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Protecting Your Fertility by Tera Schreiber

A 35-year-old woman who is married, financially secure and trying unsuccessfully to get pregnant can feel pretty bitter when she hears about the unwanted pregnancy of a teenage girl. Sometimes it seems that nature’s plan for human fertility is a bad joke. We are at our most fertile when we are less mature and less financially responsible.

Janice, from Woodinville, who herself comes from a very large family, found this out the hard way when she had difficulty conceiving at age 32. “You are told your whole life you will get pregnant if you aren’t careful, but then I wanted nothing more than to be pregnant and I could not get pregnant. I felt disappointed, inadequate and somewhat humiliated to endure the poking and prodding of fertility testing for something that was supposed to be beautiful, loving, and natural.”

Georgia, from Seattle, always thought she would get pregnant right away when she tried. Her sister and mother both conceived easily. When she did not get pregnant after months of trying, she was surprised and concerned. “It was particularly difficult because I had put a lot of thought into having a child, and the timing of it. And my husband and I had talked a lot about it before agreeing to go ahead and have a baby. So when I didn’t get pregnant right away, I was disappointed and surprised.”

Can anything be done to help assure that you will be able to conceive a child when you are ready — even if that time isn’t until your thirties or even your forties? Someone who puts off childbearing should understand that fertility naturally declines with age, says Lori Marshall, MD, board certified reproductive endocrinologist at Pacific Northwest Fertility and IVF Specialists in Seattle. Dr. Marshall finds it “troubling that movie stars who get pregnant in their forties fail to mention that it had nothing to do with their own eggs.” She cautions women to be realistic about their fertility. “We don’t want to send a message that the most important thing a woman does is have a child, or that women should put aside their professional goals to have a child,” explains Dr. Marshall. “But, we do want women to know that their biology has not changed to be consistent with the social changes that put off childbearing for a later date for so many women.”

And, according to Dr. Marshall, you can’t actually extend your fertility. “Women are born with all of the eggs they will ever have, and the rate at which they are lost is genetically programmed.” Fertility correlates with a woman’s age in many respects, as do the risks to her fertility and what she can do to protect it. In each decade of a woman’s life there are actions she can take to protect her fertility and minimize risks.

the twenties

In her twenties, a woman’s greatest risk to her fertility comes from “ignorance,” according to Susan Carr, ND, from Fertile Path, a set of Puget Sound fertility clinics that incorporate holistic health care, including acupuncture and naturopathic medicine. Many women may not know, for example, that “the biggest risk to fertility for women in this age range is sexually transmitted diseases,” according to Dr. Carr.

STDs like chlamydia, gonorrhea and HPV can damage fallopian tubes and the cervix, agrees Dr. Marshall. “Smoking can also be detrimental to your reproductive health. It may affect estrogen metabolism and be a toxin to the eggs,” she continues. Since you have all of the eggs you will ever have at birth, best to protect them from toxins for your entire life.

From the perspective of Chinese medicine, fertility is highly influenced by our jing. Jing, explains Kristi Stoddard, L.Ac., and Certified Chinese Herbalist from Sound Wellness in Wedgwood, “is inherited from our parents. We are all born with a certain amount of jing, and it diminishes throughout life via things like menstrual cycles, pregnancy and lifestyle choices.” Therefore, a woman in her twenties will have more jing, which equates to reproductive capacity, than a woman in her forties.

How can a woman preserve her jing? “Lead a life of balance,” says Stoddard. Avoid overwork, stress, excess sexual activity, overexercising and drug use. Eat a healthy diet and generally just live a life of balance that includes appropriate amounts of rest.

Dr. Carr agrees that a healthy lifestyle beginning as soon as possible will help preserve fertility. “Healthy eating habits promote healthy reproductive function and fertility,” says Dr. Carr. She especially warns against simple sugars and carbohydrates, which elevate blood sugar and insulin levels. “It is important to recognize that the ovaries are extremely sensitive to insulin and blood glucose levels,” explains Dr. Carr. It is never too early to take care of your body, which protects many aspects of health, including fertility. Along the same lines, watch your weight throughout your life. “Weight matters when it comes to fertility,” says Dr. Carr. “A body mass index between 20 and 25 is optimal.” Overweight and underweight are equal problems when it comes to fertility.

Optimal fertility at any age depends on hormonal balance, which can be disrupted by environmental toxins. “There is growing concern in the scientific community surrounding chronic exposure to chemicals that interfere with normal hormonal balance. These chemicals are known as endocrine disruptors,” explains Dr. Carr. These chemicals are found in everything from plastics to cosmetics to furniture to detergents.

