Mojo gives you a baby!


National Women’s Health Week is celebrated each year, beginning on Mother’s Day, to encourage women and girls to make their health a priority. The theme for this year is, “Women’s Health, Whole Health: Prevention, Care and Wellbeing.”In this blog post, Dr. Starostanko sheds light on the importance of prioritizing your fertility future as a woman. From understanding the decline in egg count with age to exploring lifestyle improvements and considering fertility preservation options like egg freezing, this post offers valuable insights to help you plan your family and navigate your fertility journey with confidence.

How can you navigate the importance of long-term fertility goals and find ways to work around any potential challenges?

As women age, there is a decrease in both the number and quality of our eggs. The term “egg count” or “ovarian reserve” refers to the number of eggs remaining inside the ovary. We start to see a drop in ovarian reserve at age 32 with a more accelerated loss of eggs in our late 30s and early 40s. This translates into more difficulty with spontaneous conception as women get older, particularly those older than age 35. The spontaneous pregnancy rate is 5% or less for women at age 40. If you are planning to delay childbearing for any reason (career, education, travel etc.) meeting with an ob-gyn or fertility physician is important to discuss ovarian reserve testing and review options for fertility preservation/egg freezing. Your egg count can be assessed using a blood test called anti-mullerian hormone (AMH) and/or ultrasound assessment of your antral follicle count (AFC).


How can incorporating key lifestyle improvements, such as reducing smoking and maintaining a healthy weight, positively impact your fertility journey?

Scheduling a pre-conception visit with your ob-gyn is important to review your history, current medications, and lifestyle habits to evaluate what can be optimized prior to becoming pregnant. Male and female smoking dramatically lowers the likelihood of successfully conceiving. Data is conflicted around the impact of caffeine on ability to conceive, but most experts agree that 1-2 cups a day likely doesn’t lower the odds of success. You should discontinue alcohol while trying to conceive and during pregnancy. High male and female body mass index (BMI) and being overweight are correlated with a lower ability to conceive. For most patients, an exercise plan with moderate levels of activity is best. A Mediterranean diet high in fruits, vegetables, legumes, and fish is correlated with improved outcomes.


Why is it essential to have a yearly annual with your OB-GYN, and how can you effectively discuss fertility concerns during your visit?

It is important to discuss your long-term fertility goals and ideal family size with your ob-gyn. This can help them determine if an early referral to a fertility physician is warranted to help you achieve those goals. For example, women in their late 30s may consider seeing a fertility specialist early on to discuss options if they desire more than one child given the difficulty with spontaneous pregnancy as women age.  If you are less than 35 years and have been actively trying to conceive for 12 months without success, you should undergo a full infertility evaluation. Other reasons for an infertility evaluation include women 35 years or older who have been trying for 6 months or more without success, women 40 years or older (regardless of duration of trying), endometriosis, anovulation or irregular menstrual cycles, history of chemotherapy or pelvic radiation, history of ovarian surgery, known male factor infertility, and a known genetic condition. Single individuals and those in same-sex relationships should also see a fertility physician to review their family building options.

The infertility evaluation includes assessment of both the female and male partners at the same time. The female partner evaluation includes a full medical history and laboratory studies. The doctor will determine if ovulation is occurring and will perform ovarian reserve testing. The uterus and fallopian tubes will be evaluated to determine if the uterus is structurally normal and make sure the fallopian tubes are open or “patent.” The male partner will have a full medical history and semen analysis. We recommend genetic carrier screening prior to conception to identify if you and your partner carry any of the same autosomal recessive genetic mutations as these can be passed on to your children and increase their risk of having the disease.


At what age should you consider egg freezing, and why is it crucial to understand the significance of this fertility preservation option?

Egg freezing is important to consider for individuals who are planning to delay childbearing by choice or for medical reasons (ex: cancer treatment, ovarian surgery). Women with endometriosis or low ovarian reserve should discuss the option of egg freezing with their physicians. The optimal number of eggs to freeze to give you the best chance of a live birth in the future will be dependent on your age. Age is the most important determinant of egg quality. The younger you are when you freeze your eggs, the more likely you are to have a good quality embryo to use in the future to achieve pregnancy. A fertility specialist can help determine the optimal number of eggs to freeze based on your age, medical history, and ovarian reserve, to optimize your chances of achieving your ideal family size in the future.


Any potential factors that may affect your fertility, such as medical conditions, lifestyle choices, or genetic predispositions? What to do if you have any of these factors?

There are medical diagnoses that can increase your risk for infertility including certain cancers and cancer treatments, thyroid disorders, high prolactin levels, diabetes, endometriosis, polycystic ovarian syndrome (PCOS), inflammatory bowel disease, excessive stress or exercise, and certain genetic conditions. Tobacco use and marijuana have both been shown to decrease egg and sperm quality. Certain prescription and over the counter medications can impact spermatogenesis, therefore discussing your current medications with your physician is important. Obesity in women is associated with dysfunctional ovulation and irregular menstrual cycles, decreased response to fertility treatments, altered egg as well as endometrial function, and an increased risk of miscarriage.