While you’re abuela doesn’t want to hear the phrase, “I don’t want kids,” coming out of your mouth, the reality is you’re not alone. According to a recent study conducted by the Centers for Disease Control and Prevention, fertility in the United States has hit a historic low. The number of births in 2016 were 1% lower than the year prior, bringing the fertility rate to 62 birth per 1,000 women between the ages of 15 and 44.
Millennials are the perfect group of people who are not getting pregnant as often.
Although 1% may not sound like a big deal, this shift in fertility could reflect on how the majority of millennials today are putting their careers ahead of having families.
We recently spoke with Dr. Pavna Brahma, M.D. Reproductive Endocrinologist from Prelude Fertility to talk about the importance of fertility preservation, protocol to follow when infertile and much more. Read it all in our exclusive interview below.
We're seeing more women opting to freeze their eggs, including celebrities like Sofia Vergara and Kim Kardashian. Why do you think it's important to have fertility preservation and what other options are there for women to take?
For the past several decades, we're seeing a drop in women who are in their 20's being ready to start their families. There are a lot of wonderful reasons why – women are excelling in the workforce, in education and are focusing on many things during that decade in their life. But for that reason, as a society, we're delaying parenthood and so this birth report was fascinating because for the first time in history, over the past 50 years, it's actually women in their 30's who have the highest number of births per thousand. Women in their 30's are having more babies than women in their 20's and the point is definitely well taken.
Millennials are the perfect group of people who are not getting pregnant as often. I think one of the most important reasons why to preserve one's fertility is that there's a definite decline as we age, in the number of eggs and the quality of eggs we have. One fact that we don't know or that isn't well-publicized, is that women are born with a finite pool of eggs. We only get a certain amount of eggs. With each decade of life, we see a drop and decline in the number of eggs we have and by the time a woman is 35, we've actually depleted about 90 percent of women's eggs. Women in their 20's or early 30's, who are aware they would not yet want to start their families but would like to preserve that opportunity, are now left with a really wonderful opportunity to freeze their eggs.
The scientific advancements in the field of egg freezing are making it a wonderful opportunity because over the past decade, we're seeing much higher rates in the thawing of eggs and many, many live births have been reported from frozen eggs. It’s a significantly more successful procedure than it was when it first began about 15 years ago. When women freeze her eggs, the benefits are that we basically freeze the biological clock and its advancements. So the eggs are vitrified and saved and are there as an alternative plan- In the event that she may need them in the future, she can thaw and fertilize later and complete the process of In Vitro Fertilization for either starting their family or even completing their family.
We're also seeing people's first birth is started later in life. As more women begin their path towards pregnancy in their 30's, specifically over 35, they're more likely to need fertility treatment to have their second baby. So, in those settings, it's almost like donating them to yourself in the future and it could be very, very useful.
I feel like there's this stigma behind fertilization preservation. Back in the day, we would mostly see older women going through this procedure. What do you think has changed on how we view this procedure?
That's a great point. I think society has shifted to looking at how empowering the procedure really is. It's something that allows us to have enough foresight to build an insurance policy potentially for something that can be the most meaningful achievement a woman can have. And so, by allowing us to view it as an empowering, forward-thinking event, I think we're going to change the education and the openness in society towards it. I think It's also a matter of trying to capture our fertility when our fertility is most abundant. So, being able to freeze somebody's eggs before she is 35, that would be ideal because we don't yet see a decline occur typically so outcomes tend to be excellent at those younger ages. It's tougher to freeze a woman's eggs at 40 so ideally, the more education we can build and the more positivity we can build around it, the better educated younger generations can be.
What would you say are the first steps women should take once they know they are unable to conceive?
The first steps are obviously to make an appointment with a fertility specialist and get some baseline testing done that could be even run by their gynecologist as they're waiting to collect information from their fertility specialist. One basic test that's really, really informative and easy to get is called an AMH or, anti-mallerian hormone. It’s a simple blood test that can be run at any time in a woman's cycle even if she's on the birth control pill. It gives us an idea of how many eggs are in a person's biological clock. So, it helps us to know quantitatively – are we still in a woman's optimal fertility window? That number can help to gauge a little bit of timing and how quickly they should move towards certain treatments. In our fertility world exhibition, we use AMH to guide us to treatment options, the amount of medication, as well as other options too.
I know PCOS is one of the biggest causes of infertility in women. What are other common causes of infertility?
You're right, PCOS is a very common cause of infertility because it tends to cause difficulty with ovulation and releasing an egg each month, so, women get irregular cycles and they're not necessarily ovulating monthly in a way that can be timed for fertilization to happen. Other causes can be related to fibroids or tubal issues, anatomic issues that can cause deformation of the uterine cavity can make it less receptive to an implanting embryo. Issues with the fallopian tubes, whether they're open or have scar tissue surrounding the tubes, all of these tubal issues cause infertility because the tubes are the only place in nature where fertilization can happen. From the ovarian perspective, having a low number of eggs is associated with infertility - diminished ovarian reserve. We tend to see women may not ovulate as strongly or there can be higher rates of a genetic abnormality in the viability of the eggs. As a women ages, an egg reserve depletes. There are other general, hormonal reasons why infertility can be impacted. So it's always important to make sure that your doctor is looking at your thyroid level, to make sure your metabolism is running well. Check for prediabetes, especially in the setting of things like PCOS, to see if there are medications to help with ovulation. We tend to look at it really systematically for women based on hormones, egg counts, and anatomic assessments. Another really important fact is that it is important to get a male workup started early and get a semen analysis because about 1/3 of the time, most the female and the male have some fertility findings. It's important to get ahead of the game on getting at least a semen analysis and get a basic exam by a urologist for the male partner because it can help too.
That's a crazy number! A lot of the times we overlook the fact that men themselves have issues with infertility.
You're absolutely right. That’s another stigma we should break. Right as early as we are getting testing for the female, we should be getting testing for the male started also.
What advanced fertility medicine do you see in the future?
I think one of the greatest advancements in fertility treatments and medication and IBS are related number one to our ability to vitrify and freeze. There are some of the embryologic advancements that are allowing us to grow embryos out to more advanced stages. The embryologists today are able to biopsy embryos and genetically screen embryos before a woman Is pregnant to help know ahead of time about the health of the embryos or help us to select the best embryo or the healthiest embryos, to begin with. That is making a major difference in the success rates of IBF and helps us with selection a lot. Those are some of the major advancements I'd say. Definitely applications of testing and screening early with things like AMH. Or hopefully, allowing us to meet women earlier in the process so we can have more for fertility preservation or freezing eggs or freezing embryos so that we can outline and kind of preserve everybody's options earlier in life.