Dear Alice,

I've heard so many horror stories of women who wait until their mid-thirties or later to have children, then find out that they are infertile. I'm 25 years old now and nowhere near getting married or having babies, yet I don't want this to happen to me when I'm ready. What can I do now to protect my fertility and make sure I am able to conceive when the time is right? It's causing me a lot of anxiety!!

Dear Reader,

Many factors influence a woman's fertility. Guaranteeing the ability to conceive when the time is right, however, is not one of them. Recognizing what factors you have control over, and what options you have when you cannot control the outcome, may help to decrease anxiety surrounding infertility

Infertility is defined as the inability to become pregnant, despite trying for one year (in women under the age of 35 years) or six months (in women 35 years and older). One primary reason for infertility is age. Women today are waiting longer to conceive. More women are in the workforce, marry at an older age, have easier access to birth control with more options to choose from, are working toward financial security, and/or are getting divorced — all of these factors contribute to delayed childbirth. While some women in their thirties and forties have no trouble getting pregnant, it's a biological fact that fertility decreases with age. Women are born with a certain number of eggs, and since no new eggs are formed throughout a woman's lifetime, the number of eggs, and quality of mature eggs, declines each year. Every woman's body ages differently, and there is really no way of knowing what a particular woman's fertility will be like in five or 10 years.

While you can't reverse the aging process, and you have little say in your biological makeup, you can follow some healthy lifestyle tips that may help preserve your fertility:

Visit your health care provider.
To start, schedule an appointment with your women's health care provider to see if you can learn more about your current fertility status. It's important to visit an ob-gyn or women's health nurse practitioner once a year. Your concern about infertility is something you can discuss with her or him. During your appointment, you can report any changes in your body that you might have noticed. Sometimes couples have fertility problems because of other related health problems. Conditions or diseases that affect hormone levels, such as polycystic ovarian syndrome (PCOS), can elevate risks for infertility. Increasing awareness surrounding your health status can help protect your fertility.

Maintain a healthy body weight.
Infertility cases sometimes are caused by a woman weighing too little or too much for her height and build. Being obese or overweight increases the amount of the sex hormone, estrogen, which is produced by the body's fat cells. Estrogen plays a key role in fertility. If a woman has too much body fat, her body will overproduce estrogen. This triggers her body to act as if it's on birth control, thereby limiting her chances for conception. Also, obesity causes elevated insulin levels in women, which may cause the ovaries to stop releasing eggs. Conversely, a woman with too little body fat will not produce enough estrogen, thus causing her reproductive cycle to slow or shut down. In more serious cases, a woman's ovaries may not produce any mature or viable eggs at all.

Avoid excessive exercise.
Excessive exercise can cause irregular menstrual cycles, or in more serious situations, amenorrhea (loss of menstruation). Changes in a woman's menstrual cycle can affect her fertility (i.e., you are no longer getting regular periods, or you are not getting periods at all). For instance, competitive athletes who have irregular cycles may need to change their exercise routine to increase chances of getting pregnant. If excessive exercise is a contributing factor, you can modify your workout regimen.

Stop smoking.
Studies indicate that smoking increases the risk of infertility in both women and men. Smoking is harmful to a woman's ovaries — how harmful depends upon the amount and duration of smoking. Smoking interferes with the production of estrogen, and can increase egg depletion. Smoking also can cause a woman's eggs to be more vulnerable to genetic abnormalities. If you are a smoker, stopping now can go a long way toward improving your health.

Have safer sex.
STIs are a leading cause of infertility because symptoms often are difficult to detect (no symptom at all is the most common symptom of an STI) and therefore are left untreated. In that case, STIs can infect the upper genital tract, creating scar tissue that damages the fallopian tubes. Use condoms, if you are not already, to prevent transmission of an STI if you don't know your partner's STI status, and get check-ups if you think you are at risk for or have symptoms of an STI.

When you are ready to become pregnant, a few things could happen. First, you could become pregnant right away. Or, you could become pregnant within the first year, which is the national average — the time it takes most couples to conceive. Or, it could take you a while longer. You can get checked by a health care provider if you are not conceiving to find out whether or not there is a fertility problem with you or your partner. Some problems are fixable, while others are not.

More importantly, think about what you are really worried about. Is it having a child to love and bond with that's important to you? Being fertile? Or having control over big life changes? If you are worried about having a child, there are many ways to find a child to love, and perhaps that is the issue, rather than your fertility. Realizing what in fact is your priority may help rest your mind.


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