Welcome to POPSUGAR Uninhibited: The Fertility Edition, a space where anyone who ovulates can come for information, advice and support. Here, we’ll tackle topics like fertility in your 20s, conception and egg freezing. You can find all of the stories here.
So you’re in your peak reproductive period, you’ve decided to have a baby, and you’re excitedly picking out names. The only issue? It’s just not… happening.
While everyone knows getting pregnant isn’t straightforward, we generally associate problems with fertility with people who are older. General consensus is that for women and people who menstruate (PWM) fertility peaks in their late teens and early 20s, before gradually declining.
This means if you’re trying to get pregnant in your 20s, age is on your side. However, there are several factors that can lower your fertility in your 20s, according to Dr Elizabeth Maxwell, who is the clinical director of IVF Australia in Woolongong. Thankfully, though, there are almost as many ways to address them.
“All of the factors that can affect couples in their 30s and 40s can affect people in their 20s. They are less common, but they can still occur,” Dr Maxwell tells POPSUGAR Australia. In her practice, she sees “low egg count, irregular periods, blocked fallopian tubes, and sperm problems, to name just a few.”
With this in mind, we got advice from Dr Maxwell and obstetrician and gynaecologist Dr Kristina King to understand obstacles to pregnancy in your 20s, and what you can do to boost your fertility.
Pregnancy Is Not Straightforward
Understanding the complicated mechanics of pregnancy can help ease some of the anxiety around not immediately falling pregnant. According to the British Medical Journal (BMJ), one in six couples experience a delay in conception, with 75 percent of couples who conceive conceiving in six months, and 98 percent conceiving in 12 months. Couples are only considered to be experiencing “subfertility” if they haven’t conceived in 12 months, at which point medical professionals recommend they talk to the experts, although there are some exceptions, like if you have experienced one of the below conditions or are over the age of 35.
As it turns out, conception is a complex biological feat and Dr Maxwell says that there are many misconceptions around “the basic facts” of conception. After all, by the time most people start trying, it’s been a long time since sex ed.
Related: Curious About Your Fertility? Exactly What Getting It Tested Involves (Including the Cost)
“The woman or PWM has to ovulate to produce an egg every month, healthy sperm at a certain motility [that’s movement] needs to meet the egg in the fallopian tube,” Dr Maxwell explains.
But that’s not all. The fallopian tube is between one and five millimetres wide, and in order to fall pregnant, it needs to be both open and wide enough for the sperm and the egg to meet, be fertilised and be transported to the uterus. Then, the uterus has to be healthy, to allow implantation to occur. If there are issues with any of these physical processes, fertility can be affected.
Below are the steps you can take to boost your fertility and address any potential obstacles, according to the experts.
Get Assessed for PCOS and Endometriosis
Dr Kristina King says that the most common cause of lower fertility she sees in younger people is polycystic ovarian syndrome or PCOS, while Dr Maxwell cites endometriosis as another common contributor. PCOS and endometriosis both pose challenges to young people as they both cause irregular periods and just as frequently go undetected.
According to the Royal Australian College of General Practitioners, PCOS affects between 12-to-21 percent of women and PWM of reproductive age. Because the severity of associated symptoms varies, many people with polycystic ovaries will not be diagnosed in their lifetime — it is estimated around 70 percent of people with PCOS will go undiagnosed. However, having PCOS doesn’t mean you can’t fall pregnant naturally.
“PCOS means you won’t ovulate regularly, it doesn’t mean you don’t have the eggs, it just means it’s harder to fall pregnant,” says Dr King.
Fortunately, there are some simple ways to navigate PCOS while trying to conceive, but first, you just need a diagnosis, which starts with a visit to your general practitioner.
Related: How Soon Is Too Soon to Freeze Your Eggs?
“If you have irregular periods,” says Dr King, “you should speak with your GP to make sure you’re correctly diagnosed. Not all women and PWM who have irregular periods have PCOS, but there are simple medications and measures people with PCOS can take to improve their fertility.”
Meanwhile, endometriosis affects one in 10 women and PWM, and also causes irregular periods.
“Endometriosis occurs when a material very similar to the womb begins growing outside of the womb, causing painful periods,” Dr Maxwell explains.
Endometriosis can also cause scarring of the fallopian tubes, which narrows the tube, making the passage of sperm to the ovaries more difficult. It can also trigger inflammation of the pelvic structure as well as changes in hormones, which can impact the number and quality of eggs and egg quality.
As with PCOS, Dr Maxwell says it’s important to note that just because you have endometriosis, doesn’t mean you will be infertile.
“If you have been diagnosed or suspect you have endometriosis, I recommend a management plan with your GP and gynaecologist for managing the condition and creating a plan for when you want to conceive.”
Your medical team may recommend reducing scarring by taking hormonal birth control that suppresses your periods, or undertaking laparoscopic surgery in which the endometrial tissue is removed.
Look After Your Sexual Health
Dr Kristina King says that the second major factor that can affect fertility in young people is STIs, with chlamydia and gonorrhoea being two common infections that lower fertility in people of all genders. They can also affect the mechanics of conception.
Dr Maxwell notes that the journey of sperm to the ovary is complicated — both the sperm and the egg have to travel through the narrow fallopian tube, and like endometriosis and PCOS, STIs can also cause scarring and thickening of this tube, which makes the mechanical process more difficult.
While most STIs are treatable, they often are not picked up until they have already done some damage. This means — like it or lump it — using condoms is one of the best ways to protect your fertility.
Sperm Matters
While conversations around low fertility often focus on ovaries, fallopian tubes and the uterus, sperm contributes to 40 percent of problems conceiving.
Dr Maxwell says if a cis, heterosexual couple are having difficulty conceiving, “sperm should definitely be part of the fertility investigation, it’s really important.”
Sperm is particularly impacted by lifestyle factors, and understanding how it actually functions can make a huge difference in how fast a pregnancy happens. “The lifecycle of a sperm is three months,” says Dr Maxwell. “This means that anything the person does within three months can impact its quality.”
Related: Everything You Need to Know About Ovulation and Your Fertile Window
A bout of binge drinking, recreational drug use, or an illness that involved a very high temperature will impact quality and performance, along with dietary factors are all factors which can affect sperm for three months — that is, three windows in which you may be trying to conceive. Not only is healthy sperm essential to conception, it significantly contributes to the long-term health of the child, as it’s integral to the development of a healthy placenta. Unhealthy sperm exposes you to a higher risk of miscarriage and genetic and chromosomal disorders in your baby.
Dr Maxwell recommends both parties follow an anti-inflammatory diet, like the Mediterranean diet, which is high in antioxidants, omega-3 fats, and fibre.
“This type of diet reduces inflammation and supports your immune and hormonal system, which is important for a healthy menstrual cycle, ovulation, and production of healthy eggs and sperm,” Dr Maxwell tells us.
Dr Maxwell also points to the growing body of data on the endocrine-disrupting chemicals found in plastics and pesticides. To be on the safe side, thoroughly wash fruit and vegetables, opt for paraben-free personal care products, avoid microwaving food that is stored in plastic, and switch plastic bottles for stainless steel options instead — they’re also better for the planet your children will be living on!
How Can You Improve Your Fertility in Your 20s?
Taking care of your reproductive and sexual health is number one, with STIs and conditions like PCOS the leading cause of low fertility in your 20s. If you’re in a cisgender, heterosexual relationship and trying to conceive naturally, remember that both parties need to take care of their health. Starting your fertility journey as soon as you’re able to be a smart idea, so you can identify these issues early.
