20 common questions from 20-something year olds about fertility

Discover your fertility freedom

While many think that it’s all a bit doom and gloom and scaremongering to talk about fertility from a young age, we think it’s a positive thing to be informed about fertility health, infertility and the options available.

You may not be ready to start a family or are considering if you even want to have children, but being proactive about understanding and protecting your future fertility can empower you to make the best choices for you and give you fertility freedom.

To help, we have shared some of the common questions we hear time and again from Gen Z that can help provide some guidance and support to help you understand your body better and dispel some of the myths we hear from others, see in the media and across social media.

Please remember to always seek medical advice from a GP if you have any concerns.

Why we should all care about our fertility health

1. Why should I worry about my fertility if I am not sure whether I want children or not?

In your teens and 20s it can feel like the focus is how to avoid pregnancy. Fertility conversation is not about pressuring anyone to have kids, but rather about understanding your body and considering fertility as part of your wider health and wellbeing, just like we do with our mental health. We’re empowered to make decisions when we are armed with the tools and knowledge about our bodies, even if those decisions aren’t ones we’re making right now.

2. What is infertility and what are the main causes?

Infertility is when people struggle to get pregnant after 12 months or more of regular unprotected sex. The World Health Organization estimates that 1 in 6 people may have challenges with fertility.¹

In women, infertility often occurs as a result of problems releasing eggs, or when there are issues with the reproductive organs, such as blocked fallopian tubes.²,³ Infertility in men happens when sperm is impacted from reaching and fertilising the egg, and includes problems with sperm production, quality and function.¹,⁴,⁵

Infertility is often complex, with a wide range of causes including various lifestyle factors, environmental factors, genetics, sexually transmitted infections and other medical conditions.

For further information of causes in both men and women you can visit https://www.nhs.uk/conditions/infertility/causes/.

3. How do I know if I’m fertile or not?

Tests are usually offered when people are struggling to conceive after a year of trying⁶,
but if you’re curious in your 20s about how fertile you are and don’t want to wait until problems may arise, help is available.

Your doctor can advise you about how best to understand your reproductive health and whether there are any underlying issues that could affect your fertility now or in the future. There are some tests available to check for female indicators such as hormones and egg reserves, and male indicators such as sperm function. Test results can be confusing and it’s important to be able to discuss them with a health practitioner, so please speak to your doctor if you’d like to find out more.

4. Why does it feel like the pressure is on the woman with fertility? Don’t men have fertility challenges too?

There is perceived pressure by some people that fertility is typically associated with a woman’s health, but some studies suggest that male factors may account for up to 50% of fertility issues⁷, so it is important for everyone to be aware of their reproductive health and fertility.

Factors affecting fertility

5. Does age really matter?

For both men and women, fertility decreases with age. Females are born with all their eggs at birth (around 2 million)⁸, and the number of eggs available decreases each day from birth onwards⁹. Female fertility then falls sharply from the age of 35⁸ and by age 37, around 25,000 eggs remain.¹⁰ Male sperm quality also reduces with age.¹¹

It is important to remember that it is possible to conceive after 35 and you may not struggle at all, but it does become more difficult, especially when a male and female are both in their late 30s and 40s.⁷,¹⁰,¹² There are many other factors that can impact fertility too, like lifestyle and genetics.

6. How can lifestyle factors affect fertility?

A healthy lifestyle can mean different things to different people, but there are some key areas that research shows can influence fertility. Being overweight, smoking, drinking alcohol, taking certain drugs such as steroids and having too much stress can all increase the risk of infertility – these factors may reduce or stop periods in women, and may reduce semen quality in men.²,⁹

7. Can my genetics impact my fertility?

It has been estimated that nearly 50% of infertility cases are due to genetic defects.¹³ There is no single fertility gene as such, but rather a wide and complex range of genes are involved in reproduction.¹⁴ There are also some genetic conditions that are associated with infertility, such as cystic fibrosis and Klinefelter’s syndrome.¹⁴,¹⁵ Genetic counselling can help people to understand the results of genetic tests and how they affect fertility.¹⁶

8. Does ethnicity play a role in fertility health?

Ethnicity can affect access to and outcomes of fertility treatment, although it is not always clear why.

For example, a report by the Human Fertilisation & Embryology Authority (HFEA) revealed that people from Black and Asian populations undergoing fertility treatment are less likely to have a successful treatment, with the lowest outcomes in Black people. Several factors may be involved, including higher rates of pre-existing health conditions such as obesity and fibroids, which can affect IVF success. Fibroids are tubal factor infertility are more common in the Black population compared to average.¹⁷

You can read the full report on the HFEA website here.

9. Which underlying problems or medical conditions can impact fertility?

In addition to genetic disorders, there are some other medical conditions that can affect both male and female fertility. In females this includes polycystic ovarian syndrome (PCOS), endometriosis and thyroid disorders,³,¹⁸ and in males, hormonal imbalances and problems with testicles.³ Sexually transmitted infections (STIs) can also affect fertility.²

If you have any of these conditions or think you may have an STI, speak to your doctor to understand the impact it might have if you decide to have kids, and the treatment options available.

