Essential Fertility Knowledge For Those In Their 20s: Critical Considerations For Future Reproductive Health

  • Rebecca BarryMaster of Science - MS, Medical Anthropology, University of Oxford

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Introduction 

For most young people in their 20s, their fertility status is not something that is often thought about. Unless you have been already diagnosed with a health condition that is known to affect your fertility, it is assumed that starting a family will be easily attainable. 

However, more and more individuals and couples are delaying parenthood. Perhaps career goals or other personal endeavours are taking priority over parenthood, and consequently, it is pushed back to later in life.

While this is not necessarily a bad thing or something to avoid, it is worth being aware of how fertility changes throughout your life.1 Fertility declines with age and can be affected by environmental factors, so being aware of this can help to ensure that if starting a family is something you intend to pursue, you have optimal chances. 

Therefore, in this article, we look at the biological peak and fall of fertility over the life course. We also look at environmental impacts on fertility, including suggesting some ways to reduce the chances of your fertility declining prematurely as a result of lifestyle factors. We also briefly look at some reproductive technologies that could be utilised if fertility struggles are anticipated. 

How does your fertility status change through your life course? 

Fertility status changes throughout life due to various biological, environmental, and lifestyle factors. Understanding these changes is crucial for making informed decisions about family planning and reproductive health. 

1. Fertility in the 20s

  • Biological peak: Fertility is typically at its highest during the early to mid-20s. Women have the largest number of healthy eggs, and ovulation (the monthly egg release) is generally regular. For men, sperm quality and quantity are usually optimal
  • Egg and sperm quality: In this period, eggs are less likely to have chromosomal abnormalities (which can cause health conditions in children), and sperm motility (the ability of sperm to move efficiently) is generally strong, contributing to higher chances of conception (sperm meeting egg)2,3

2. Fertility in the 30s

  • Gradual decline in egg quantity and quality: For women, fertility begins to decline in the early 30s and more significantly after age 35. The number of eggs in the ovaries decreases, and the risk of chromosomal abnormalities in eggs increases (increasing the risk of genetic abnormalities in children)
  • Decreased sperm quality: While men can remain fertile into older age, sperm quality, including motility and morphology (shape), may begin to decline slightly in the 30s. Usually, this decline in fertility is less pronounced in men than women
  • Increased risk of miscarriage and complications: As women age, the risk of miscarriage and complications during pregnancy, such as gestational diabetes or preeclampsia, increases due to the decline in egg quality and other health factors2,3

3. Fertility in the 40s

  • Significant decline in female fertility: For women, fertility continues to decline sharply in their 40s. By age 40, the chances of conceiving naturally each month drop significantly, often to around 5-10%
  • Menopause: Women typically reach menopause (the end of a woman having menstrual cycles) between the ages of 45 and 55, marking the end of their natural reproductive years. Perimenopause, the transitional phase leading up to menopause, can begin in the early 40s, characterised by irregular menstrual cycles and further reduced fertility
  • Male fertility changes: While men can still father children in their 40s and beyond, sperm quality tends to decrease further, with lower motility and an increased likelihood of DNA fragmentation, which can affect the chances of conception and the health of the child2,3

4. Fertility in the 50s and beyond

  • Post-menopausal stage: Women are typically not fertile after menopause. While some women may still ovulate occasionally during perimenopause, the chances of natural conception are very low
  • Male fertility in later years: While men may still produce sperm into their later years, the quality and quantity continue to decline, and the risk of genetic mutations in sperm increases, which can lead to a higher risk of birth defects and other complications in offspring2,3

Why does fertility change through life? 

