This article was last updated on May 27, 2021.
At Modern Fertility, we advocate for accessible education about female fertility — whether or not you’re currently trying to get pregnant. That's because when you educate yourself about your own fertility, you can more closely monitor your general health, get more info about your reproductive window, and adjust your plans to help you conceive in the future (if that’s something you want to do).
What exactly are we talking about when we say "female fertility"? It's the ability of a person with ovaries to conceive and give birth to a healthy baby. And OB-GYN and Modern Fertility medical advisor Dr. Jenn Conti, MD, MS, MSc says that lots of patients in their 20s and 30s tell her they wish that they'd talked with a doctor about it earlier.
"Creating the space early to consider things like if and when you want kids, how many you want, and your ideal spacing between kids helps me guide my patients through how to plan and prepare — how to get into that proactive mindset," explains Dr. Conti. "Fertility is something you can have agency over, whether you're years or months away from having kids. The key is planning ahead, having early conversations, and doing what's in your control to prepare for the future you want."
So, if you’re ready to get into that proactive mindset, here are five steps you can take.
1. Check in on those hormones.
Your hormones are fertility detectives, so if you're thinking about having kids in the future, getting acquainted with what they're up to now gives you a leg up on the process. The Modern Fertility Hormone Test is a simple blood test that will tell you your reproductive hormone levels, empowering you with the info you need to have conversations with your doctor and make the best decisions for your fertility journey. In fact, we test the same hormones doctors do when assessing fertility in people who've been trying to conceive for 6-12 months (six for those over 35 and 12 for those under) but haven't gotten pregnant.
Depending on your hormonal birth control, the fertility hormones you can check with Modern Fertility include:
- Anti-Mullerian hormone (AMH): This reproductive hormone is a proxy for your ovarian reserve, signifying how many eggs you have.
- Thyroid-stimulating hormone (TSH) (and sometimes free thyroxine or fT4): TSH is produced by the pituitary gland in the brain to signal to the thyroid gland to produce fT4. Both hormones are involved in thyroid health and function.
- Estrogen: There are three types of estrogen, but we’re talking about estradiol, also known as E2. Estrogen is a “female” sex hormone responsible for the development and maintenance of sex characteristics (breast growth, menstruation, pregnancy, etc.). E2, which is produced by your ovaries. As we get closer to ovulation (which is the only time it’s physically possible to get pregnant), estradiol levels increase.
- Follicle-stimulating hormone (FSH): Also produced by the pituitary gland, FSH helps your ovaries grow your ovarian follicles (the fluid-filled sacs that house and release eggs) into mature eggs that can be ovulated and fertilized by sperm.
- Luteinizing hormone (LH): Produced by the pituitary gland, luteinizing hormone (LH) preps the body for possible pregnancy and surges 24-48 hours before ovulation to let your maturing ovary follicle know it can release an egg. (Measuring LH levels with ovulation tests, like ours, allows you to predict ovulation and your most fertile days.)
- Prolactin: This hormone facilitates milk production during breastfeeding/chestfeeding and suppresses ovulation after birth.
Testing these hormones (and retesting them over time) can help you and your healthcare provider get a clearer picture of your ovarian reserve, the regularity of your ovulation, how your thyroid is functioning, any potential fertility problems, and other aspects of your reproductive health so you can move forward with as much information as possible.
When to test your hormones
We recommend testing your fertility hormones before you start trying to conceive and retesting them once a year — so you can get a baseline on your fertility today and start mapping out trends in how your hormone levels are changing over time. If you test your fertility hormones with Modern Fertility, you'll get personalized recs on when exactly to test again.
There are two situations where we might recommend testing more or less frequently than once a year:
- If you’re under age 35, have a normal AMH level, or your AMH level is staying pretty constant, we’ll typically recommend waiting at least a year (or more) before testing again. Testing less frequently helps you capture trends over time, rather than get caught up in expected fluctuations.
- If your AMH is changing rapidly, you have a lower AMH level, or you're over age 35, we’ll typically recommend testing more than once a year. Testing more frequently helps you stay on top of rapid changes in AMH (and potentially your fertility) and discuss your timeline with your partner or your doctor.