10. What are the main indicators of male fertility? What do I need to look out for?

Sperm count, sperm motility and sperm delivery are essential when trying to conceive.⁴
There are many factors that affect normal sperm function, including elevated temperature of testicles and hormone imbalance.⁴ It has been suggested that working in warm environments and radiation from phones can all reduce sperm quality, so it’s important to be aware of these factors.⁴,¹⁸

There are often no signs or symptoms of male infertility, but indicators of underlying issues may include low sex drive, erectile dysfunction, reduced facial or body hair and pain, swelling, or lumps around testicles.⁴ If you’d like to find out more about how to protect your future fertility, it’s always a good idea to speak to your doctor.

Sexual health, reproductive health and fertility

11. What is the difference between reproductive health and sexual health?

Reproductive health refers to the overall health of the male and female reproductive systems and the freedom to conceive, whereas sexual health encompasses health wellbeing in relation to sexuality. The two are closely linked; for example, sexually transmitted infections can cause infertility.²⁰

12. Can sexually transmitted infections (STIs) affect fertility?

STIs can affect fertility if they aren’t treated, as they can cause inflammation and scarring in the reproductive system. Chlamydia and gonorrhea in particular are closely linked to infertility, so it is important for this to be treated as early as possible.²¹ They are usually easily treated with antibiotics.

Many people don’t know they have an STI, so it is important to get tested regularly if you think you’re at risk. You can get checked at a sexual health clinic – you can find your nearest one here.

13. If I don’t have my period every month, does this mean I have fertility issues?

It is important to remember that everyone’s menstrual cycle is different. Ovulation occurs about half-way through your menstrual cycle, and this is when you are most fertile. You can’t fall pregnant if ovulation hasn’t occurred.²² Generally, the menstrual cycle is a good indicator of overall health and fertility health.²³ While irregular periods don’t always affect fertility, it can be more difficult to fall pregnant as ovulation may not occur as regularly.²⁴

Underlying conditions such as polycystic ovary syndrome (PCOS) or thyroid conditions may affect periods and ovulation.³ You can speak to your GP if you have any concerns.

14. Does emergency contraception (AKA morning after pill) affect fertility?

Emergency contraception works by delaying ovulation during that cycle, meaning the fertile window where you can get pregnant is put on hold so sperm can’t fertilise an egg. Given it only affects that particular cycle, your regular cycle will return to normal. The evidence does not show that emergency contraception affects your fertility.²⁵

15. Can long-term hormonal contraception use affect my fertility? Especially if prescribed from mid-teens

Hormonal contraception works by using hormones such as oestrogen and progesterone to stop ovulation, as a result preventing pregnancy.²⁶ For most forms of hormonal birth control, your regular ovulation will return once you stop taking it.²⁷ Current research shows that for most women, once they’ve stopped taking hormonal birth control, their cycles return to normal within three months and then they can get pregnant again.²⁸ Fertility may take up to a year to return to normal following the injection.²⁹

16. Does prior pregnancy loss or abortion impact fertility?

Evidence does not show that abortion affects your future fertility, but there are risks associated with an abortion procedure such as a womb infection, which can affect future pregnancies if not treated. Infections can be treated effectively with antibiotics and only happens in a small number of cases.³⁰,³¹

Egg and sperm options

17. What is egg freezing and what it is for?

Egg freezing is a method used to preserve fertility, so that people can try and have children at a later date. It involves collecting eggs, freezing them and then thawing them for use in fertility treatment. Eggs can currently be frozen for up to 55 years, subject to renewing storage consent every 10 years. Once thawed, eggs are fertilised using fertility techniques such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).³²

18. How do I know if egg freezing is right for me?

People may consider freezing their eggs for lots of reasons, including if they are having cancer treatment, or if they’re not sure when they may want to have kids.³²

Freezing eggs in your 20s and early 30s is considered the best time, when the eggs are highest quality. People can still decide to do this later, but it may be less successful.³³

19. What are the options for sperm donation?

Sperm donation is an option to help those who wish to conceive in circumstances when heterosexual couples are experiencing problems with sperm count or quality, or when women in a same sex couple or a single person would like to have a child.³⁴,³⁵ Donor sperm is inseminated into the receiving womb or mixed with eggs in IVF treatment.³⁶

20. What are the options for single men or same sex couples to become dads?

Egg donation can be considered when a problem is found with female fertility, or for single males and same sex couples who want to conceive. For single men and same sex couples, the donor egg can be fertilised with sperm and then implanted into a surrogate.

Sperm freezing is also an option for those who are not yet ready to become dads and would like to in the future, or those with low/decreasing sperm count, given that age can affect sperm quality. When sperm is ready to be used, fertility treatment such as vitro fertilisation (IVF) or intrauterine insemination (IUI) is necessary.

You can find out more about egg donation, sperm freezing and surrogacy via the Human Fertilisation & Embryology Authority.

This article is part of Fertility Network UK’s wider campaign to empower young adults, particularly young women, with more fertility knowledge for their future. The content and development of this article has had scientific input and editorial review from Merck Serono Ltd and Fertility Network UK. This article is sponsored by Merck Serono Ltd.

UI-NONF-00944 | November 2023


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