Do you know what your fertility is like? Can you have children or is it already too late? If you want to get pregnant (sometime), you should read this
For many young women, for years it has been about the question: “How do I prevent getting pregnant?” For this reason, condoms are bought, pills are swallowed, diaphragms are introduced, ovulations are calculated, super good attention is paid and in the end it is still banished that nothing happens that could throw the life plan over the top.
By mid-30s at the latest, however, many people’s attitudes change, sometimes abruptly. Children suddenly become a possibility, often a wish. Most women suddenly have a lot of questions about fertility. We have 12 answers:
1. When does a woman’s fertility decline?
It differs from woman to woman. With a combination of blood tests and ultrasound, the gynecologist can determine whether it is already 5 to 12 on your biological clock. On the one hand, this is how the so-called anti-Müllerian hormone is determined in the blood. This hormone, which is formed in the follicles that are capable of maturation, has not been known for that long, which is why the test is only now gaining acceptance. The more of it is detectable, the more egg cells are still dormant in the body.
In addition, the visible follicles are counted in the ultrasound at the beginning of the cycle. “If two can be seen on each ovary, that is rather modest, twelve indicate good remaining fertility,” says Professor Heribert Kentenich, chief physician at the DRK Women’s Clinic and the Fertility Center in Berlin.
In this way you can determine what you could only guess so far – how loud the clock is ticking for you personally right now. “This test helps women around 40 in particular to decide for or against rapid fertility treatment,” says the reproductive medicine specialist. The blood test at the gynecologist or in a fertility center costs around 50 euros.
2. How can I influence my biological clock?
Difficult. Hormonal contraceptives do not significantly delay the breakdown of the ovarian (i.e. the egg) reserve. Because at the time of her birth, a girl has around 1 million egg cells; the first rule is 450,000 fewer.
The ovulations that you save with the pill are simply irrelevant. According to gynecologist Kentenich, there is only one way to slow the ticking away: stop smoking. By the way, it is also otherwise very healthy.
3. Why do smoking or coffee reduce fertility?
Smoking creates free radicals in the body and these affect not only your skin, but also the egg cells. It is also clear that both overweight and underweight have an unfavorable effect on fertility because they make ovulation more difficult. According to a new study, a lot of caffeine could also reduce the chances of conceiving: The substance slows down muscle contractions and can thereby impair the egg’s journey from the ovary to the uterus.
4. How soon after stopping the pill can I get pregnant?
You have to expect that your cycle will be the same as it was before the pill within 2 to 3 months: For example, if you had irregular bleeding, you can expect it to be the same again.
In the very first time after weaning, it is normal that things get a little confused and that the period is sometimes stronger and sometimes weaker, for example. “You can get pregnant right away,” says Kentenich. This applies from day one, even if (as in every cycle) it becomes more likely towards the middle of the cycle. Even after you’ve let yourself go on the IUD. Only with the hormonal IUD does it take 1 to 2 months to reach full fertility again.
5. Does an abortion affect my fertility?
An abortion performed according to local standards “actually has no effect on later fertility,” explains Kentenich. At least not if it went without complications. When can an abortion be healthier than carrying to term .
6. How do I know if I will get pregnant easily or difficultly?
You can ask your mother and grandma if they had to wait a long time. The ability to conceive easily or rather difficultly is thought to be inherited. However, this has not been proven, and there are no genetic tests or the like.
The information as to whether female relatives entered the menopause early could also be a clue. Because, of course, fertility depends largely on the egg reserve. And there is a lot to suggest that this is similar with you as with mother and grandmother.
7. When is fertility at its highest?
This can be said quite clearly: Under 35 is better than over 35 years. Kentenich: “After that, it becomes much more difficult, a woman simply has to know that.” Also because then it comes more often to miscarriages.
The problem is the eggs, whose number and quality decrease over the years. Very rarely, women become mothers even in their late 40s: According to Kentenich, this is about one for 2400 mothers a year in the Berlin DRK Women’s Clinic.
“Beyond 50 years, however, a baby is actually only possible with the help of an egg donation,” according to the physician’s assessment. Also with regard to the baby, he advises to have the first child before 35: Because from this age the probability of chromosomal abnormalities increases significantly.
