Protecting your future fertility

These days, women are more likely to be climbing career ladders than thinking about having children [1]. And because of this, an increasing number of women are waiting until later in life to start a family. In fact, five times as many women over 45 are having children compared with the previous generation [2].  

There’s plenty of discussion on whether waiting is the right choice (and ultimately, it’s down to personal preference). But, if you do decide to wait until your later reproductive years, your chances of pregnancy reduce.  But are there ways to protect your future fertility? 

In this blog, we discuss: 

• Can I have a healthy pregnancy over the age of 35?
• What are the signs and symptoms of infertility or fertility issues?
• What lifestyle changes can I make to reduce my risk of infertility? 
• How can I monitor my fertility? 
• What hormones should I be thinking about when considering my fertility? 
• Should I be considering my fertility, even if I don’t want children now? 
   

Can I have a healthy pregnancy over the age of 35?
 

If you're in your mid-30s or 40s, it's very likely you can have a healthy pregnancy and baby, but there are some things to be aware of [3].  

Firstly, it can take longer to get pregnant as you get older, because both the number and quality of eggs declines. If you do become pregnant the risk of miscarriage and other complications also increases slightly.  

Miscarriage affects around [4]:  

• One in 10 pregnancies in women younger than 30 
• Two in 10 pregnancies in women between 35 and 39 

Women over 40 are also at higher risk of pregnancy complications, including:  

• High blood pressure and diabetes 
• Having a multiple birth (twins or triplets), which may cause complications 
• Preeclampsia 
• Stillbirth 

Because of this, you're likely to have additional tests during pregnancy, and if you're over 40, your pregnancy team may recommend consultant-led care over midwife-led care.  

Despite these risks, with healthy lifestyle choices and proper medical care, most women over 35 go on to have a healthy pregnancy.  In fact, more babies now are born to women over 35 than under 25. 

What are the signs and symptoms of infertility or fertility issues?
 

Often infertility won’t show symptoms, and you may not know if you have any issues with fertility until you start trying to conceive. It’s important to note that conception doesn’t always happen straight away, and on average, can take anywhere up to a year or longer [5].  

However, there are signs and symptoms that could indicate a cause of infertility (such as polycystic ovary syndrome [PCOS]).  

Signs and symptoms which may be related to infertility include: 

• Irregular, painful, or absent periods. 
• Excessive hair growth on the face, chest, or back (which could be a sign of PCOS). 
• Recurrent pelvic pain (this could indicate pelvic inflammatory disease or endometriosis).  

Experiencing these symptoms doesn’t necessarily mean you will have fertility problems, but they may need to be investigated, so it’s important to see your doctor sooner rather than later. Some conditions may be harder to treat the longer you leave them 
 

What lifestyle changes can I make to reduce my risk of infertility?
 

Lifestyle changes can have a huge impact on reducing your risk of infertility, as well as helping to improve your overall reproductive health. But what lifestyle changes can you focus on? 

1. Protect yourself against sexually transmitted infections (STIs)  

Some STIs can cause infertility if left untreated [6]. It’s important to practise safe sex and get regular STI screenings if you’re sexually active.  

2. Avoid smoking  

Smoking is associated with a higher risk of infertility, as well as miscarriage and premature birth [7]. If you smoke, quitting is one of the best things you can do for your fertility and overall health. If you need some help, the NHS has great resources for quitting smoking.  

3. Maintaining a healthy weight  

Being significantly under- or overweight can negatively affect your fertility by impacting hormone levels and ovulation [8]. It can also prevent fertility treatments from working, such as in vitro fertilisation (IVF). There are lots of approaches for maintaining a healthy weight, and it's important to find something that works for you and is sustainable.

Losing weight can be a challenge. It all comes down to making sure you're in a calorie deficit. A two-pronged approach is best, namely reducing your calorie intake but also exercising more. It doesn't have to be drastic — small, consistent changes make a big difference over time. The NHS provides more tips and advice on how you can maintain a healthy weight.

For people who feel unmotivated or struggle to hold themselves accountable, joining a weight loss programme can be very effective, such as Slimming World, GetSlim, or Weight Watchers. Alternatively, you could set a goal and start a fitness journey with a friend or family member instead. 

