Sexual Health and Fertility Update: 7 Surprising Facts

A Q&A with Dr. Sana Salih, oncofertility program director at Generations Fertility Care

Q: We hear more often about age affecting fertility now that the average age a woman has her first child is 25.2, according to the Centers for Disease Control. How does this work?
A: When a woman is younger, it’s easier for her to get pregnant for many reasons. A woman is born with all of the eggs she’ll ever have. The older a woman is, the less eggs she’ll have. As a woman gets older, her eggs get older—it’s about quality. Those eggs have been there for longer. Older women can also have eggs with more of  a chance of chromosomal abnormalities because the eggs in the ovary have been in a state of cell division for all of those years—there’s more of a chance for abnormalities.  

With age there’s an increased risk of gynecological problems—endometriosis, fibroids and tubal obstruction due to exposure to infections and inflammation.
 
Q: You said egg quantity is an issue. What about women that have been on birth control for a number of years—won’t they have more eggs since birth control stops ovulation?
A: Whether women use medication to stop ovulation or not, they’re still going to lose the same amount of eggs. The egg goes through a process of programmed cell death. Every month, there’s a certain amount of eggs that will grow—about 1,000. Only one makes it to ovulation. This is why even if a woman doesn’t ovulate that month, they will still experience decreased ovulation reserve in their late thirties and they will still go through menopause at the same time.

Q: What are things that younger women and men can do to “preserve” and/or boost their fertility?
A:
The first thing people should do is educate themselves. They need to think about [if they want kids when they’re younger].
Patients should seek out a healthier lifestyle, which includes not smoking—it’s detrimental to the ovarian reserve. Avoid excessive
caffeine. Studies show moderate to heavy alcohol intake can decrease fertility. Heavy alcohol use is more than 14 drinks per week; moderate use is 3–13 drinks per week. I always advise women that anything more than 3 drinks per week can decrease fertility.

For young people it’s more important to go for pre-conception counseling with their physician, because simple advice can help. I see a lot of patients who use water-based lubricants, which can be toxic to sperm. Oil-based lubricants are better.

Q: How does Generations work alternative health care practices into a patient’s regime?   
A:
Some patients report using alternative therapy methods like yoga, herbs and acupuncture. One thing I would not recommend is herbs, because you don’t know if they have hormones in them or not.

It’s still controversial if acupuncture before or after IVF embryo transfer improves the pregnancy rate. One study showed that it did improve success rates. However, another randomized, controlled study after that one did not show that. So, I think that we’re not quite sure. If someone is really stressed and they need to decrease stress, acupuncture does help, as does yoga.

Q: How have fertility treatments improved, and what’s next?  
A:
We’ve come a long way. Most of the treatments we do now are enhancing natural conception. As an example, for in vitro fertilization we are doing single embryo transfer for couples that are under 35 that have good quality embryos.  

I think these days IVF is simpler, more affordable and much more successful. Some of the treatments [in the past] were expensive and had more chance of twins and multiples.  

There are improved levels of investigation and testing—now there are a lot of things you can find out yourself. Women can time their fertility better with ovulation predictor kits, or take an ovarian reserve test, because not everyone wants to go to a fertility specialist. Sperm check fertility kits will be available soon at the convenience store. [Previously] for most of those kits you had to visit a doctor.

Moving forward one of the big areas will be in extending fertility. Many more successes have been made out of egg freezing. We’re not there yet, [currently egg preservation is] mostly offered to people who are undergoing chemotherapy or radiation, which can affect fertility. But this could delay the biological clock for women because they could preserve their eggs at a younger age and have kids when they’re older. We’re not there yet, but hopefully soon.

Shayna Miller is multimedia and style editor of Madison Magazine.

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