4 Questions to Ask Early About Your Fertility
CEO, Fertility Nutraceuticals
Hi! I’m Jodi Neuhauser, the new CEO of Fertility Nutraceuticals. We are a research-backed fertility company started by the scientists and IVF doctors that discovered the benefits of DHEA’s use in fertility treatment. You may know us as the makers of Fertinatal DHEA – the industry-leading DHEA supplement for fertility treatment. While we currently focus on fertility supplements, I’m excited to lead the company into our next phase, as we build a fully integrated reproductive platform.
I’m 37 and I’ve been through my own reproductive journey for the last 5 years – I’ve asked a lot, learned a lot and been through a lot. It’s taken me from New York to South Africa and back, but it’s all been worth it – as my partner Justin and I are currently expecting our first child in August.
Infertility is a topic I’m passionate about, and a topic we, as women and as couples, don’t talk enough about. This week is National Infertility Awareness Week so it’s a perfect time to start the conversation.
1 in 8 couples will have trouble getting pregnant – and 1 in 4 women will suffer a miscarriage at some point in their reproductive journey. You or someone you love has experienced this pain.
We don’t talk about infertility for lots of reasons – because it’s taboo, because it’s hard, it’s confusing and because we think we are alone.
But there’s a simple way to start – with yourself. When I began my fertility journey, I started with 4 questions I asked myself, my mom and my doctor – these are 4 questions for every woman to know about her fertility.
1. What are my fertility goals?
As women we are all faced with a reproductive decision-point in life given our body’s natural time clock. When I was in my early 30’s and super single, I started to ask – Do I want to have kids? Might I want to have kids in the future? Do I want the option to have kids (or more kids) later in life? I’m grateful that I have an amazing OBGYN in Michelle Morgan, MD who each year at my annual exam gave me a loving, yet appropriate nudge towards considering my fertility goals. Planning for your fertility future hinges on taking a moment to pause and really feel through the answers to these questions.
The team at Elanza Wellness, who poured through 3,000+ research studies on lifestyle and fertility for their book Everything Egg Freezing, have put together a free worksheet to help guide you through this process.
2. Mom, when did you go through menopause?
Getting the answer to this question can reveal a lot about your own fertility status – it can be an estimation of when you may experience it – which is important if you are starting a family later in life, like me. The Mayo Clinic defines menopause as the time that marks the end of your menstrual cycles. Menopause is medically diagnosed after you’ve gone 12 months without a menstrual period. The average age in the United States is 51, though this can vary based on a number of factors. If your mom experienced menopause early, this could be a sign that your ovarian reserve is diminishing at a faster rate.
Research shows that there is a correlation between when your Mom went through menopause and when you may do so. A 2004 Fertility and Sterility study examined the menopause heritability rate of 164 mother-daughter sample pairs, in other words, the likelihood that you inherit menopausal age from your mom. Of the 164 daughters in the sample group, almost half experienced menopause around same age as their mother. On average, the daughters experienced menopause one year earlier than their mothers.
My Mom and I had this discussion last year and I’m eternally grateful that we did – I found out that she went through menopause in her early 40’s – a piece of information that has been vital to my own fertility planning.
Note that menopause symptoms can start up to 10 years before you are officially “in menopause.” This potentially wide timespan can impact your fertility window if you’re starting a family later in life.
3. What’s my AMH level?
AMH is a fertility hormone in your body that is a proven indicator of ovarian reserve (the number of eggs you have left in your ovaries). We’re born with a set amount of eggs and lose them each month during our cycle, and at a faster rate as we get older. AMH levels (low, normal, high) are proportional to the number of eggs in your ovaries. So, if your AMH levels fall within the normal range, you’re likely working with a healthy number of eggs. Research, including this 2016 study, shows that your AMH levels (representing how many eggs you currently have left) can predict when you’ll experience menopause (when you’ll no longer have any eggs). Ultimately, AMH levels are an accurate biomarker indicating one element of your fertility, your egg count.
Dr. Morgan and I began testing my AMH levels in my early 30’s as a part of my regular annual exam blood work. I was shocked at how fast, and how far they fell over the years – especially as I approached 35. For a healthy, Ironman competitor it was eye-opening. Now, it’s super easy to test your AMH at home with Modern Fertility or Everlywell, at your doctor’s office or at clinics such as Kindbody that focus on Women’s Health.
4. What does my AMH + Mom’s Age of Menopause tell me about my fertility compared to my goals?
This is a great conversation to have with your doctor once you have both pieces of information. While your mom’s age at menopause can roughly predict when you’ll experience menopause, combining that information with your own AMH levels can more accurately predict this timing. In reality, the combo is the most powerful indicator of how fast you may need to move if having children naturally is part of your fertility plan.
In a 2013 study in Human Reproduction researchers demonstrated a significant association between a mother’s age at menopause and their daughter’s AMH levels. In the study, the daughters whose moms experienced early menopause onset (meaning 45 or younger) experienced a faster rate of AMH level decline, compared to those who said their mothers went through menopause at an average (46-54) or later (55 or older) age.
In a study a year later, researchers asked a group of 150 daughters when their mothers went through menopause. They also measured the daughters’ AMH levels. Ultimately, they wanted to figure out if the mother’s age at menopause or the daughter’s AMH levels was a stronger predictor of when the daughter would experience menopause. When the scientists followed up with the daughters 12 years later, they discovered the AMH measurement had done a better job of forecasting the daughter’s age at menopause than their mother’s age at menopause. Adding AMH level to a mother’s age at menopause added 47% improvement in predictive accuracy. While both pieces of information are valuable, having both will give you a more accurate predictor of time to menopause.
For me, after gathering info and consultations with medical and fertility experts, my falling AMH levels and the fact that my mom went through menopause in her early 40’s, combined with my desire to ultimately have a family with at least 2 kids – and lack of a partner at the time, led me to start my fertility journey by freezing my eggs in Cape Town, South Africa when I was 35. It was on that trip that I met my now partner, Justin and I swear we fell in love because I forgot my trigger shot on our first date. Another story for another time….
Ultimately, if you decide you do want to have kids now – or later – there are a number of steps you can take to preserve that option including egg freezing. If this is of interest, the book Everything Egg Freezing is totally worth the quick read. Once you are ready to get pregnant, your fertility at that period of time is influenced by your egg count + your egg quality. Once you have the information above there’s lots to dig into about the health of your body down to a cellular level – and how to prepare your body (especially as you get older) to mature the highest quality eggs possible, which accounts for about 95% of the health of an embryo. We’ll dig into that in another whole post.
For more information, Modern Fertility has a great post on AMH and Menopause. In the spirit of starting the conversation, I’m also happy to answer any questions, through your journey with you or share more about my own – the more conversations we can start, the less painful we can make the entire process for future parents globally.
I’m so passionate to help all of you through this journey. First, let’s start the conversation.