While fertility is impacted as toxins build up over time, even very young women are affected. “We are seeing the greatest increase in reported fertility problems related to toxins in women under the age of 25,” says Julia Varshavsky, coordinator of the Fertility and Early Pregnancy Compromise Working Group. The group is part of the Collaborative on Health and the Environment, a nationwide network of individuals and organizations who are working to advance knowledge and effective action to address concerns about the links between human health and environmental factors. “Many factors contribute to fertility success, and a growing body of scientific evidence indicates that many chemicals we are exposed to through our air, water and everyday products may potentially impact our reproductive health and fertility in a variety of ways,” Varshavsky says.

Frustratingly, many of these chemicals are not tested or regulated effectively. Yet Varshavsky advises that consumers do have some control over their use. Check out the Collaborative’s Web site (www.healthandenvironment.org/infertility/vallombrosa_documents) for a list of common toxins that can compromise fertility and suggestions for how to avoid them.

Varshavsky also encourages consumers to ask government for stricter regulations, and to push industry into using safer alternatives by seeking healthier options themselves. By avoiding the known endocrine disruptors whenever possible and seeking healthier options, women can minimize the risks of environmental toxins.

the thirties

While all of the issues that influence a woman’s fertility in her twenties continue as she ages, other things come up as well. “As we age,” says Dr. Carr, “our reproductive system does suffer from the cumulative impact of stress, unhealthy lifestyle, nutrition choices and toxic load.” The biggest “fertility buster” for a woman in her thirties, according to Dr. Carr, is stress, primarily from her career. A woman can work to preserve her fertility by incorporating stress-reducing activities into her life, such as moderate exercise, supportive relationships, meditation, counseling and laughter.

Another way to combat the reproductive decline caused by stress is to consider engaging in yoga for fertility. Lynn Jensen has taught these yoga classes specifically geared toward enhancing and protecting fertility in various Puget Sound locations since 2002. In that time, more than 200 of her clients have achieved successful pregnancies. “Yoga is a well-recognized de-stressor,” says Jensen. “Stress hormones can cause physiological changes in the body, including reducing the blood flow to the internal organs, such as the ovaries and uterus, which negatively affects fertility. Yoga also calms the central nervous system, which stops the release of stress hormones.” Yoga for fertility has other benefits as well, for women of all ages, including balancing hormones and opening the pelvic area.

If you are already taking yoga, don’t assume you are getting the benefits of a yoga practice specifically geared toward enhancing fertility. “Some versions of yoga that are currently being taught, such as hot yoga, or power yoga, or classes which focus on abdominal strengthening are not useful,” says Jensen, “and can even be detrimental for women trying to achieve pregnancy.” Instead, a yoga practice geared toward fertility will vary based on where a woman is in her cycle. “In a general yoga class, a student may end up doing poses that are not suited to her particular cycle phase,” warns Jensen.

Everyone appears to agree that fertility declines significantly after age 35, regardless of protective steps taken in earlier years. “Loss of eggs is most accelerated on average at 37 to 38 years old,” says Dr. Marshall. “We always recommend that women over 35 who are trying to conceive seek care early and recognize that they may take longer to get pregnant.”

For women who run into other health problems, such as cancer, which will artificially cut short a woman’s reproductive years, the option of freezing eggs is possible, says Dr. Marshall. She and her colleagues at Pacific Northwest Fertility and IVF Specialists offer this service. Success rates increase with eggs retrieved and frozen in women who are younger than 35.

For women seeking to delay childbearing for career or other reasons, the idea of freezing eggs sounds like a great solution. However, freezing eggs is not currently an option for women who are simply seeking to delay childbearing for social reasons.

the forties

Whatever degradation to a woman’s fertility started in her thirties accelerates during her forties. “Only 13 percent of women over the age of 45 are fertile and most of those pregnancies are unintended,” says Dr. Marshall. “Any woman who is starting to try to get pregnant in her forties has to be realistic and understand that she might not be able to get pregnant with her own eggs.”

Yet, the “biological clock” can lead to a lot of stress for women in their forties and that stress can negatively influence fertility, according to Dr. Carr. She recommends that a woman in this age group focus on what she can do instead of worrying over her age, which is beyond her control at this point. “Many women can reverse many of the effects on aging by getting adequate rest, minimizing stress, consuming plenty of filtered, clean water and consuming healthy and nutrient dense foods,” explains Dr. Carr.

