‘When should women start to think about freezing their eggs?’: A reproductive expert answers your fertility questions
All your fertility questions answered by the experts, from treatment options to fertility testing advice.
At our Fertility First event, our host, Síle Seoige, sat down with fertility expert Dr John Waterstone, consultant gynaecologist and founder of Waterstone Clinic, and Laura Hackett, fertility nurse specialist at Waterstone Clinic in Dublin.
They discussed all aspects of fertility, walking through the practical steps to take when starting out, and gave their expert advice on what to expect, when to have your fertility checked and what treatment options are available. You can watch the full virtual event here: IMAGE Fertility First
The guide is below, with in-depth answers to ten of the most commonly asked questions about fertility testing, fertility preservation and fertility treatment. Their expert advice will be useful for anyone already on their fertility journey and those who might be considering some forward planning.
Fertility Testing and Fertility Preservation
When should women start to think about freezing their eggs?
The short answer is as early as possible. The right time will vary from person to person and will also depend on your personal circumstances and life plans, but ideally women would start thinking about freezing their eggs in their twenties. The younger you are when you freeze your eggs, the more likely you are to have a greater number of eggs to freeze. In turn, this will increase your chances of a successful outcome from treatment at a later stage. The aim of freezing your eggs is to have the eggs available as your backup plan: hopefully, you will never need them.
If you want a family in the future, or even think you might want one, it’s really important to assess your fertility potential periodically from your twenties. That information will give you a baseline and tell you if there are any issues. Ideally, fertility health checks at a fertility clinic would be as routine as general health checks such as cervical smears. Of course, tracking your AMH isn’t the full picture and should be looked at in conjunction with an ovarian scan as these will help assess ovarian reserve and help you make decisions about your future.
If you’re not ready for a baby right now, or not in a relationship, freezing your eggs in your twenties can be a way to safeguard your future fertility. Being proactive about your fertility can make all the difference when you are ready.
Is there anything I can do about my AMH level?
You can’t change the value of your AMH, but you can change your plan to work with what you have. Your AMH level can give you a better understanding of your reproductive health and help you plan ahead in many ways. There isn’t any way to improve it, but the important thing to remember is that AMH is one piece of the fertility puzzle. Put together with a scan at a fertility clinic, it will give you important information you can use to discuss with your doctor to make informed decisions about fertility preservation or fertility treatment.
Women are born with all the eggs we’ll ever have, and because the body is very inefficient with its use of eggs, the number declines throughout our lives, and very rapidly so after age 35. While we can’t change AMH results, it’s important to keep in mind what AMH does and does not tell us. AMH gives us an insight into how many eggs are available to you in each cycle: how many are in the crop developed by your ovaries each month. A low AMH means a low number of eggs are available in each cycle, and that window of time you have to create your family may be shorter. It doesn’t tell us, however, if you will or won’t conceive. Remember too that if you do receive values that are lower than expected for your age, the quality of your eggs is also a factor, which is even more important than the number.
What are your fertility tips for males?
Male fertility can often be taken for granted. It often surprises people to know that as many fertility issues stem from men as they do women, and that is why we always recommend that couples are assessed as a couple. Semen analysis tests are simple, non-invasive and inexpensive. There is no need to be embarrassed or stay in the dark about your reproductive health.
Men are often worried about getting poor results but suppose your semen analysis test does reveal an issue with the sperm, such as low sperm count, poor motility (movement) or poor morphology (sperm shape): it’s important to know that these results can usually be improved quickly with simple lifestyle changes. The body takes about 12 weeks to produce fresh sperm, so improving your nutrition, physical activity, quitting smoking or vaping can significantly impact the quality of your sperm and lead to the development of new healthy sperm. Researchers have also seen promising improvements when men take zinc, vitamin C, folic acid, and selenium supplements and include whole nuts, spinach, and lentils in their diet. If you make these positive changes to your lifestyle, you could see improvements in your fertility in just three months. It’s also important to note that the use of certain medications, such as anabolic steroids, can drastically affect fertility and discontinuing their use, even temporarily, can have a positive impact.
An important fertility tip that is often missed for men is that their own fertility is tied to that of their partner. Age does not have the same impact on male fertility, but time and age impact their partner’s fertility. By delaying, you run the risk of not having the family together that you might hope for, should your partner have difficulty conceiving.
I am 30 but my partner and I are not planning on having children for another 5 years – are there fertility tests we should get to avoid any disappointment down the line?
Straight off, as a fertility expert I have to tell you that my best advice would be to readjust your plan. Waiting 5 years from the age of 30 for a female is just too long. I would fear that if you wait too long, you may regret it later. If you are confident that this is the best plan for you right now, then fertility testing is crucial to know where you stand. However, fertility testing won’t tell you what your fertility will be like in five years. Our best advice here is to sit down with your partner and discuss how many children you want in your future family: Would you both like more than one child? have you discussed the implications of waiting to start your family? Are you prepared to undergo fertility treatment if it’s required?
Having a fertility test now will give you an idea of how realistic your plan may be, but keep in mind that five years is a long time in fertility. Waiting until 35 to start your family, which is the age that fertility declines rapidly, could risk your dream of having more than one child.