Doctors also do ovarian reserve testing (usually AMH and FSH) before egg freezing or in vitro fertilization (IVF) to estimate outcomes, so if that's something you're interested in doing down the line, you can get that info early with Modern Fertility.
2. Take prenatal vitamins.
Taking prenatal vitamins is virtually the simplest thing you can do to start planning ahead for your fertility. Doctors recommend prenatals with 400 mcg of folate (aka methylfolate, folic acid) before conception. How long before? At least one month (the clinical rec) to give your body enough time to build up its levels of key nutrients prior to pregnancy. Daily prenatals with folate (the Modern Fertility Prenatal Multivitamin has the easy-to-absorb methylfolate) help you support fetal neural tube (brain and spine) development and fill nutritional gaps in what you're getting from food.*
3. Keep an eye on your lifestyle choices.
- Alcohol: Many studies show that having 1-2 drinks a day won’t adversely affect your chances of conceiving, while some show that this level of moderate drinking can be harmful. It's ultimately up to you to decide what feels the most comfortable: avoiding alcohol entirely or drinking more moderately.
- Marijuana: Unfortunately, we don't fully know the impact of marijuana on fertility. But given what the medical community does know, for the time being, choosing not to smoke weed if you're trying to get pregnant is the safest approach to avoid possible health effects on conception and the fetus down the line. Experts also recommend always talking to your healthcare provider about the potential impact of your cannabis use.
- Diet: There’s no such thing as “hacking” your fertility with food — especially not with overly restrictive, extreme diets. That said, in terms of overall health, balanced eating (think mostly Mediterranean style) is recommended.
- Caffeine: Research shows that high levels of caffeine consumption (>5 cups a day) can decrease fertility. A more moderate 1-2 cups a day, on the other hand, doesn’t adversely affect fertility. If you’re a heavy caffeine drinker, your doctor might recommend cutting back while trying to conceive.
- Tobacco and nicotine: Smoking cigarettes has a severe impact on your fertility. The chemicals in nicotine speed up the loss of eggs (which naturally die off as you get older) and also damage sperm. Smoking can also negatively impact how you respond to IVF, and can result in ectopic pregnancy (when the pregnancy grows in the fallopian tubes), preterm labor, and birth defects. That said, once you quit smoking cigarettes, your health (reproductive and in general) can improve fairly quickly — so, the sooner you quit, the better.
- Exercise: Moderate exercise (30 minutes, five days a week) is recommended for most people with ovaries before they’re trying to conceive, and one study even suggests that some ovulatory infertility may be manageable through nutrition and exercise choices. Moreover, people with PCOS and irregular menstrual cycles may especially see benefits from exercise.
3. Learn about your genetics and your medical history
How much do you know about your known family's medical history? There are specific questions you can ask your family as well as yourself to get the background info you need:
- When did the people in your known family go through menopause? Finding this out can give you a good estimation of when you might enter menopause.
- Did your birthing parent have any issues with getting or staying pregnant? If they experienced recurrent miscarriages or had difficulty conceiving, it’s worth finding out if they dealt with out-of-range hormone levels or specific reproductive health conditions.
- Do you have a family history of thyroid conditions? What about polycystic ovary syndrome (PCOS) or premature ovarian insufficiency (POI)? (You can also get that info about your own likelihood for these conditions with the Modern Fertility Hormone Test.)
Finding out everything you can about your known family's health can help you predict fertility issues you might be at higher risk for in the future. That way, you can speak with your healthcare provider and take action on a timeline or path to parenthood that aligns with your family goals.
Personal health factors to keep tabs on
- Check your STI status: It's important to get tested for sexually transmitted infections (STIs) before you try to conceive, and for your partner as well. Untreated STIs, including chlamydia and gonorrhea, can cause pelvic inflammatory disorder (PID), which can result in infertility or require ART. If you do test positive for an STI, you can work with your doctor to come up with a treatment plan before you start trying to get pregnant.
