Fertility: A Downhill Slide

So hopefully, the last post on fertility vs infertility helped to explain why it appears some people can't seem to stop procreating, while others can't start… it's all a long continuum from fertile to infertile. One thing that's kind of HUGE that I didn't touch on (the post was already lengthy) is the relationship age has on the spectrum. It's kind of a sensitive topic for me… I think you'll see why.

By the definition of infertility, all women are headed that direction. If the definition is simply the inability to become pregnant with unprotected sex within a year, I bet you can guess which part of the population is 100% infertile. Yep, menopausal women. And unless you've found a way to ward off the dreaded change in your body, you're headed towards "infertility" too. Let's look at a chart for all the visual learners out there:

Find your age: The black line is the likelihood you'll conceive in a year,
the green line is the rate of infertility. I was SUPER lucky to fall into that 5%.

Here's the thing I really hate about charts like this and the label "infertile": There is a really distinct difference between me, 28 and unable to conceive after 32 cycles and countless medical procedures and my mom, 57 (sorry mom) who is well past menopause. We're both unable to conceive, but I have no real explanation, while she, she's simply too old. I personally feel like there should be a difference in the diagnosis or terminology or something. Many of my friends and I, who were diagnosed with infertility at the height of our fertile years, we are different from other women who are diagnosed with infertility because they are a few years if not mere months away from menopause. It may suck for both parties, but we are different. One group has an abnormal and unnatural occurrence within the body, the other has a body behaving exactly as it should. To call me and a 50 year old woman the same thing in terms of ability to procreate is just kind of dumb.

But how does age relate to the fertility spectrum? Well, unfortunately, no matter who you are, it's pretty much just like the title says: a downhill slide. Most girls start their period in their teenage years, 12 is currently the average in America, but somewhere between 10 and 15 is normal. For a few short years, a girl's body is regulating, meaning most girls don't start off with regular, monthly cycles. And even when they do have a cycle, they don't always ovulate… the system is kind of working out some kinks. The problem of course in terms of teen pregnancy is that when teenagers do ovulate, most of them, will have excellent eggs. Egg quality really doesn't get much better, to the detriment of many an American teenager. But that's a different topic all together. A woman reaches peak fertility about 20… the eggs are stellar (normally) and the body is in rhythm (most of the time). That peak fertility window only lasts a few years. In fact by 24, the downhill slide has already begun. I know, believe me, I feel your pain. The good news is that initially it's a slow decent; unfortunately it picks up speed later.

Now many of you are probably thinking, "but I know someone who got pregnant at 42, 45, 47" or whatever and she never did IVF. Well first of all, don't be so sure. A lot of women may choose not to share their personal journey towards a child quite so outspokenly as I have. Hollywood is RAMPANT with women utilizing Assisted Reproductive Technology in secret in their later years. But you're also right. You probably do know someone who had a child in her forties without ART. That's because even at 45 our handy chart says there's a 5% chance of conception. Basically, out of 100 45 year old women, 5 will become pregnant within a year. So yes, it does happen. It's just a lot less likely to happen than at 25 or 35.

"What about Sarah from the Bible?" some of you may wonder. She was 90! If she had a baby at 90, it must be possible at 40, 50, 60 and so on. You're right, Sarah was old. In fact, Sarah was so old that when she heard she would have a child, she laughed. (I have quite a few ideas about that laughter, but that's for a different post). Sarah's story is in the Bible in detail because it was a MIRACLE. If pregnancy late in life was the norm, Sarah would most likely have received one simple line: "And Sarah, Abraham's wife, gave birth to a son."… the end. Could it happen again? I think so, absolutely… and it would still be a miracle because it's not only unlikely, it's impossible without divine intervention.

Okay, so back to the average, regular, mostly fertile woman. At 24 the downhill slide begins, but it's not something she's going to notice. She'll simply slowly start to have fewer eggs available while at the same time the eggs that are available become lesser quality. This degenerative process by which eggs are lost regardless of ovulation, pregnancy, or even birth control is called atresia. What does this mean for the average woman's chances at conception? Well on a macro scale, the above chart tells us that a woman my age should have around a 78% chance of conception within a year. But on a micro scale, the average, normal, fertile woman has about a 22% chance of conception.

Find your age: The percentage is your chance of conception per month
(if you're normal).You'll note the decline picks up dramatically later.

