Conversations to have about your fertility — even before trying to have kids

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Asking the right questions can make a world of difference in your reproductive health.

by Dr. Rashmi Kudesia, Reproductive Endocrinologist at Houston IVF


For decades, the general societal advice around reproduction for women in the U.S. has been something like this: Value abstinence throughout your teens and even your early 20s; once you become sexually active, use safe sex practices and contraception; focus on your career and establishing your profession (maybe becoming a #girlboss!); and somewhere along the way, when the right circumstances fall into line, if you feel like it, start a family. Even for women in more socially conservative communities, conversation around sexuality and the reproductive system is generally very restricted until marriage.

This narrative has done women a disservice in so many ways — but from my perspective as an infertility specialist, it carries a dangerous and inaccurate sub-text: Fertility is not something to worry about until you’re ready to have a child, and technologies like egg freezing and in-vitro fertilization (IVF) can make your goals available on demand.

Fortunately, more and more women, reproductive healthcare providers and savvy organizations are working hard, especially via social media, to correct the inherent errors in that message. That’s where the #SaytheFword campaign comes in, and it’s a message I could not believe in more strongly. So. All of that said, what are the conversations all women should be having about their fertility?

1. Talk about your period. 

Many important medical conditions like endometriosis and polycystic ovary syndrome (PCOS) are diagnosed very late, partly due to women not having a good barometer of what constitutes a “normal” period! Talking to your mom, aunts, sistersfriends, and of course your gynecologist can help you gain a clearer sense of whether you are experiencing abnormal symptoms — and if so, whether they can be alleviated! Symptoms such as the period changing significantly, not coming every 21–35 days, or causing debilitating pain should all be checked out.

2. Decide which forms of contraception are really best for you

Contraception is not one-size-fits — all! Your choice should be based on your symptoms, physiology and priorities. Make sure you get thorough counseling about the pros and cons of your choices, and pick something that fits your lifestyle. For many young women, a long-acting reversible contraceptive like an intrauterine (IUD) or implantable device is an extremely effective, low side effect and long-term solution.

3. Understand the natural course of female fertility

I have the unfortunate responsibility to inform countless women each month that their chances of a spontaneous healthy conception once they’re past age 40 is in the single digits, percentage-wise. Though many women in their 40s can and should become moms (even first-time moms!), it is important for all women to understand that the natural ability to get pregnant each month starts declining in our 30s, more precipitously after age 37 or so, as the miscarriage rate goes up. If you’re in your mid-30s and looking to have children in the future, it may make sense to consult with a fertility specialist to hear the stats, understand what fertility preservation options exist and decide if they may be right for you (and, no, I don’t tell every woman that asks that she should freeze her eggs!)

4. If you’re an LGBTQ person or single, think about your family-building options.

For many of my patients who don’t have immediate access to eggs, sperm, and a uterus, it is frustrating that starting a family often requires a more medicalized method of conception. Unfortunately, insurance is often even less helpful than it is for heterosexual couples with infertility diagnoses. That being said, there are many options for starting a family, and talking to friends in a similar position can help you become familiar with the landscape before the time comes. This can be helpful when weighing decisions like whether to use anonymous or known donor sperm for lesbian or single women, or for transgender individuals, options for preserving future fertility in the context of medical or surgical gender affirmation treatment.

5. Understand what you should do when you’re getting ready to “start trying”.

Many of the healthy lead-ups to conceiving can (and should!) happen before you actually start trying — but most women won’t know this unless they talk to a friend or physician about it. Starting a prenatal vitamin, getting up-to-date on your routine preventative health, considering genetic carrier screening for you and your partner to increase the chance of a healthy child, discussing possible harmful lifestyle or environmental exposures, optimizing your weight, nutrition and/or any ongoing medical problems — these are all things that should ideally happen before you start trying. My patients find it very frustrating when they come to see me and are already dying to be pregnant, and I tell them that for their own health, and that of their future children, we have to postpone treatment to address these types of issues. Discuss how to become your healthiest self ahead of time!

6. Understand when should you seek help getting pregnant

I find that many couples don’t agree on the right time to seek help, and this leads to anxiety and bickering that no one needs. In general, if you suspect there is an issue relating to ovulation (your periods are irregular), Fallopian tubes (history of pelvic inflammatory disease), or sperm count (childhood history of undescended testes), or you have any cause for concern over the health of your potential pregnancy, it’s always recommended to meet with a reproductive specialist early in the process. Otherwise, if you’ve tried for more than a year with unprotected intercourse without conception (or 6 months if you’re 35 or older), you should seek assistance. The reason it’s helpful to discuss this with friends is that though infertility is incredibly common (probably one in every seven or eight couples), it’s not highly discussed (#SaytheFword!), and having an informal (or structured) support group can help you manage any anxiety you could be having. This network can also help steer you toward doctors that will treat you kindly, holistically, and not push you toward a treatment plan that’s not right for you. A personal recommendation goes a long way.

Understanding and knowing your body is a process that happens over years, so don’t feel pressured to think about all of this right now. Try starting a conversation with a friend about the topic that feels most relevant to you — you could be surprised by what you both get out of it. Hopefully, by opening up to each other, sharing knowledge, and gaining support, we’ll start to steer the societal dialogue around women’s health and reproduction in the right direction.

This blog was written by Dr. Rashmi Kudesia, a Reproductive Endocrinologist at Houston IVF, in support of the #SaytheFword initiative to increase the number of conversations women have about fertility and reproductive health.