The Fertility Factor: A Conversation With Dr. Janet Choi
In honor of National Infertility Awareness Week (April 19-25), our CEO Sarah LaFleur sat down with Dr. Janet Choi, an NYC-based reproductive endocrinologist.
When it comes to preserving and optimizing fertility, women today have more options than ever before. And yet, there are still so many misconceptions about how (and when) to take action on this front. Our colleague, Rachel Flynn, bravely spoke about her struggle with infertility in a previous M Dash post, and I’ve also had my share of challenges, which I spoke about in a podcast for the Wall Street Journal. Over the past two-and-a-half years, I’ve been through three rounds of IVF and a host of treatments, including induced menopause. There’s an ending to this (which I’ll share in a future post), but the doctor who was there for me through thick and thin was Dr. Janet Choi at CCRM. She is a rare combination of warm and caring, but also direct and fact-based.
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It’s not like your ovaries automatically drop off a cliff when you turn 35. But when you look at trends as women go from 30 to 35 to 40, you do see a decrease in normal monthly pregnancy rates—or what doctors call “fecundity.” So for a typical woman at age 30, I’d say there’s a 15-20% chance of getting pregnant each month. At 35, it’s more like 14-15% per month. At 40, it might be 8-10% per month. So 35 is just a reference point for when your fecundity may begin to decrease more rapidly. And that’s because your egg quality and supply decreases as you age. Throughout your twenties, thirties, and forties, you constantly slough off eggs, just as you slough off skin and hair cells. Sometimes patients ask me, “How can I grow my eggs back?” The short answer is: you can’t. Once they’re gone, they’re gone.
The truth of the matter is: age impacts female fertility. But that doesn’t mean that every woman over 35 is doomed to infertility—that’s absolutely not the case.
There’s nothing we can do to fend off the natural aging process, so in your twenties, it’s really about maintaining overall health. I tell women to maintain a healthy body mass index (BMI), stay up to date on their vaccines, and if they’re sexually active, use condoms to protect themselves against sexually transmitted infections, which can adversely affect their natural fertility down the road. And definitely avoid smoking, or if you currently smoke, try to stop as soon as possible. There is data that suggests smoking may cause you to lose eggs at a faster rate, and smokers may hit menopause at a younger age than women who don’t smoke.
I hear the same refrain a lot: “My boyfriend doesn’t understand why I’m so stressed and why I’m in tears every month I get a period. He thinks I just need to relax.”
I hear the same refrain a lot: “My boyfriend doesn’t understand why I’m so stressed and why I’m in tears every month I get a period. He thinks I just need to relax.” And I tell these patients, “Just bring your partner in, and I’ll smack him around for you—figuratively, of course.” I try to speak to men in a very measured way, so they understand that just because some men become fathers into their fifties, sixties, and seventies doesn’t mean women have that flexibility. There are also lots of studies showing that as guys get older, their sperm is not as robust. So it might behoove men to start thinking about having families sooner—not just because of their female partners’ fertility timeline, but because of their own biologic factors. The American Society for Reproductive Medicine has some good resources that can help couples facilitate this conversation and get the ball rolling.
There’s no one “normal” anymore in terms of what’s considered a family unit. As long as the intentions are good and the drive is there, there are many ways to go about creating a family.