8. How complex is the process of freezing egg cells?
It’s not that easy: you have to take hormones and have an operation to remove the eggs from the ovary. That costs around 2000 euros. Then it is frozen, storage in liquid nitrogen at minus 170 degrees costs around 100 to 200 euros per year. You should be sure that you want a child later.
But of course there is no guarantee that fertilization will work in the laboratory. “In my 20 years as a reproductive medicine specialist, only one completely healthy patient asked me to have an egg collection”, says Kentenich. It is different with young women who develop cancer: For them, freezing is often the only way to have a biological child after chemotherapy.
9. Do large intervals between menstrual periods affect my fertility?
Yes, this is possible. Because then at least one of the hormones that control the cycle is out of balance, for example due to thyroid problems. Or there is too little estrogen in the blood, as in many competitive athletes with very low body fat percentage.
“One in 100 women goes through menopause before their 40th birthday,” says Kentenich. Be sure to have this clarified by the gynecologist, then it is also clear whether and how the cycle comes back. As soon as you have regular bleeding again, i.e. regular ovulation, full fertility is back.
10. Is there an ideal age for fertility treatment?
In any case, it is always too early to despair. If you have only been giving up contraception for a few months, it is perfectly normal that nothing has happened yet. You should have tried it for at least one year before seeking medical treatment.
The exception to this rule, according to Kentenich: If the woman is already over 40. Then it is advisable not to lose any time, especially if there are already concrete indications that it could be difficult – such as hormonal disorders or fibroids, benign growths of the uterine lining, with which the woman has been dealing for a long time.
Even if you or your partner have unintentionally remained childless in a previous relationship, you should check all alternatives early. “Then it makes sense to be examined as soon as possible, regardless of age,” says the reproductive physician.
11. What makes it difficult to get pregnant?
This cannot be said unequivocally, because: “It is always a network for many reasons that makes it difficult to become pregnant,” says Kentenich. “However, the age of the woman plays an increasingly important role.” Because many women in Germany today decide late for a baby.
According to a new study by the health insurance company KKH-Allianz, the number of expectant mothers between 20 and 24 has fallen by 28 percent in recent years, while the birth rate among 40 to 44-year-old women has risen by an impressive 46 percent. On the one hand, this means that it very often works out late, but not as easily as in your mid-20s.
Other possible reasons for long waits for the baby are, for example, hormonal problems, impermeable fallopian tubes and adhesions on the uterus, fallopian tubes or ovaries. By the way: In about half of the cases, it is up to the man if there are procreation problems. He should therefore also be examined.
12. What happens during a fertility treatment?
This is a very complex issue. Basically, there are several possible procedures for this:
- Hormonal stimulation Ovulation is triggered with the help of tablets or syringes, because in some couples the cause of the problem is that the follicles do not mature without this support.
- Insemination If, for example, the sperm of the man are poorly motile or simply rare, the doctors can help by insemination: The semen is injected into the uterus. It can also be specially prepared beforehand.
- In vitro fertilization This is the fertilization of the ice outside the body, in which egg and sperm cells are united in a petri dish. This is recommended, for example, if impermeable fallopian tubes stop the egg on its way to the uterus. Almost always, before that, the ovaries are stimulated with hormones so that several follicles can be removed. Recently, however, experts have been discussing dispensing with the stressful treatment of women over 40 and carrying out egg retrieval in coordination with the natural cycle. Because at that age, women often form little follicles despite hormone doses.
- ICSI In this procedure, intracytoplasmic sperm injection, the sperm cell is injected directly into the egg, so fertilization takes place in any case. ICSI is used, for example, when there is much to suggest that a sperm does not make it into the egg. Sometimes there are no sperm at all in the ejaculate. Then sperm cells can be taken from the testicles and used for ICSI, for example if a man still wants a child many years after sterilization.
Do not panic if the desire to have children does not work out immediately. It is normal for a couple to have to wait about a year for the first baby. Trust your body and your fertility. The more relaxed you are, the higher the success rate for fertilization.