Being aware of your fertility is always the first step, and it might be wise to explore fertility preservation to avoid disappointment later. Your results will tell you your current status and together with your doctor, you can discuss your plans and make decisions that are right for you both.
Fertility Treatment Questions
Advice on what I can do during my treatment cycle to have a positive outcome?
Fertility treatment can be nerve-wracking when there is no guarantee that the outcome will be positive. It’s completely normal to want to do all you can to influence this, but there aren’t any secret tips. Our best advice here is to know that you can’t control the outcome, but you can control how you experience your cycle. Know that you are doing the best you can and do what you can. Read over the information that the clinic gives you, follow the advice for your cycle.
In the leadup to a cycle, it’s important to make sure the maximise the opportunity you have and make any changes you would like to your lifestyle, routine or diet, to be healthier both mentally and physically prior to starting your cycle. To support this, many clinics offer counselling and I always encourage people to use these services to discuss relaxation, stress reduction, and preparing for the wait for your results, which can often be the hardest part.
All in all, remember that you are doing what you can to create your family. You and your partner are in treatment together, so take time to be together and enjoy each other’s company, away from fertility talk. You are putting in the work, and you have taken every step possible. Trust the process, trust your team, and ask any question you have: we are here to support you.
Is secondary infertility normal? What advice do you have on it?
Fertility is often thought of as an absolute, that you can either conceive or not. However, since fertility is directly related to age, it is common for a couple to conceive a child and then have trouble conceiving a second child because a few years have passed, and they are that much older starting to try.
In our Clinic, we see many people struggling to conceive their second or third child. Our best advice for people experiencing secondary infertility is to follow the same guidelines as those trying for their first baby: don’t wait too long before seeking help. If you are under 35, trying for 12 months, if you are over 35, trying for 6 months, or if you are 40 or over, see a fertility specialist. This way, you won’t lose time, and if you do need some treatment, we can get you on the path sooner rather than later.
My fresh embryo transfer was successful – is a frozen transfer for a sibling likely to be?
Congratulations! The great news here is that treatment with frozen embryos is really successful. Cryopreservation has really transformed fertility treatment. Looking back 10 years ago, about 5% of the babies born each year at Waterstone Clinic were from frozen embryo transfers. Since then, a technique called embryo vitrification revolutionised embryo freezing and dramatically increased success rates. Now, over 95% of the embryos frozen survive the freezing and thawing process, and 40% of the babies born via our Clinic each year are from frozen embryo transfers.
A good clinic with a robust freezing programme will cryopreserve the embryo safely. The embryos should offer the same chance of success as they would have had in the fresh cycle in which they were created, even years later.
Are pre-conception supplements actually useful?
Supplements are beneficial, mainly to ensure that you have enough nutrients like folate, folic acid and vitamin D (especially important, living in Ireland!) to prepare for and support a healthy pregnancy. Supplements can promote healthy sperm development, so it can be useful for men to take supplements with Vitamin C, zinc and selenium. However, an essential thing to remember is that supplements should only support our diet, and we should try to get as many nutrients from our food as possible. A balanced, healthy diet with fruit and vegetables, fish, and lean meats contain many nutrients that work together to keep us healthy, and we can’t get that same effect from a supplement. Eating well, staying active, drinking plenty of water, and keeping your BMI in the normal range will do great things for your overall health, and your supplements can then work to support that healthy lifestyle.
The absolutely essential one is folic acid. It is still often forgotten about when someone is struggling to conceive. Very few people we see are infertile, most simply have a fertility delay and I would strongly advise everyone not to stop taking the folic acid supplement: while you might become weary of taking it when you’re trying for a long time, you could still conceive naturally while waiting on treatment!
If you are moving clinics, what information do you need from your previous clinic?
This is one of the most common questions we are asked. Patients can seek second opinions or change clinics for treatment if they wish. Calling around to speak to different clinics can be very helpful, it will let you see whose approach you connect with, to explore their expertise and success rates, and to be confident in who you’d like to treat you. If you do decide to change clinics, it is really beneficial to bring your medical notes from your original clinic. Getting your notes can take a few weeks, and once you have them, you may not need to repeat all your tests. You can also move samples or embryos along with you, once all the documentation is put together by the clinics. If you don’t have your notes, a good synopsis of care letter, all test results and a cycle summary of treatment cycles undertaken are the important elements to bring with you.
What are the next steps if IVF isn’t working out?
If you’d like to continue treatments, the first step is to meet with your team to review all your cycles and make a plan together. There may be further investigations that could assist, or a change of approach. The team will review how your treatment cycles progressed, how many eggs were produced, how many embryos were produced, and the quality of those embryos. They may suggest other treatment options for you such as egg or sperm donation treatment.
It can be very challenging when an IVF cycle, or multiple cycles, haven’t been successful. There are other steps to take, depending on what you and your partner want. It can also be very helpful to talk to a fertility counsellor: we offer counselling support free of charge at Waterstone Clinic. Ask your team every question you have and then you can move forward with renewed hope, we’ll support you every step of the way.
Over the last 18 years, Waterstone Clinic has built a family of five clinics nationwide (Dublin, Cork, Kildare, Limerick and Waterford) where they provide pioneering fertility science, outstanding success rates, and exceptional care. For further information or to book a consultation visit our website or call 0818 333 310.