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Deborah Howell (Host): You know, just like your body changes over time, so does your fertility. Today, we'll be talking with Dr. Jennifer Hirshfeld-Cytron, a reproductive endocrinologist at Fertility Centers of Illinois as we examine fertility in our 20s, 30s and 40s, including potential obstacles and ways to boost our fertility.

This is the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Hirshfeld-Cytron, it's so nice to have you with us today.

Dr Jennifer Hirshfeld-Cytron: Well, thank you so much for having me.

Deborah Howell (Host): The pleasure is all ours. Let's jump right in. How does age impact a woman's fertility potential?

Dr Jennifer Hirshfeld-Cytron: Probably more than anything else, age impacts our fertility and probably so many other ways in our life. Forty is the new 50, 50 is the new 60, but our ovaries have not caught up to that. And so, age really dictates probably more than anything else our likelihood of conceiving with and without treatment.

Deborah Howell (Host): Okay. That's putting it on the line and let's get even more real. What are the chances of conception for a 20-year-old versus a 30-year-old versus a 40-year-old woman?

Dr Jennifer Hirshfeld-Cytron: So peak mother nature fertility for someone in their 20s is probably about 25% will conceive every month, and that's our ceiling, which I think really sets the stage for human reproduction. You could argue it's not as robust as some may think. So if 25 is the ceiling, when we're 30, it's probably about 12% to 15% per month. And when we're 40, that number is probably more towards 5% to 8% per month.

Deborah Howell (Host): Wow. Okay. Now, when trying to conceive, at what point can a woman be diagnosed as infertile and does it change depending on age?

Dr Jennifer Hirshfeld-Cytron: It absolutely changes depending on age. Just like when we were in school, there's a bell curve. And this bell curve has been determined by looking at many populations through time, engaging what is the average number of months it would take to conceive. And when you fall outside the bell curve, sort of kind of 15% higher than what's considered normal where 85% to 90% of couples have already conceived, that puts someone who's less than 35 after a year of unprotected intercourse. And for those greater than 35, it's six months.

Deborah Howell (Host): And are there diagnoses that are more common in women over 35?

Dr Jennifer Hirshfeld-Cytron: Probably the diagnosis that's more common for women over 35 is related to age-factor infertility.

Deborah Howell (Host): Now, sort of a heartbreaking question, but we got to ask it because we're trying to get the information out there. How does age factor into pregnancy loss?

Dr Jennifer Hirshfeld-Cytron: So as we get older, women are born with a fixed number of eggs. And those eggs are depleted most substantially in our fetal life. Then, when we are born, every month. And so because we are born with a fixed number of eggs, the egg that ovulates when I'm 39 has been with me since I was born. And so its ability to do its function, which is to combine with sperm in such a way to minimize risk of miscarriage, becomes more complicated as you get older. And so yes, age impacts pregnancy loss.

Miscarriage rate for those conceiving on their own in our mid-40s, probably one in two. In our twenties, it's probably about 15%. So not only do the number of eggs deplete, but their quality depletes with time.

Deborah Howell (Host): Sure. That makes sense. All right. Now, how do lifestyle choices play a role in fertility?

Dr Jennifer Hirshfeld-Cytron: Well, we've spent so much time talking about age, but none of us as of now has the capacity to change our age, but we can change how we live our lives. And so, the things that we can control can absolutely matter. So it's a hundred percent important to be of healthy weight. And so that involves, for most of us, doing something physical, some type of movement 15 to 20 minutes a day. It does not have to be an intense HIIT class. It could simply be walking, dancing, yoga. To try to eat really healthy in such a way that we get most of our calories from fruits and vegetables. We eat the color of the rainbow, that's how we take in so many great antioxidants. We avoid things that are toxins in our environment, tobacco, cannabis, excessive alcohol, excessive caffeine. To live in moderation and to be of healthy weight and to be active, those sort of things can absolutely impact and those are things we can control.

Deborah Howell (Host): Say a woman has not been the healthiest, in terms of her habits, if a woman of reproductive age adopts healthy habits, can it improve egg quality and fertility?

Dr Jennifer Hirshfeld-Cytron: If a woman of reproductive age has been overweight or obese and is able to become of a healthy weight, absolutely. Can we see an improvement in pregnancy success, a diminishment in miscarriage? So I think it is important because it shows that those actions can make a difference. And same with tobacco use. Quitting tobacco of any capacity that's been done in the past. We have further insults. So if you think about all of these things like toxins in our environment and so many people want to take supplements to minimize toxins, but what's even better than taking supplements to minimize our toxins is to stop the toxins, which is easier said than done. None of these things are easy to do. It's absolutely not easy to lose weight. It is absolutely not easy to quit tobacco use. But it can make a difference, so that's why it's important to know.

Deborah Howell (Host): And you mentioned cannabis use as well. Can you explore that a little bit more for us?

