Babies on the brain: Fertility, explained
Baby Bust
If you thought pandemic boredom would lead to a baby boom, think again. The data is in, and baby-making, apparently, is not. All around the world, birth rates dropped during 2020, and Canada is on track to hit another record-low birth rate for at least the second year in a row. (Its total fertility dropped to its lowest point in 2019.)
With all this baby talk, we have one question: What do we mean when we talk about fertility?
Baby Brain
Our social media timelines might not be as full of baby pictures as we thought they would be by now, but one thing the pandemic did give potential parents was plenty of time to think and talk about parenthood.
We spoke with Dr. Prati Sharma, reproductive endocrinologist and fertility specialist at Create Fertility Centre. According to her, Canadians have babies on the brain like never before. Whether you'd love to have them or prefer your babies covered in fur, the doomsday mindset of the past year — combined with increasing awareness about the science of fertility — has more and more people broaching the topic of their reproductive health with new urgency.
When people talk about fertility, they're actually talking about a set of circumstances that are unique to each individual. These are referred to as "fertility factors" and, taken together, they determine a couple's chance of success at conceiving. Here's a basic breakdown:
Ovulation factor: This is the frequency at which a menstruating person (or a person who should be menstruating, but does so infrequently and/or randomly) ovulates.
Tubal factor: In order to conceive, a menstruating person's fallopian tubes need to be open and functional.
(Psst — here's a great video about the female reproductive system, in case your memory of high school biology is a little fuzzy.)
Male factor: In other words, semen virility. Since 40% of infertile couples can pinpoint the problem as being, at least in part, down to the male factor, this is one of the more important considerations to take into account if you're having trouble conceiving.
Age factor: Unfortunately, it's a fact of life that fertility declines with age, mainly because a menstruating person's egg count — which is fixed from birth — decreases with every menstrual cycle, starting in puberty. For some reason, your body also sheds the best eggs first, meaning egg quality decreases with age as well. (Clearly, the notion of saving the best for last does not apply here. 😑)
Uterine factor: Simply put, the uterine factor is whether or not the uterus is up to snuff.
Peritoneal factor: This takes into account the condition of the abdominal lining of the person carrying the baby.
The Fit Factor
We know that's a lot to consider, and it's just the tip of the iceberg. We haven't even touched on the other set of factors that influence the ones mentioned above: lifestyle.
Now, we were just as peeved as the next woman when the World Health Organization (WHO) recently released a global action plan on alcohol that seemed to target women of childbearing age as needing to be "monitored" for their alcohol consumption. (The average childbearing age ranges from 15 to 50, FYI.) After the first draft of the plan was released, the WHO understandably came under fire for what was considered sexist and outdated messaging — especially since it failed to address alcohol consumption in men, despite the fact that male alcohol consumption can cause male factor infertility. (We'll get into that momentarily.)
Obviously, alcohol consumption negatively impacts fertility. But that's heavy alcohol consumption. Don't sweat the small stuff.
Alcohol isn't the only no-go for optimal fertility. Whether you're contributing the egg, the sperm, or the uterus (or any combination of the three!), these are the lifestyle recommendations to keep in mind:
• Maintain a healthy weight and diet.
• Prevent sexually transmitted infections (STIs).
• Manage stress, and practice good sleep hygiene.
• No smoking.
• Limit alcohol, and cut it out all together if you're trying to conceive.
• Curb caffeine (one to two six- to eight-ounce cups is fine).
• Talk to your doctor about medications you might be taking and how they could impact conception.
• Avoid exposure to toxins like pesticides and lead (which we think is a general rule to go by, and not just for people hoping to have kids 😬).
The Doctor's In
Unfortunately, you can follow all the rules and still experience infertility. Approximately 10% of couples will experience infertility with no known cause. And though it's possible to conceive within the first month of trying (or during that drunken fumble in the dark with what's-their-name from the bar), it takes the average couple five to six months to conceive.
Which isn't to say that you're infertile if you fail to conceive within that timeframe. A few things to keep in mind: 1. Infertility is a super broad term, and 2. Its (very broad) definition is dependant on the age of the menstruating person, when other factors — like the ones above — aren't at play. The age threshold is 35; anyone younger than that isn't considered infertile until they've been having unprotected sex for one year without conceiving, while it's six months for those who are older.
"When we look at the causes of infertility, usually we see about 20% — and maybe even more — being diminished ovarian reserve or age-related infertility," says Dr. Sharma. "We know that as women get older, particularly over the age of 35, their [egg count] and egg quality goes down."
Dr. Sharma breaks down the causes of infertility into four main categories: age-related, male factor, tubal factor, and unexplained. At her clinic, she most often deals with causes in the age-related category.
"More women are trying to conceive at a later age now," she says. "We know that the average age of [people] having [their] first child has really increased over the last five to 10 years. Whereas in the past, it was probably early 30s, now it's mid-30s — maybe even a little past."
Because increasingly more people are choosing to delay pregnancy (for many reasons, but financial concerns and career progress being the two most common among people in developed countries), Dr. Sharma has also seen younger individuals taking charge of their fertility, before it's too late. She sees menstruating people coming in at a much younger age for evaluations and egg-freezing to ensure they have younger, higher-quality eggs on hand for whenever the time comes that they want to start a family.
Egg-freezing and fertility evaluations are just two of the many options offered at the Create Fertility Centre, which also specializes in assisting same-sex couples and single parents. Whatever shape or size these families come in, helping them conceive usually involves some combination of in vitro fertilization (IVF), intrauterine insemination (IUI), or surrogacy.In vitro fertilization (IVF) describes assisted fertilization, embryo development, and implantation. Put simply, IVF is a multi-step process over several months, involving medication to mature the eggs for fertilization, egg retrieval, mixing the eggs with the sperm, and implanting the fertilized eggs into the uterus. In Canada, the average cost for one round of IVF is $15,000 — usually without coverage. (Ontario, Manitoba, New Brunswick, and Quebec all offer some level of assistance through their provincial health-care systems.) Unfortunately, for many people, it takes multiple rounds to find success.
Intrauterine insemination (IUI) is the process of putting sperm directly into the uterus to help it get closer to the egg(s). The price for this procedure can range from $1,500 to $4,000.
Surrogacy is an option where a surrogate, or gestational carrier, acts as the "host womb" by carrying a baby for someone else. This process also involves IVF for the intended mother or egg donor in addition to legal fees, so it can be quite expensive: anywhere from $58,000 to $90,000 on average across Canada.
The Financial Factor
Obviously, kids are expensive — and that's true even if you're lucky enough to be able to conceive them naturally. The most recent data available for the cost of raising a child in Canada comes from 2011. Now, given the pandemic, inflation, and an out-of-this-world national housing bubble, the costs — and the average person's finances — are going to look a little different now than they did 10 years ago. But, with the available data, it's estimated that the average cost of raising a single child to the age of 18 here in Canada is $253,947 — or roughly $14,000 per year.
It therefore goes without saying that fertility assistance is heavily skewed toward the wealthy. It's also no wonder that birth rates were steadily declining across Canada even before 2020. For so many of us, fertility is a lot more complicated than doing the horizontal tango (if you catch our drift 😉).
People have long said it takes a village to raise a child, but turns out, it also takes one to make them.
No matter where you are on your fertility journey (and regardless of what you want the final outcome to be), you're most definitely not alone. ❤️