Now you understand why, despite fearing that you'll be just like me, it's unwise and unnecessary to run for the doctor if you aren't pregnant in three months. Out of one hundred 28 year old women, 22 will be pregnant at the end of the first month… they are either Wonder Fertile Woman, or they shacked up with Super Sperm Man, or everything was just darn perfect. But the other side of that statistic tells us that at the end of the first month, 72 of the 100 women will not be pregnant… so if you're not, you're in good company, and not necessarily (or even likely) in company with me. Breathe easy. One thing to note is the chart is again the AVERAGE, but most importantly it's the average for a normal, functioning woman meaning that women like me are not skewing the numbers. You may certainly find that your chances are higher than this... you might be 28 and have a 27% chance of conception each month. Likewise, you might be 28 and have a 20% chance each month... both are normal functioning women.

So what does all of this tell us? Well, for the average fertile person, unless you are ready to have children at 22, you're likely going to miss your most fertile window. And unless you are akin to Michelle Duggar, you are unlikely to have multiple babies in your forties. But the good news is that there are quite a number of relatively fertile years in there. I certainly wish I could wave a magic wand and increase fertility and extend it a few years, but as I cannot, either for myself or for you, it's wise to know what you're up against and what the future most likely holds. As you age, no matter who you are, you will move further down the fertility spectrum. Someone may be at the far, far left end of out spectrum in her twenties, but in her late thirties she will most certainly be less fertile. She will require more time and/or more resources to become pregnant. She might find herself somewhere in the middle of our spectrum... requiring LOTS of sex and maybe even a few pills. Someone who was more average in her twenties, maybe requiring 6-9 months to achieve pregnancy, will most likely require even more time and/or resources in her late thirties.... both can still get pregnant, but both have been affected by age as well.

Unfortunately, age is not the only factor in infertility, but it is certainly a factor. Every woman is headed towards the inability to procreate, some of us just arrive there ahead of time. Some women have diagnoses for things such as Diminished Ovarian Reserve or Premature Ovarian Failure. DOR is a natural occurrence… we're all headed there. But it becomes a major problem when you receive that diagnosis at 25 or 30 rather than 45. POF is the loss of ovarian function before 40, and unfortunately it can occur as early as fertility begins as some conditions are present at birth. In both of these instances, when the diagnosis comes during your fertile years, it means that the "normal" no longer applies. Your body may be 25, but your ovaries are behaving like they're 45. Therefore, you essentially have the same chance at conception as a 45 year old.

For myself, my infertility appears to be unrelated to my age, either my actual age or the age my ovaries think they are. There's no way to know, but I may have been equally infertile at 16 and 20 as I am now. My doctor says that if egg quality is my issue, there were really no indicators. For most women with egg quality issues, there are red flags such as hormone levels. Typically egg quality is in direct correlation with egg quantity. If you google egg quality, you will find that just about every article discusses the direct link between egg quality, quantity,  and age. Anytime you find an article addressing poor egg quality and young women, you'll read about indicators like high FSH or low AMH leading to a diagnosis of one of the above conditions, DOR or POF. I have neither of these. I am a one of the rare women who appears to have ample eggs, but a higher than normal proportion of poor quality eggs. Remember the chart with the red and green dots, well it appears I have a lot more red than green. So even when we do IVF, the odds of us scooping up 5 green eggs are low. We do not, at this point, know why. As to whether my infertility will worsen at a faster rate than a normal 28 year old, we don't really know. But as I've been given worse odds than the average "normal" 45 year old for conception on my own, I don't really think it matters.

So what's the point of all of this? As I stated before, I'd like to assure my friends who are just starting out and afraid of what it means when one cycle fails, that things are most likely incredibly normal and your baby is on the way. I hate to think that my own story will become a terrifying drama played out in the bedroom of my friends… sort of. I say sort of because, while I don't want to scare anyone, honestly, if my story causes you to kick the birth control to the curb 6 months or a year before you're both "ready," I won't feel bad. Yes, the odds are that you'll get pregnant 3-6 months before the opportune time, but really is there ever a perfect time? And if by chance you're one of the ones who finds yourself not pregnant within the first six months, and you're starting to wonder and worry, well when that pregnancy test shows positive at the the eleventh month, you'll thank me for getting you started sooner. You're welcome.