Dr Jennifer Hirshfeld-Cytron: So in the context of cannabis, and I would say the challenge is a lot of these studies come from a time when cannabis was not legal. So this additives within cannabis or the marijuana product at that time may not be a hundred percent reflective now, as it's more legal, particularly in Illinois. Cannabis is felt overall to be more impactful for sperm quality, but potentially for egg quality. It is something that, once pregnant, I would avoid because of concerns about health and safety in pregnancy. So it's probably more of a factor once pregnant than the capacity of fertility for women and for egg health, but still in that category of something that we can control and change.

Deborah Howell (Host): This is getting into the weeds a little bit, but what about CBD oils and bombs? Because so many people use those these days.

Dr Jennifer Hirshfeld-Cytron: I think it's hard to correlate CBD oils with cannabis. And I think the challenge is whether it's a CBD oil or it's a supplement you get online, is those additives in the CBD oil or the supplement aren't regulated, so nobody truly even knows what's in the product that you're taking. And once pregnant, I think the rule of thumb is less is more.

Deborah Howell (Host): Yeah. Enough said. Okay. What are some of the options for women who want to get pregnant later in life?

Dr Jennifer Hirshfeld-Cytron: So I think what's really wonderful and exciting is that there are treatments. I mean, we've spent so much time, it sounds so dreary, on what age does. But being proactive, so if you're someone in your late 20s or 30s and you've already decided that you want to delay childbearing to your late 30s or 40s, then pursuing options, theoretically, like egg freezing. If you're somebody who is over 35 and has attempted to conceive for six months without success, it really is important to see someone. I think people spend a lot of time internally concerning that they haven't coordinated intercourse correctly, or they haven't taken this supplement correctly. But there's such a power in knowledge, and the knowledge can be obtained by doing infertility testing. And so I just think it's being mindful of saying, "Where do I fall on this spectrum? Let me get the testing. Let me learn about the options," because it's not just in vitro fertilization, which can be a wonderful choice. There are other options that exist, and I think the most important piece is to see someone to get the testing and to learn how you uniquely could be.

There's so much value in seeing someone if you're less than 35 and it's been a year, or you're greater than 35 and it's been six months. So you can do the testing, you can get the diagnostics, you can learn which treatments can be most helpful to you and your partner as a couple.

Deborah Howell (Host): I was wondering if you could expand a little bit about treatments beyond IVF.

Dr Jennifer Hirshfeld-Cytron: So in IVF, I would just say it's like a huge category, whether we're doing in vitro fertilization and screening embryos. Genetic factors that can impact miscarriage is probably one of our strongest tool to negatively impact miscarriage rates with age, or it's simply doing IVF because we need a place for egg and sperm to meet, that the tube is blocked.

Beyond that large category, insemination is another alternative. Insemination is this idea how sperm bypasses the cervix and is placed into the uterus. That gives us sort of a head start and that often can be combined with medications that can optimize the number of eggs released every month. For some individuals who do not ovulate, it's about taking medicines to help them to ovulate.

Deborah Howell (Host): This is so informative. Is there a point, doctor, when women can no longer get pregnant, even with fertility treatments?

Dr Jennifer Hirshfeld-Cytron: There unfortunately is a point where our fertility treatments become futile. I think every treatment that you do, every medication that you take, we really want to make sure that the risk outweighs the benefit. It doesn't matter if it's fertility medicine or heart disease. I mean, that's sort of the adage of medicine, is to do no harm.

And so sometimes it's having those very candid conversations where for some women, based on their reserve, they may not be responding to any of the medications or someone in our mid to late 40s, we see really low success with IVF using your own eggs. Many clinics actually have an age cutoff, probably around 45.

And I would say it's not that you can't get pregnant, but potentially you're getting pregnant in a way you hadn't envisioned. Maybe you're utilizing egg donor or embryo donation or something more outside the box that had been envisioned. I think it really is important to have those candid conversations with your fertility physician, so you know what is my likelihood of success. And one of which is at a time that maybe I'm outside that expectation of success and there may be other treatments that would serve me better.

Deborah Howell (Host): As you said, there's just a litany of brand new things evolving every day in this sector. And it's a really exciting time to be in the field, I would imagine.

Dr Jennifer Hirshfeld-Cytron: Yeah, absolutely. there's nothing better. The highs are so high. I mean, the lowest can be low. The highs are so high and being able to help couples have families, single women, single men, same-sex women, same-sex men, heterosexual couples. Everything to expand and have a family is just such a gift. It never gets old. It is amazing each and every day.

Deborah Howell (Host): I can hear it in your voice, your passion for this. Is there anything else you'd like to add to our conversation?

Dr Jennifer Hirshfeld-Cytron: Just thanks to those that are listening. I hope this feels empowering, not deflating. Please see someone if it's been those time periods or you're just interested in learning a bit more about your own fertility and your own body. Information really is power.

Deborah Howell (Host): Well said. Wonderful information, Dr. Hirshfeld-Cytron. Thanks so much for being with us today to share your experties.

Dr Jennifer Hirshfeld-Cytron: Thank you.

Deborah Howell (Host): That was Dr. Jennifer Hirshfeld-Cytron, a reproductive endocrinologist here at FCI. And you can schedule an appointment to talk to a fertility specialist at 877-324-4482 or visit fcionline.com for more information.

And if you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do. This has been the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.