- Get up to date on vaccines: While you’re at the doctor’s, don’t forget to check in on any vaccines you're due for so you’re protected from infections when you’re pregnant. There are some vaccines you definitely can’t get while pregnant, like varicella and MMR. One vaccine that’s totally safe to get while pregnant? The flu vaccine. The recommendation is to get vaccinated every year, whether you’re pregnant or not. This is also an excellent time to get the COVID-19 vaccine if you haven’t already, which experts say has no negative impact on your fertility.
4. Talk to your doctor.
Your Modern Fertility Hormone Test results can be a starting point for conversations with your doctor about your plans for kids. If your known family history or personal health could potentially present issues with getting pregnant, you can work with your doctor to determine the best next steps. Do they recommend sticking with your original timeline for having kids or acting sooner rather than later? Do they recommend egg freezing? What about assisted reproductive technologies like IVF or intrauterine insemination IUI?
It can be helpful to write down your questions before you go into your visit so you can spend more time listening and talking to your doctor — and less time trying to remember if you asked about everything you intended to.
Potential causes of infertility
The following are some of the more common causes of female infertility (some of which involve out-of-range hormone levels) and male infertility. If you have reason to believe any of these conditions could be impacting your future fertility, you can always bring them up with your doctor:
- Ovarian issues: Infertility can be caused by diminished ovarian reserve (DOR) or polycystic ovary syndrome (PCOS) — two different diagnoses that both involve the ovaries. Your fertility hormone levels and a transvaginal ultrasound can help your doctor understand if these are possible diagnoses for you.
- Endometriosis or tubal diseases: Whether it’s caused by endometriosis (a condition where tissue similar to the uterine lining grows outside of the uterus), PID, or untreated STIs (the most common STIs are chlamydia and gonorrhea), tubal factor infertility results in 25%-35% of infertility cases in people with ovaries.
- Fibroids or adenomyosis: Benign growths of the uterine muscle (fibroids) or uterine lining that grows into the uterus’ muscular wall (andenomyosis) can potentially result in fallopian tube blockages, miscarriage, or uterine abnormalities that impact implantation.
- Thyroid conditions or insulin resistance: While these conditions can affect your fertility, you can work on a treatment plan with your doctor to mitigate the risk of fertility and other health issues down the line. Your Fertility Hormone Test results will give you important insight for these conversations.
- Male factor infertility: While people with ovaries are often conditioned to believe fertility is their responsibility alone, 40% of opposite-sex couples who visit infertility specialists will be diagnosed with male factor infertility. Depending on what the semen analysis reveals, infertility treatment options can range from hormonal medications to surgery, often combined with intrauterine insemination (IUI) or assisted reproductive technology (ART) like IVF, or even utilization of a sperm donor.
5. Get acquainted with female fertility myths.
There's a lot of inaccurate information out there about fertility — and it's vital to be able to tell the difference between what's true and what isn't. That’s why we’re busting these three big myths about fertility.
The myth: You can't have a baby after age 40.
The science: You can conceive after age 40, but because fertility declines as we age (albeit gradually), it can be more complicated. Talking to your healthcare provider before trying to get pregnant can help you figure out if fertility treatments like IVF or IUI or using donor eggs might improve your chances.
The myth: Being on hormonal birth control will damage your fertility.
The science: "Birth control has not been proven to have any harmful long-term effects on a woman’s ability to conceive," says Dr. Douglas. However, depending on which birth control you're on, it might take you longer for ovulation to return. Keep in mind that if you were taking hormonal birth control to alleviate symptoms of PCOS or endometriosis, those symptoms will return when you stop taking birth control and you may need to find another way to manage them.
Myth: Egg freezing guarantees you'll be able to have a child one day.
The science: While freezing your eggs can preserve the quantity and quality of the eggs you're able to retrieve today, it doesn't guarantee a future pregnancy. There are many factors to contend with, including your age when you freeze your eggs, your age when you decide to use the eggs, and how many eggs are viable. Your healthcare provider can help you figure out if egg freezing is the right move for you.
These five steps will help you get proactive about your fertility so that you're armed with the information you need to make decisions about your health and your future. So go forth and get that knowledge! Whether we’re deciphering hormone levels or helping you navigate fertility treatments, Modern Fertility will support you each step of the way.
This article was reviewed by Dr. Jennifer Conti, MD, MS, MSc.
|*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.|