  • Natural ageing process: The primary reason for changes in fertility is the natural ageing process. In women, the number of eggs is finite, and they are gradually depleted from birth until menopause. The quality of these eggs also declines with age, leading to reduced fertility and increased risks of complications. For men, while sperm production continues throughout life, the process becomes less efficient with age, leading to a gradual decline in sperm quality
  • Hormonal changes: Hormonal fluctuations play a significant role in fertility changes. In women, levels of hormones such as estrogen and progesterone decline with age, affecting the menstrual cycle and ovulation. In men, testosterone levels gradually decrease with age, which can impact sperm production and sexual function
  • Cumulative effects of health and lifestyle: Over time, factors such as diet, exercise, stress, environmental exposures, and overall health can accumulate and impact fertility. Conditions like obesity, smoking, and excessive alcohol consumption can further reduce fertility
  • Increased risk of medical conditions: As people age, the likelihood of developing health conditions that can affect fertility, such as type 2 diabetes, increases. These conditions can complicate conception and pregnancy. Ensuring you adopt healthy behaviours from a young age can reduce this risk1

How can we use this knowledge with regard to family planning? 

  • Early planning: Understanding how fertility changes over time can help in making informed decisions about when to start a family. For those who may want to delay childbearing, options like egg or sperm freezing can be considered
  • Regular health check-ups: Regular reproductive health check-ups can help monitor fertility status and catch potential issues early, allowing for timely interventions
  • Awareness and education: Being informed about the natural changes in fertility and how lifestyle choices impact reproductive health can empower individuals to take proactive steps in managing their fertility throughout life

In summary, fertility status changes significantly throughout life, primarily due to the natural ageing process, hormonal shifts, and lifestyle factors. Understanding these changes is crucial for making informed decisions about reproductive health and family planning.

What lifestyle factors can we control to help optimise fertility? 

Optimising fertility involves adopting a healthy lifestyle that supports reproductive health. Several factors can influence fertility in both men and women and making positive changes in these areas can enhance the chances of conception. 

1. Healthy diet and nutrition

  • Balanced diet: Consuming a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can support overall reproductive health. Nutrients such as folic acid, iron, zinc, and omega-3 fatty acids are particularly important for fertility
  • Antioxidants: Foods high in antioxidants (like vitamins C and E) can protect eggs and sperm from oxidative stress (and therefore damage), which may improve fertility
  • Maintain a healthy weight: Being underweight or overweight can negatively affect hormone balance and ovulation in women and sperm quality in men. A healthy body looks different for everyone, and there is no one size fits all, but prioritising health habits to feel good, fit, and nourished is key

2. Regular exercise

  • Moderate exercise: Engaging in regular, moderate exercise (such as walking, swimming, or yoga) helps maintain healthy body functioning and reduces stress, both of which are important for fertility
  • Avoid over-exercising: While staying active is important, excessive or intense exercise can disrupt menstrual cycles in women, and lower sperm production in men. It’s crucial to find a balance that promotes overall health without overtaxing the body. If a woman over-exercises consistently, she risks losing her period and most likely will be unable to get pregnant during this time, as well as suffering other health complications

3. Stress management

  • Mind-body practices: Practices like mindfulness, meditation, deep breathing exercises, and yoga can reduce stress levels, which in turn can support reproductive health. Chronic stress can disrupt hormone levels and ovulation in women and reduce sperm quality in men
  • Adequate sleep: Getting 7-9 hours of sleep per night helps regulate the hormones that are critical for fertility, including those involved in ovulation and sperm production

4. Avoiding harmful substances

  • Smoking: Smoking is linked to reduced fertility in both men and women. It can damage eggs, reduce sperm count and quality, and increase the risk of miscarriage and ectopic pregnancy. Quitting smoking can improve fertility outcomes
  • Alcohol consumption: Excessive alcohol consumption can impair fertility. For women, it can disrupt the menstrual cycle, and for men, it can lower testosterone levels and sperm quality. Limiting or avoiding alcohol is recommended when trying to conceive
  • Caffeine: While moderate caffeine intake (200-300 mg per day) is generally considered safe, excessive consumption has been associated with fertility issues. Limiting caffeine intake may be beneficial for those trying to conceive

5. Environmental and occupational factors

  • Avoiding toxins: Exposure to environmental toxins such as pesticides, heavy metals, and industrial chemicals can negatively impact fertility. Limiting exposure to these substances, using natural cleaning products, and avoiding plastics with BPA can help reduce risks. Try reducing your use of disposable plastics, perfumes, and heavy cleaning chemicals. Wash all of your fresh food produce thoroughly5,6,7
  • Heat exposure: For men, avoiding prolonged exposure to heat, such as from hot tubs, saunas, or tight clothing, is important because high temperatures can impair sperm production. The effects of heat on sperm count are usually reversible within a few months of changed behaviour6,7