4. Limit alcohol 

For women trying to conceive, it’s safest not to drink alcohol at all to give the best chance of success and keep health risks to the baby as low as possible [9]. 

However, for people who are concerned about long-term fertility, the best advice is to reduce alcohol intake as much as possible and to stay within the recommended limits of no more than 14 units per week. 

5. Reduce caffeine intake 

It's not entirely clear how caffeine affects women's long-term fertility but most research agrees that less than 200mg of caffeine daily is unlikely to cause problems for most people [10]. This is about one or two cups of coffee daily depending on the strength. However, excessive caffeine might increase your risk of early miscarriage. So, if you're trying to conceive, it's best to cut down your caffeine intake as much as possible.

6. Manage stress 

Chronic stress can interfere with ovulation and decrease fertility [11]. So, it’s important to find healthy ways to manage stress. You could try something such as yoga or even some of our unconventional ways to reduce stress.   

7. Eat a fertility-friendly diet  

There’s evidence to suggest things like replacing unsaturated fats with more monosaturated fats (such as avocadoes and nuts), and eating more plant-based unprocessed protein, such as tofu and lentils can increase your chances of fertility [12]. It is also important to focus on key vitamins and nutrients such as vitamin D, iron, and folate, as deficiencies in these may affect fertility.  

Ensuring you make healthy lifestyle choices as above, can reduce your risk of infertility, as well as increase your chances of conception.  
 

How can I monitor my fertility?
 

When most people think about monitoring fertility, they may initially think of periods – which is a great first step. But when considering fertility, there are a few factors (other than periods) that you may wish to monitor, including:  

• Basal body temperature – this is your body’s temperature at rest. Your basal body temperature stays steady most of the time, but you are likely to see a rise just after ovulation. This can help you to identify when you have ovulated and when your fertile window has ended.  
• Cervical mucus – changes in cervical mucus can indicate when you are approaching ovulation.  
• Ovulation – a good first step is to check whether you’re ovulating normally. You can do this with ovulation predictor kits or with our at-home Ovulation Progesterone Blood Test.  
• Hormones – as well as looking at progesterone, there are other hormones that may give you more insight into your fertility and reproductive status.  
   

What hormones should I consider when thinking about my fertility?
 

1. Follicle-stimulating hormone (FSH) 

Follicle-stimulating hormone (FSH) is a hormone made in the pituitary gland, which helps to control the menstrual cycle and egg production. 

As eggs mature, they release oestradiol which inhibits FSH release. Over time, the number of viable eggs declines, and therefore less oestradiol is made, allowing FSH levels to increase. As such, high FSH can sometimes suggest your body's egg count has declined.  

High FSH is typically seen in menopausal women, but it is worth noting that FSH levels can vary extensively during perimenopause (the years preceding menopause), being normal one month, and high the next, as the menopause nears.   

2. Oestradiol  

Oestradiol is a steroid hormone that is produced by a developing egg in the ovaries, and is responsible for preparing the uterus for implantation. Oestradiol levels decline as you get older, so that by the time you reach menopause, your oestradiol levels will be a fraction of their peak levels.  

Low oestradiol, together with elevated FSH, can indicate that you may be approaching menopause. During perimenopause, oestradiol (like FSH) can fluctuate hugely.  

A single low oestradiol or high FSH result may not be significant, and also may not mean that you can’t conceive. However, it may be a sign that your body is starting to transition into menopause.  
 

3. Anti-Müllerian hormone (AMH)  

AMH is a hormone created by follicles within your ovaries, which helps to predict egg count. The more eggs/follicles you have, the higher your AMH level is likely to be. Measuring AMH can help to diagnose premature ovarian insufficiency and is used by fertility clinics to assess the likelihood of successful egg retrieval.  

High AMH levels can also be caused by polycystic ovaries, and there is ongoing research into how AMH testing could help in the diagnosis of polycystic ovary syndrome (PCOS). For women interested in their future fertility, it can help guide them in family planning.  

AMH is not a precise measure of how many viable eggs a woman has and should only ever be used as a guide. It also can’t tell you anything about egg quality which declines with age. We suggest that a low AMH result should be followed up with an antral follicle count scan (where a doctor counts the number of activated follicles in the ovaries).  

You can read more about AMH in our blog: what can AMH tell you about your fertility? 

