time-to-pregnancy. While about 45% of women 25 or younger may conceive after one cycle, this stat is closer to 20% for women over 35.

There are also many health conditions that impact fertility, including polycystic ovary syndrome (PCOS), thyroid disorders, uterine fibroids, fallopian tube damage, endometriosis, primary ovarian insufficiency (POI),), and sexually transmitted infections (STIs). These can all affect the hormones regulating your cycle and your chances of conception. 

Ask your family about their medical history

Genetics plays a role in your reproductive health — if any relatives started menopause early, had trouble getting pregnant, or were diagnosed with conditions like PCOS or endometriosis, it’s possible you might experience the same issues down the line. So, talk to the women in your family and find out if they’ve had any health conditions or difficulties with pregnancy, and when they reached menopause.  

If you’re planning on conceiving with a partner, it’s important to check in on their health in addition to your own. If your partner has sperm, they can also take tests to check in with their fertility (male factor infertility accounts for 40-50% of couples’ difficulty conceiving). If your partner has ovaries and is the one planning to carry a child or use their eggs for assisted reproductive technology (ART) procedures, pass along this info so they can get proactive about their fertility, too.

Test for sexually transmitted infections (STIs)

STIs are very common — and many people can have them without realizing. But when chlamydia and gonorrhea go untreated, they can lead to pelvic inflammatory disease (PID), which is an infection of the uterus, fallopian tubes, ovaries, and cervix; and sometimes even infertility. If you have a partner you’re planning to conceive with, it’s important to make sure they’re also getting tested.

Get ahead of decisions around birth control

The contraceptive method you use might affect how long it takes for your cycles to regulate — and, as a result, how long it takes for you to get pregnant — after stopping. With most types of birth control, the return to ovulation will occur within a few months. But because each type of birth control is different, let’s break down how each one uniquely impacts fertility: 

Intrauterine device (IUD): One 2015 study of 69 former IUD users (50 copper and 19 hormonal) and 42 former non-IUD users found that there was no difference in the time to pregnancy in IUD users as compared to non-IUD users.

Oral contraceptives (aka the pill): According to a 2013 study, the use of birth control pills as the last contraception method before attempting to conceive was associated with a short-term delay in return of fertility, when compared to condoms. In another study, 20% of participants got pregnant in their first cycle after stopping the pill, and 80% got pregnant in a year. And in case you were wondering: No, you don’t need to do a birth control cleanse.

Vaginal ring (like the NuvaRing): There isn’t a lot of research looking into the vaginal ring’s influence on fertility, but one study did find that most women will begin ovulating immediately after stopping use. In my experience, the ring is pretty similar to the pill in terms of how long it takes for your cycle to regulate after stopping use — expect a few months before things are totally back to normal, but also remember that missing even one pill or ring insertion could also lead to pregnancy when you aren’t yet trying to conceive, so there is no one-size-fits-all answer.

Implant (like Nexplanon): Researchers in India observed the return of fertility for 74 former Implanon users, which is the original iteration of Nexplanon. 40% of the women who had the implant removed (and discontinued birth control in general) had ovulation return within one month. 29.16% conceived within three months, 62.50% within six months, 66.66% within nine months, and 95.8% within 12 months.

Shot or injection (Depo-Provera): A widely cited study notes that while fertility returns about 10 months after you stop taking Depo-Provera, ovulation can be delayed for up to 22 months — making conception more difficult. Remember though that you can also get pregnant after missing your shot by even a week.

Make any adjustments to daily habits that impact conception

There are certain factors we know that can make conception more difficult in the future. Making adjustments to these daily habits now can help improve your chances later: 

Address your smoking habits: If you smoke, quitting can improve your health (reproductive and overall) within weeks or months. Smoking also has huge negative impacts in pregnancy.

Use glass instead of plastic: Plastics can contain endocrine-disrupting chemicals (like BPA) that affect fertility, so consider switching to a glass or stainless-steel water bottle and avoid storing or microwaving food in plastic containers. 

Take prenatal vitamins: Start taking prenatal vitamins (with 400mg of folic acid) up to a year before getting pregnant to reduce early miscarriage rates and prevent neural tube (brain and spine) defects at birth.

Understand the link between weight and fertility: If you have a lower body-fat percentage, that can lead to period loss and difficulty getting pregnant — but, most of the time, gaining weight will restore menstrual function. If you have a higher body-fat percentage, a weight decrease of 5-10% has been shown to improve ovulation and increase fertility.

Keep up with your movement routine, but don’t overdo it: Exercise is important to staying healthy when you’re trying to conceive, but too much exercise can impact your menstrual cycle and your chances of getting pregnant. If you’re not getting a period or having trouble getting pregnant, make sure to discuss your exercise routine with your OB-GYN.

Check in on your hormones

Hormones are the chemical messengers responsible for regulating the body’s functions. There are a few key hormones that play the role of “fertility detectives” in your body — for example, anti-Mullerian hormone (AMH) is the best predictor of ovarian reserve (aka how many eggs you have), but it’s used as a proxy for this answer and has some important caveats to consider

Looking into your fertility hormone levels can give you important insight into your ovarian reserve, potential onset of menopause, thyroid function, health conditions like PCOS, and possible outcomes for egg freezing or in-vitro fertilization (IVF). Fertility hormone tests like Modern Fertility make this easy with an at-home finger-prick test that measures all of the hormones most important to reproductive health.

Get familiar with your cycle and ovulation pattern

If you’re not already tracking your period or ovulation, it’s a good idea to start getting familiar with your body’s cycle patterns. Ovulation predictor kits (OPKs) can help you anticipate ovulation and find your two most fertile days by measuring surges in your luteinizing hormone (LH) level. There are a few other ways to track your cycle (like cervical mucus monitoring or simple cycle counting-based methods), but they’re less precise than OPKs

Here’s the bottom line

If you’re at all considering having kids in the future, there’s no downside to getting proactive about your fertility — all of these tips are beneficial for your overall and reproductive health whether or not you end up trying to get pregnant. 

Another thing to keep in mind is that your reproductive health is more than just your fertility. Irregularities with your cycle can affect other areas of your health — and reproductive conditions and untreated STIs can make sex painful. That’s why I truly believe that staying on top of your reproductive health is important for all people with ovaries, whatever your plans for kids might be.

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