Planning future children
A guide to having kids (or not) on your terms
Dr Tharni Vasavan, BSc (hons), MSc, PhD
Last medically reviewed 16.05.22
Dr Tharni Vasavan, BSc (hons), MSc, PhD
BSc (hons), MSc, PhD
What is ovarian reserve?
We’re all too familiar with the loud ticking of our biological clocks. But what does it actually mean? And how many eggs does a woman have? It all boils down to your ovarian reserve. Let’s take a closer look.
Your fertility (ability to conceive a child) will depend on different aspects of the reproductive system playing their part. The release of an egg from your ovary (ovulation) is one of the most important factors for a successful pregnancy. Your ovarian reserve is the number of eggs in your ovaries that can be successfully fertilised. If you’re biologically female, also known as assigned female at birth (AFAB), you will have been born with all the eggs you’ll ever have. With each menstrual cycle (your period), you’ll lose some eggs, until you reach the menopause which marks the end of your ovarian reserve and reproductive years.
The number of eggs you have start to decline after birth and by the time you reach puberty, you will have about a quarter of what you originally started off with.4 Whilst you may read stats about how many eggs you’re estimated to have at any given age, the most important thing to understand is that the size and quality of your ovarian reserve (and how much this declines with age) varies hugely from one person to another. This is partly why some people are able to get pregnant at the age of 40 without help, whilst others struggle to get pregnant in their 20s.
Whilst there is still some debate amongst doctors about whether a scan or an Anti-Müllerian Hormone (AMH) blood test is the most accurate way to check the size of your ovarian reserve, an AMH test is definitely the least invasive way of finding out. AMH is produced by the follicles that contain your eggs and is a good indicator of egg count, unless you have a condition where you have excess follicles such as PCOS.5 Unfortunately, there is no test for egg quality, however there are tests that can detect chromosomal abnormalities in eggs fertilised by IVF.
Testing your ovarian reserve alone isn’t enough to determine if you are fertile; many other aspects of your reproductive and general health need to be working in order to have a baby. This is why the Hertility at-home hormone and fertility tests do not measure AMH by itself.
Instead, our online health assessment works by taking your medical history along with symptoms and lifestyle to create a personalised at-home hormone test just for you. This allows us to assess your ovarian reserve, overall reproductive health and flag whether you may have an undiagnosed condition that could affect future fertility, such as PCOS, menopause, hypothyroidism or hypothalamic amenorrhea - in just 10 days. In fact, we’ve supported 29% of our Hertili-team community on the journey to getting a diagnosis for a previously undiagnosed reproductive health condition.
Could your medical history affect your fertility future?
Understanding your medical history helps us to check whether you have a previous diagnosis that may affect fertility, or whether there are any aspects of your health, such as your menstrual cycle function, symptoms, biometrics, STI history and lifestyle, which could indicate or eventually cause an underlying health condition or hormonal imbalance that affects fertility. This gives you the opportunity to either treat these issues so you’re at your optimal health when you try for a baby, or adjust your timeline for having children accordingly.
Being diagnosed with a reproductive health condition can affect your fertility in a variety of ways. PCOS or thyroid conditions can lead to problems with ovulation whereas conditions like endometriosis, fibroids or pelvic inflammatory disease (PID) may cause structural changes or scarring in the Fallopian tubes or uterus which can prevent the fertilised egg from travelling or implanting to make a pregnancy. This is referred to as structural infertility. Take a look at the FAQs to see how hormonal contraception and STIs could also be important to consider when planning future babies.
Whilst it is possible to have a reproductive health condition and not have any issues with fertility, it’s important to acknowledge that it might become a barrier to getting pregnant and that you might need to plan ahead and take action before trying to conceive. Each person’s condition and how it impacts them is different, however some examples of treatment include medication, surgery or fertility treatment (more on this below). At Hertility, we’re building a science-backed eco-system of care around every woman. So whatever your results, we have answers and can provide quick referrals to additional blood tests, pelvic ultrasounds or surgery if required.
The impact of your current lifestyle on your fertility
Research shows that the way you choose to live your life today could impact your chances of successfully conceiving in the future. Although the egg which gets ovulated is chosen during the first half of the month (the follicular phase of your menstrual cycle), the maturation and development process of this egg actually starts almost a year prior.6 Therefore, factoring in time to lead a healthy preconception lifestyle before you’re ready to start trying for a baby will give you the best chance to develop healthy eggs and therefore a healthy pregnancy. Take a look at the FAQs to see how certain lifestyle choices such as smoking, drinking, stress, sleep, exercise and nutrition could affect your ovarian reserve and/or your reproductive health.
Test your fertility
How to make sure you don’t leave it too late
Unless you’ve already gone through menopause, it’s impossible to know if you have waited too late to try for a baby, or investigate your fertility. We believe everyone should take a proactive approach to family planning, whether you want kids, or not.
Check your ovarian reserve with an at-home test
Take our online health assessment and receive a personalised hormone blood test and comprehensive report from a private gynaecologist without leaving the house.
Rule out having a reproductive health condition
Hertility at-home tests can signpost 9 of the most common gynaecological conditions which impact fertility, such as PCOS, hypothalamic amenorrhea and thyroid imbalances.
Take action to treat any potential fertility issues
Quick referrals to specialist care for pelvic ultrasounds, fertility counselling, nutritional support, or fertility and egg freezing treatment if required.
Don’t waste your time or your money
Forget lengthy waiting lists. Get answers (or an action plan to investigate further) in 10 days. Private fertility clinics cost over £1,200 but we’re making it accessible with our £149 test.
