Female newborns are born with all the eggs they will ever have, about 1.5 million. There is no constant production of eggs in the ovaries like the constant production of sperm in males. Each month during your menstrual cycle, a group of eggs is selected, but only one egg is chosen to mature and ovulate. The rest are discarded. Unfortunately, there is no way to recycle the unused eggs from that group.
The older you are, the longer this process has been going on and, therefore, fewer eggs remain in the ovaries. The drop off in the quantity of eggs from birth through your thirties and into menopause is quite drastic and, according to the American College of Obstetrics and Gynecology, by age 50, only an average of 1,000 eggs remain.
These inner workings of our biological clocks are the reason fertility planning is essential, especially as it becomes more common to delay motherhood into the thirties.
Many women today begin to think and plan for their fertility in their thirties. According to the US Census Bureau, the median age for first time mothers in the US reached 30 as of 2019. When planning fertility, one of the main determinants of success is age. As you age, both the quantity and quality of the eggs in your ovaries decline. Because of this decline, it becomes more difficult to get pregnant and the chance of a miscarriage becomes greater. One of the best ways to plan for your fertility goals is to proactively get your fertility assessed. Having that assessment can let you know where you stand and what timeline and treatment (if any) will suit your body best.
Many people don’t think to look into their fertility until they’re having trouble getting pregnant, but the best time to have a doctor look into your fertility is before you’re even trying to conceive. There are simple blood tests and ultrasounds that can tell you a lot about where you lie on the fertility spectrum. This information can help you know what the best next steps are for you and when you need to think about getting pregnant or preserving your fertility.
Some tests that may help shed light on your current fertility:
Anti-Mullerian Hormone (AMH) - AMH is a hormone released from the cells surrounding each immature egg in the ovaries. If your AMH is high, you can presume that you have a lot of eggs remaining in your ovaries. If your AMH is low, the opposite assumption can be made. AMH levels naturally decrease with age, so the normal range shifts accordingly.
Antral Follicle Count (AFC) - An AFC is done using a Transvaginal Ultrasound to examine your ovaries. Within the ovaries, the doctor will be able to count the group of eggs that were selected this month. This number is known as the AFC or antral follicle count. The AFC is another predictor of how many eggs are remaining in the ovaries and can help to predict your fertility status.
Follicle Stimulating Hormone (FSH) - FSH is a hormone produced by the pituitary gland in the brain. The presence of this hormone stimulates the ovaries to grow an egg to maturity in preparation for ovulation. If the FSH level is elevated, this means that the body is needing to put in extra effort (more FSH) to get the ovary to respond, which can indicate a low Ovarian Reserve.
If you would like to read more about eggs and AFC, check out this article.
A fertility specialist will very likely order these tests as part of an assessment of your ovarian reserve. Your OB/GYN can probably order these tests as well, but you might have to ask for them specifically.
The information gained from a fertility assessment can let you know if you need to expedite your family planning goals or if you have more time. If starting a family right now isn’t in your plans, there are options for you, too!
Being in your thirties, you may decide it’s time to make some decisions about your fertility. There are a few things to consider:
Do you want children now or in the future?
Are you interested in egg freezing?
What is your timeline for either scenario?
The first step in fertility planning is determining when and if you want children. If the answer is yes, you can use your fertility testing results to help you determine if you should start right away or if you can delay for a while.
Regardless of age, it can take some time to get pregnant. The amount of time can change depending on your exact age and fertility status. After the age of 35, fertility rates decline and the risk of miscarriage increases. Because of this, the recommendations for seeking help from a doctor changes at the age of 35.
When should I seek help from a fertility specialist?
Age 34 or younger:
Try to conceive for 1 year before seeking help from a fertility specialist
Ages 35 to 39:
Try to conceive for 6 months before seeking help from a fertility specialist
Age 40 and older:
Seek help from a fertility specialist when you start trying to conceive
When trying to conceive in your thirties, it’s especially important to maintain your physical health. Taking care of your body by eating healthy and exercising will help create the best environment for a growing baby. Both increasing maternal age and BMI play a big role in the development of certain conditions during pregnancy, like gestational diabetes and preeclampsia (severely high blood pressure in pregnancy). These conditions cause health risks for both the mother and baby.
BMI stands for body mass index. It’s calculated using height and weight. The healthy range for BMI is 18.5-24.9
Adopting simple lifestyle habits like a balanced diet and exercise before you try to conceive can help keep you healthy and lower your risk for complications during pregnancy.
If you think you want to have children, but maybe not right now, egg freezing is a great way to preserve your fertility. Freezing your eggs doesn’t guarantee a baby in the future, but it does provide an opportunity. The frozen eggs’ quality remains the same as the day they were retrieved. This allows you to use 30-year-old eggs when you are 40, for example.
Check out Egg Freezing 101: The Basics of Fertility Preservation to learn more.
Members of the LGBTQ community may have additional considerations when making a plan to either preserve their fertility or to start a family in their thirties.
Same sex female couples and anyone who was assigned female at birth have to consider if they want to start a family now or in the future. If the plan is to start a family now, the next step is to determine a sperm source. The most common option is anonymous donor sperm, which can be selected from a Cryobank. In order to conceive a pregnancy, the options are either IUI (Intrauterine Insemination) or IVF (In Vitro Fertilization).
Embryos created through IVF can be used right away to try to get pregnant as soon as possible or they can be frozen and used in the future when you are ready to start a family.
Same sex female couples and anyone who was assigned female at birth also have the option to freeze their eggs to preserve their fertility and to allow for the possibility of having children in the future. The best time to freeze your eggs is before the age of 35, which makes it extra vital to make a plan for your fertility as you reach your thirties.
Male same sex couples or anyone who was assigned male at birth have other options to consider when planning their fertility. The main things to consider if you want to start a family are egg source and gestational carrier. The most common route is to choose an egg donor through a donor agency and a gestational carrier through a gestational carrier agency. Then the donor will go through ovarian stimulation to create embryos with the sperm of one or both partners and the resulting embryo can be transferred into the uterus of a gestational carrier to carry the pregnancy.
Sperm is constantly being produced, so there isn’t a push to freeze sperm to preserve fertility. For males, age does make a difference, but the drop off in fertility doesn’t seem to be as significant. There are currently many studies being conducted to determine just how much age affects male fertility and sperm quality.
If you would like to learn more about fertility options for members of the LGBTQ community check out our article HERE.
Many people wait until their thirties to begin thinking about and planning for their fertility. Knowing about your body and the resources available to you can help you make educated decisions throughout your fertility journey.
Bureau, US Census. 2022. “Stable Fertility Rates 1990-2019 Mask Distinct Variations by Age.” Census.gov. April 6, 2022.
“Female Age-Related Fertility Decline.” 2014. Acog.org. 2014.