6. Sexual health and safe practices

  • Regular STI screening: Sexually transmitted infections (STIs) can lead to fertility issues if left untreated. Regular screening and prompt treatment of STIs are essential for protecting reproductive health
  • Timing of Intercourse: Understanding the timing of ovulation can help in optimising the chances of conception. Engaging in intercourse during the fertile window, typically a few days before and during ovulation, increases the likelihood of conception

7. Minimising the use of hormonal contraceptives (when planning to conceive)

  • Transitioning off birth control: If planning to conceive, it’s advisable to stop using hormonal contraceptives a few months before trying, to allow time for menstrual cycles to normalise and for ovulation to become regular. It may take longer than anticipated, and this varies between women, so allowing for an extra few months of hormonal balancing can be important

8. Monitoring reproductive health

  • Tracking menstrual cycles: For women, keeping track of menstrual cycles, including ovulation signs like basal body temperature and cervical mucus changes, can help in understanding fertility patterns and timing conception attempts. There are plenty of free apps which can help with tracking
  • Regular health check-ups: Regular visits to a healthcare provider for reproductive health check-ups can help detect and manage any potential fertility issues early

9. Limiting Exposure to Endocrine Disruptors

  • Awareness of endocrine disruptors: These are chemicals found in certain plastics, personal care products, and household items that can interfere with hormone function and impact fertility. Choosing products free from these chemicals (like BPA and phthalates) can help protect reproductive health6,7

By incorporating these lifestyle factors into daily routines, individuals can significantly optimise their fertility, improving their chances of conceiving naturally and supporting overall reproductive health.

What reproductive technologies could help with fertility? 

Several reproductive technologies can assist individuals and couples facing fertility challenges. These technologies range from relatively simple treatments to more complex procedures, offering a variety of options depending on the specific fertility issue. The interventions can help at various points of the reproductive cycle.

However, it is important to note that there is often no guarantee with these technologies, which makes them relatively unreliable. They are usually a last resort for most couples, as in the UK, they can also incur very high financial costs. 

Interventions for preparatory measures/fertility preservation for the future

1. Egg freezing (oocyte cryopreservation)

  • Procedure: Egg freezing involves retrieving and freezing a woman’s eggs for future use. The eggs can be thawed, fertilised, and implanted at a later date
  • Uses: This option is beneficial for women who wish to delay childbearing due to personal, medical, or career reasons, or before undergoing medical treatments (like chemotherapy) that could affect fertility4

2. Sperm freezing

  • Procedure: Sperm freezing (cryopreservation) allows men to store their sperm for future use. The frozen sperm can be used in IUI, IVF, or ICSI procedures (these procedures are detailed later in the article)
  • Uses: Sperm freezing is an option for men who may face infertility due to medical treatments, advancing age, or those who want to preserve their fertility before undergoing a vasectomy (male sterility procedure)

3. Embryo freezing 

  • Procedure: An egg from a woman is fertilised with sperm from her male partner. This embryo is then frozen for later implantation and pregnancy
  • Uses: This can be an option if upcoming medical treatment may make one partner infertile. This can also be a form of security in the case of a healthy, fertile couple who do not intend to reproduce until later life, where age may become an obstacle to conception4,8

Interventions for increasing current fertility 

Fertility medications for women:

  • Ovulation induction: Medications such as Clomiphene Citrate (Clomid) and Letrozole (Femara) are commonly used to stimulate ovulation in women who have irregular or absent ovulation. These drugs can help increase the chances of conception by promoting the release of eggs from the ovaries
  • Gonadotropins: These injectable hormones (like FSH and LH) stimulate the ovaries to produce multiple eggs. They are often used in conjunction with other fertility treatments like intrauterine insemination (IUI) or in vitro fertilisation (IVF)4,8

Hormonal treatments for men:

  • Procedure: Hormonal treatments, such as the administration of human chorionic gonadotropin (hCG) or gonadotropins, can be used to stimulate sperm production in men with certain types of hormonal imbalances or low testosterone levels.
  • Uses: These treatments are typically used in cases of hypogonadism or other conditions where low hormone levels impact sperm production. 