The takeaway? Forearmed is forewarned. It’s best to know if something is not quite right so you can take action before it’s too late.Start your assessment
If your Hertility test leads to you being diagnosed with a condition that may affect your future fertility, we can also guide you through a management or treatment journey to improve your quality of life and maximise your chance of getting pregnant when you’re ready to start trying. One size does not fit all, but some examples of ways we can help include surgery if you have a condition that causes structural infertility (e.g. endometriosis or fibroids), treatment to resolve a cause of irregular ovulation (e.g. an underactive thyroid or hypothalamic amenorrhea), and nutritional advice to optimise your preconception health.Start health assessment
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FAQS about fertilityStart health assessment
In short, yes. This is because the changes in the quantity and quality of eggs play the biggest role in why getting pregnant gets more difficult as you get older. An AMH test is one of the most accurate ways to check the size of your ovarian reserve.
A common question we get is, how many eggs does a woman have? Biologically speaking, after around 37 years old, you lose substantially more eggs with each menstrual cycle compared to when you were younger. Your doctor would describe this as your ovarian reserve or fertility decline being faster. At around the same time, the quality of your eggs also declines more rapidly due to chromosomal abnormalities (changes in your eggs’ DNA). This means that your eggs are less likely to get successfully fertilised and/or implant into your uterus and are more likely to end in a miscarriage or a baby with a genetic anomalies (such as Down’s Syndrome). It’s also important to note that chances of success with IVF will also decrease with age.
It’s important to remember that successful conception is just the beginning and a healthy pregnancy and birth requires a healthy mother. The Royal College of Obstetricians and Gynaecologists (RCOG) views you as having an advanced, or older, maternal age as soon as you hit 40 years old and after this age, your pregnancy is considered to be riskier as you are more likely to experience conditions such as high blood pressure and diabetes whilst you are pregnant as well as being more likely to have complications for both you and the baby during childbirth.
Female fertility is only half the equation, and whilst it is less commonly discussed, men also have a peak age of fertility and experience a fertility decline as they get older. Although some men will produce sperm and be fertile their entire life, there is evidence that factors such as sperm count, morphology, motility and DNA integrity significantly declines with age, particularly after 40.
Depending on the type, your use of hormonal contraception may temporarily suppress your ovarian reserve and it can take several months for both your ovarian reserve and periods to return to what is normal for you. So, whilst there is no evidence to suggest that hormonal contraception can impact fertility in the long term, it’s worth knowing your body may need time to get back to normal when planning future pregnancies.
Your STI history may also play a part in your fertility. This is because some STIs such as chlamydia and gonorrhoea can impact your fertility by causing scarring in your reproductive organs. This is particularly true if you have repeated and/or infections were treated late. If you are sexually active (espeically with multiple partners), it’s a good idea to do regular STI checks to keep an eye on it and act fast if you do get any infections.
Cigarette smoking has been associated with infertility in both males and females with the evidence showing that smokers have a smaller ovarian reserve and poorer reproductive function. Both of which lead to taking a longer time to conceive and reaching menopause at an earlier age. Use of cannabis has also been shown to affect reproductive function and could therefore impact your ability to conceive in the future. It is therefore recommended to steer clear of smoking both tobacco and cannabis as part of preparing your body for future pregnancies.
Whilst some of us tend to reach for a glass of wine to relax, regularly drinking alcohol and binge drinking has been shown to impact reproductive function by affecting the hormones that control your egg maturation, ovulation and overall menstrual cycle. As part of preconception care, it’s best to keep your alcohol intake to a minimum or avoid it completely if you want to give yourself the best chance of success of conceiving in the future.
A life full of stress is known to have a negative impact on your mental health and we now know that mental health and reproductive health go hand in hand, with each heavily influencing the other. High levels of stress have been linked to decreased pregnancy rates in women who undergo IVF as well as causing conditions which disrupt ovulation such as hypothalamic amenorrhea. So if you’re wanting to get yourself in the best position to prepare for a successful pregnancy, take a look at your current lifestyle. Are you currently under a lot of stress? Our in-house fertility counsellor is on hand to support you and your mental well being?
We’ve all heard of beauty sleep but how important is sleep for your reproductive health? Well, very important. Sleep is needed to stimulate the release of many of your reproductive hormones, so too little or disrupted sleep can impact your menstrual cycle and therefore fertility. Sleep deprivation has also been linked to changes to levels of menstrual cycle-related hormones such as FSH, LH, progesterone and estradiol. So, if you’re looking for ways to optimise your chances of success for future baby making, make that 8 hours of sleep a night a priority.
When it comes to exercise, it’s not actually a case of the more the better. Whilst moderate physical activity has been shown to have a positive impact on your fertility and success rates for women undergoing IVF, over-exercising or not eating enough calories can also put you at risk of a condition called hypothalamic amenorrhea causing your periods to stop completely. So, when it comes to exercise, the key is to not overdo it.
What you eat and how much you eat is also a big part of preconception care. Just as being underweight can cause issues, there is also evidence that being significantly overweight can affect your fertility too. Recently, exposure to some chemicals (known as endocrine disruptors), such as heavy metals (like lead and mercury) and certain pesticides, have been shown to affect reproductive health so it’s important to be mindful of what and how much you're putting into your body to avoid impacting your reproductive health.
Menopause is confirmed in women over 45 years old when they have not had a period for over 12 months whilst not on hormonal contraception. However, at least 1 in 100 women under 40 years old will actually undergo menopause prematurely so if you have symptoms of menopause such as irregular periods and hot flashes, it’s best to check by measuring your Follicle-Stimulating Hormone (FSH) levels. Our at-home tests will check in on your FSH levels along with other hormones which are known to indicate a diminished ovarian reserve and menopause, such as Anti-Müllerian Hormone (AMH), Luteinising hormone (LH) and Estradiol.