This month’s issue of Retail Pharmacy Assistants e-magazine is dedicated to women’s health, so in one of our health features, we decided to look at fertility and ask the question: what happens to fertility after 35?
Fertility: a definition
Fertility, according to Jean Hailes for Women’s Health, is simply one’s “ability to produce a child”.
To conceive a child naturally requires both healthy sperm from the male and a healthy egg from the female. All going according to plan, the healthy sperm can then travel to the healthy egg, “penetrate the egg and then that egg is successfully implanted in the lining of the uterus”.
Among the factors that can make it more difficult for a woman to fall pregnant, a major one is, age. As Jean Hailes points out, “fertility declines with age”.
“Women are born with all the eggs they will ever have, and as they age these are either released (ovulation), disappear or deteriorate,” the organisation states.
Melanie McGrice, Fertility and Prenatal Dietitian at Nutrition Plus, says that with the loss of eggs each month with each menstrual cycle, “in some respects, as soon as we hit puberty, our fertility starts to decline”. She adds that from the age of 35, “we see a significant drop in both our egg count and quality”.
What causes fertility problems?
The Fertility Society of Australia and New Zealand (FSANZ) states that “one in six couples in Australia and New Zealand suffer infertility”.
It adds that “many couples who suffer infertility can be successfully treated with medical or surgical techniques or lifestyle changes”.
FSANZ lists some of the causes of infertility as:
- Many medical conditions and other factors.
- Ovulatory disorders.
- Ageing. “As you get older, your fertility declines. Particularly after the age of 35, it gets harder to fall pregnant.”
- Endometriosis.
- Fallopian tube damage.
- Uterine fibroids.
- Autoimmune disorders, e.g., lupus, Hashimoto’s.
- Lifestyle and environmental factors:
- Smoking and illicit drug use.
- Excess alcohol and excess caffeine can reduce your chance of falling pregnant.
- Bodyweight.
- Physical activity levels: excessive exercise can make it harder to fall pregnant.
- Severe stress: stress hormones such as cortisol disrupt signalling.
While many factors impact fertility, Ms McGrice says hormones “have a huge impact on our fertility”.
“Hormones act like traffic signals, telling our body when to perform particular functions, such as when to ovulate,” she says.
“In fact, about 30% of infertility is thought to be due to oestrogen imbalances.”
And what are the signs that your hormones may be out of whack? Ms McGrice says a sign that this may be occurring is “irregular or non-existent menstrual periods”.
Owner and pharmacist Jacqui Coote, of Strathpine WholeLife Pharmacy in Queensland, says, says hormonal imbalance affects fertility by preventing the release of a healthy egg in a woman’s monthly cycle.
“Most commonly,” she says, “this would be due to PCOS [polycystic ovarian syndrome] or anovulation due to other causes, such as stress.”
Ms Coote says stress is a huge factor that impacts female fertility and is exacerbated “when women are juggling pressurised careers and home life and finding the time to actually be intimate with their partners”.
Additionally, as women age, their eggs become “less viable”, she says, and the likelihood of “falling pregnant at each cycle gets smaller” – which can add to the overall stress women may experience.
Diet and lifestyle
Ms Coote says that when dealing with women who come into the pharmacy reporting concern with hormonal imbalance, an important first step is teaching them “to be aware of their cycles and … in tune with their bodies”.
“Our bodies are very sensitive to external stressors and changes, so if our body feels under threat, normal reproductive processes take a back seat,” she says.
“There are different supplements available to assist with different hormonal imbalances. However, an individualised approach is best when helping women select products to help balance their hormones.”
In terms of recommendations around vitamins and mineral supplements (VMS), as a fertility dietitian, Ms McGrice says she “often provides prophylactic VMS for women over the age of 35 who are trying to conceive, to reduce the risk of chromosomal damage to eggs and to optimise fertility and pregnancy outcomes”.
“Chromosomal damage to eggs is one of the most significant factors impacting fertility in women over the age of 35,” she says.
“Research suggests that a diet rich in omega-3 [fatty acids] is a key dietary strategy for optimising oocyte health in older women.”
Additionally, she recommends “400mcg of folate daily for at least one month prior to conception” for women trying to conceive. This, she underscores, is “the most important piece of nutrition advice”.
The role of a pharmacy assistant
Ms Coote cautions: “Pharmacy assistants should be aware that discussing hormone imbalances is often a sensitive subject, and they should be considerate of the women’s feelings and privacy.
“Every person’s situation is different, so it’s important to understand some of the most common recommendations, to be able to help the majority of women and be able to refer to the pharmacist for more complex requests.
“Pharmacy assistants should become familiar with different preconception multivitamins, to be able to tailor the recommendations to the woman’s needs.”
In addition to making general recommendations around diet, lifestyle and VMS, Ms McGrice points to the importance of referring these customers to a specialist, such as a fertility dietitian, for further support.
For more information and to read the feature in full as it appears in the March issue of Retail Pharmacy Assistants e-magazine, visit: rpassistants.com.au/retail-pharmacy-assistants-march-2022