The obvious result of the natural decline in fertility is that a woman in her forties may be more likely to need medical assistance in getting pregnant. Yet, Dr. Carr cautions against the indiscriminate use of fertility medications, which may actually compromise fertility. “I have seen many fertility drugs cause problems,” she explains. Some of these drugs will decrease conditions necessary for fertility, including decrease in the uterine lining, drying of cervical mucus, and the onset of hot flashes. “This does not promote natural conception and in fact has the opposite effect,” says Dr. Carr.

Dr. Marshall agrees that clomiphene, known by the brand name Clomid®, a first-line fertility drug commonly used to induce ovulation in women who don’t ovulate on their own, “may cause a decrease in their uterine lining or abnormal cervical mucus in about 15 percent of women. While it is effective when given to women with irregular cycles, it has barely shown to increase fertility in women who have normal cycles.” As such, Dr. Marshall discourages it as a sole treatment for unexplained infertility, and uses it primarily with well-timed inseminations, where it can triple fertility rates. Likewise, Dr. Marshall agrees that clomiphene may cause irritability or hot flushes.

Robert Steiner, Ph.D., Professor of Obstetrics & Gynecology and Reproductive Endocrinology & Infertility at the University of Washington, agrees that fertility drugs should not be used indiscriminately. “All fertility drugs merit a cost-benefit analysis,” says Dr. Steiner, who recommends women work with an expert in reproductive endocrinology and fertility before taking any medications for fertility. However, he warns against drawing any conclusions about “fertility drugs” as a group because there are so many and treat so many different conditions that it’s impossible to generalize.

Dr. Carr says that recurrent use of fertility drugs may even accelerate reproductive aging. “I call it ovarian burnout,” she says. She recommends that women carefully consider the use of fertility drugs not only for these reasons but because of the other health effects as well. “It is important for women to realize that the ovaries are very important glands that not only influence reproduction, but also impact bone health, cardiovascular health and neurologic function.”

Dr. Marshall disagrees with the concept of “ovarian burnout.” “There is no evidence anywhere that any fertility drug accelerates reproductive aging,” asserts Dr. Marshall. “Each month a group or cohort of eggs present themselves, one ovulates and the rest die. Even gonadotropins, or injectable fertility drugs, which can stimulate five, ten, or even more eggs to mature in a cycle, really just rescue eggs from death and don’t change anything about the time to depletion of eggs.”

Dr. Steiner also encourages women to consider their age when considering fertility options. “When you are in your forties, the clock is not only ticking, but it’s ticking faster than it was in your twenties. Every year — and maybe every month — makes a difference.” He advises that telling a woman to go slowly and approach a natural pregnancy in her forties may be unwise if having a biological child with her own eggs is a priority.

when to see a doctor

“A woman with irregular periods should contact her doctor right away,” says Dr. Marshall. She needn’t wait until she is trying to conceive. The irregularity can be a sign of an issue that can be addressed early. Also, a woman with excessive cramps and bleeding, endometriosis and fibroids should contact her health care provider about those conditions as soon as possible in order to help preserve future fertility.

From a naturopathic perspective, Dr. Carr recommends that women and their partners seek preconception health care several months before trying to conceive. “Fertility is not just about getting pregnant, but more importantly about having a healthy baby. Preconception health care is usually not a onetime visit, but a process.” That means every woman who is seeking a pregnancy will want to achieve her optimal health and well-being, not just to get pregnant, but to achieve a healthy pregnancy and protect the future health of her child.

It’s not far-fetched to say that protecting your fertility is a lifelong issue. “Aspects of a woman’s fertility can be determined as a fetus,” says Dr. Carr. “There is growing evidence that reproductive health is highly influenced during fetal development. A woman who is concerned about the reproductive health of her children should be mindful of how the environment she lives in and the things she puts into her body during pregnancy can impact the ability of her children to have children.”

Tera Schreiber frequently writes about women’s health issues for Seattle Woman.

To Learn More About Environmental Toxins and Fertility

• Having Faith by Sandra Steingraber, Ph.D.
• Environmental Working Group: www.ewg.org
• Pollution in People Web site, which includes a list of toxic chemicals found in Washingtonians in a study performed by Washington Toxics Coalition, as well as safer alternatives for the sources of toxic exposures: www.pollutioninpeople.org

©2008 Caliope Publishing Company