Other hormones to consider include progesterone, testosterone, and thyroid hormones such as TSH, T3, and T4.  

Understanding these hormones can provide you with valuable information about fertility and help identify any underlying issues that could be affecting your reproductive health.  
 

Should I be considering my fertility, even if I don’t want children now?
 

It may seem excessive to be considering your fertility when you don’t have immediate plans to conceive. But, if you want to have a baby at some point, planning ahead of time is a perfectly valid thing to do.  

Making healthy lifestyle choices and understanding your current fertility status can help you prepare for when you are ready to start trying. Taking these early steps can help you make informed decisions about your reproductive health and help protect your future fertility.   

For more information on fertility, visit our Fertility Hub.

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References 

1. Stahl, A. (2022) New study: Millennial women are delaying having children due to their careers, Forbes. Available at: https://www.forbes.com/sites/ashleystahl/2020/05/01/new-study-millennial-women-are-delaying-having-children-due-to-their-careers/ (Accessed: 30 May 2023). 
2. PA, L.S. (2022) Women who choose pregnancy in later life - the pros and cons, LeicestershireLive. Available at: https://www.leicestermercury.co.uk/news/uk-world-news/women-having-babies-later-life-6727872 (Accessed: 30 May 2023). 
3. NCT (National Childbirth Trust) (2020) Pregnancy and birth for women over 35: Pregnancy articles & support: NCT, NCT (National Childbirth Trust). Available at: https://www.nct.org.uk/pregnancy/tests-scans-and-antenatal-checks/pregnancy-and-birth-for-women-over-35 (Accessed: 30 May 2023). 
4. How age affects fertility (no date) Tommy’s. Together, for every baby. Available at: https://www.tommys.org/pregnancy-information/planning-a-pregnancy/fertility-and-causes-of-infertility/how-age-affects-fertility (Accessed: 30 May 2023). 
5. How long it takes to get pregnant (no date) NHS choices. Available at: https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/#:~:text=Most%20couples%20will%20get%20pregnant,fertile%20as%20they%20get%20older. (Accessed: 30 May 2023). 
6. Infertility & stds - STD information from CDC (2023) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/infertility/default.htm#:~:text=Chlamydia%20and%20gonorrhea%20are%20important,tube%20infection%20without%20any%20symptoms. (Accessed: 30 May 2023). 
7. Products, C. for T. (no date) How smoking affects reproductive health, U.S. Food and Drug Administration. Available at: https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-affects-reproductive-health#:~:text=Smoking%20can%20reduce%20fertility%2C1,may%20negatively%20affect%20hormone%20production.&text=Smoking%20and%20exposure%20to%20tobacco%20smoke%20can%20harm%20the%20reproductive%20system.&text=Smoking%20can%20damage%20the%20DNA%20in%20sperm. (Accessed: 30 May 2023). 
8. Department of Health & Human Services (2015) Weight, fertility and pregnancy health, Better Health Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/weight-fertility-and-pregnancy-health#:~:text=Being%20underweight%20(BMI%20under%2018.5,a%20year%20to%20get%20pregnant. (Accessed: 30 May 2023). 
9. Does drinking alcohol affect your fertility? (no date) Private healthcare. Available at: https://www.bupa.co.uk/newsroom/ourviews/alcohol-affects-fertility#:~:text=Even%20drinking%20between%20one%20and,reduce%20your%20chance%20of%20conceiving. (Accessed: 30 May 2023). 
10. Caffeine and getting pregnant (no date) Tommy’s. Together, for every baby. Available at: https://www.tommys.org/pregnancy-information/planning-a-pregnancy/are-you-ready-to-conceive/caffeine-and-getting-pregnant (Accessed: 30 May 2023). 
11. Does stress affect your chances of getting pregnant? (2023) Clearblue. Available at: https://www.clearblue.com/how-to-get-pregnant/how-long-does-it-take/stress-affect-chances-getting-pregnant#:~:text=Excess%20physical%20or%20emotional%20stress,exercise%2C%20can%20also%20stop%20ovulation. (Accessed: 30 May 2023). 
12. Bda (no date) A clinical update on diet and fertility, British Dietetic Association (BDA). Available at: https://www.bda.uk.com/resource/a-clinical-update-on-diet-and-fertility.html (Accessed: 30 May 2023).