Interventions in the fertilisation process

Intrauterine insemination (IUI)

  • Procedure: IUI involves placing specially prepared sperm directly into a woman’s uterus during ovulation, increasing the likelihood of fertilisation. This procedure is often used when there are mild issues with sperm count or motility, or unexplained infertility
  • Uses: IUI is a less invasive and less expensive option compared to IVF and can be used in conjunction with fertility medications to improve success rates

In vitro fertilisation (IVF)

  • Procedure: IVF is a process where eggs are retrieved from the ovaries and fertilised with sperm in a laboratory before being transferred into the woman’s uterus. IVF is one of the most common and effective fertility treatments currently available
  • Uses: IVF is used in cases of blocked fallopian tubes, severe male infertility, endometriosis, advanced maternal age, or when other treatments have failed. It is also an option for same-sex couples and single individuals who need donor sperm or eggs

Intracytoplasmic sperm injection (ICSI)

  • Procedure: ICSI involves injecting a single sperm directly into an egg to achieve fertilisation, which is then followed by the standard IVF process
  • Uses: ICSI is typically used in cases of severe male infertility, such as low sperm count or poor sperm motility, or when previous IVF cycles have failed to achieve fertilisation4,8

These reproductive technologies offer a wide range of options for individuals and couples facing fertility challenges, allowing them to choose the approach that best suits their needs and circumstances. Consulting with a fertility specialist is essential to determine the most appropriate treatment plan based on individual medical history and fertility goals. 

However, again, it is important to reiterate that currently, these technologies are expensive and unreliable, and therefore it is advised that they are not the first or only option used in fertility optimisation. 

Summary

  • Fertility peaks in your 20s and then declines with age, making conception increasingly difficult after women reach age 35
  • Lifestyle factors including a healthy diet, a regular exercise routine, avoiding toxins, reducing stress, and sleeping well all contribute to cultivating optimal fertility throughout the life course
  • Planning and allowing extra time with regard to family planning may avoid unanticipated emotional and physical struggles around conception
  • Reproductive technologies can provide an opportunity to aid fertility but come with other considerations

References 

  1. What every 20-something should know about fertility | carolinas fertility institute [Internet]. 2019 [cited 2024 Aug 12]. Available from: https://carolinasfertilityinstitute.com/every-20-something-know-fertility/
  2. Parents [Internet]. [cited 2024 Aug 12]. What to know about infertility in your 20s, 30s, and 40s. Available from: https://www.parents.com/getting-pregnant/infertility/causes/infertility-in-your-20s-30s-40s
  3. Health D of. Age and fertility [Internet]. [cited 2024 Aug 12]. Available from: http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility
  4. nhs.uk [Internet]. 2017 [cited 2024 Aug 12]. Treatment for infertility. Available from: https://www.nhs.uk/conditions/infertility/treatment/
  5. Optimizing fertility part 2: environmental toxins | british columbia medical journal [Internet]. [cited 2024 Aug 12]. Available from: https://bcmj.org/articles/optimizing-fertility-part-2-environmental-toxins
  6. Office for Science and Society [Internet]. [cited 2024 Aug 12]. Facts and myths of male fertility: tight underwear, hot tubs, marijuana, and more. Available from: https://www.mcgill.ca/oss/article/health/facts-and-myths-male-fertility-tight-underwear-hot-tubs-marijuana-and-more
  7. Impact of edcs on reproductive systems [Internet]. [cited 2024 Aug 12]. Available from: https://www.endocrine.org/topics/edc/what-edcs-are/common-edcs/reproduction
  8. Fertility preservation | fertility network [Internet]. [cited 2024 Aug 13]. Available from: https://fertilitynetworkuk.org/learn-about-fertility/fertility-preservation/ 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Rebecca Barry

MSc Medical Anthropology, University of Oxford

Rebecca Barry is a medical anthropologist and freelance journalist, who holds several years of writing experience within the medical humanities. Her qualitative research lies mainly within the domain of female health, but she also frequently explores social and environmental justice issues.

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