Understanding Your Fertility: What Everyone Should Know
Before diving into this post, I want to clarify that I am a medical assistant working in a Reproductive Endocrinology clinic. This article is not medical advice, but rather my personal reflections on what I’ve learned about reproductive health as someone with a uterus.
Reproductive Endocrinology: What Does That Mean?
Reproductive Endocrinology may sound complex, but let’s break it down. The reproductive organs in biologically female individuals include the uterus, fallopian tubes, ovaries, cervix, and vagina. “Endocrinology” refers to the study of hormones in the body. Essentially, Reproductive Endocrinology is the branch of medicine that focuses on infertility as it relates to hormones and reproductive health.
Ovarian Reserve: A Key Term to Know
One term you might not be familiar with is “ovarian reserve.” Individuals born biologically female are born with all the eggs they will ever have. This ovarian reserve declines at a steady rate throughout life until menopause. However, ovarian reserve is not a predictor of fertility but is used to assess eligibility for treatments like In-Vitro Fertilization (IVF). Ovarian reserve can be evaluated through lab tests (such as Anti-Müllerian Hormone and a hormonal panel), ultrasounds to count antral follicles, and age, with age being the most significant factor.
What Determines Fertility?
Fertility, or one’s ability to conceive, is influenced by several factors: ovulation, male factor infertility, and pelvic factors. Let’s break this down:
- Ovulation: Does the person ovulate regularly each cycle?
- Male Factor (if applicable): Is there sperm present? What is the concentration, motility, and morphology of the sperm?
- Pelvic Factors: Are all parts of the reproductive system present and functioning? The fimbriae (finger-like projections at the end of the fallopian tubes) must pick up the ovulated egg, and the fallopian tubes need to transport the egg for fertilization. Conditions like infections and endometriosis can impair this process, leading to scarring and inflammation that disrupt the egg’s journey.
I was surprised to learn how many undetected pelvic infections can cause scarring in the fallopian tubes, making it more challenging for sperm and egg to meet.
Fertility Treatment and Preservation Options
Many individuals seek fertility treatment after unsuccessfully trying to conceive for over a year (or longer). Others may explore fertility preservation, such as freezing oocytes (eggs) for future use in creating embryos.
A lesser-known but valuable option in the fertility world is the adoption of donor embryos. Some people undergo IVF, create embryos, and may not utilize all of them due to personal circumstances (e.g., completing their family). These unused embryos can be donated to organizations that match them with individuals or couples seeking to adopt. After completing legal requirements, the adoptive family becomes the legal owners of the embryos, which can then be transferred. Even though the embryos may not be biologically related to the intended parents, the person carrying the pregnancy will leave an epigenetic imprint on the developing fetus. This process provides an incredible opportunity for individuals who cannot conceive naturally or through IVF with their own eggs or sperm. Embryo adoption is often more affordable than conventional IVF or adopting an already-born child.
Final Thoughts on Fertility
This post barely scratches the surface of the complex and multifaceted world of fertility. However, one of the most important lessons I’ve learned from working in Reproductive Endocrinology is this: If you wish to have a biological child, don’t delay family planning.
I had two reactions when I first heard this advice—one logical and one emotional. The logical side understands that ovarian reserve and age do not wait for the perfect time in life. Whether you’re at the peak of your career, haven’t met the right partner yet, or feel you’ll be ready in a year, ovarian reserve declines significantly after age 35 for most people with ovaries. My hope for those seeking obstetrical and gynecological care is that if having your own biological children is important to you, take charge of your fertility. Plan ahead to avoid realizing you’ve passed that critical window!
Resources
I have attached some resources below to read further about this subject.
https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/female-fertility/art-20045887
https://www.asrm.org/nrcks?gad_source=1&gclid=Cj0KCQjwjNS3BhChARIsAOxBM6oUTioGnl1jLqGApV5fIMw48-Y_-u4B74yOSVDaMQkh8BSELEs-gCoaAraDEALw_wcB
Written by Emily Wiley
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