A Mother's Day Gift For 30-Somethings Trying To Get Pregnant
May 7, 2012 1:07 p.m.
SDSU Psychology professor Jean Twenge is well-known for her books documenting increases in narcissim in the young..in such books as Generation Me. Now she's out with a book that hits closer to home -- it's called "The Impatient Woman's Guide To Getting Pregnant."
Dr. Sanjay Agarwal, Clinical Professor and Director of Fertility Services at UC San Diego
Related Story: A Mother's Day Gift For 30-Somethings Trying To Get Pregnant
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. Women today have more choices than at any style in history about how they want to live their lives. They can get married, stay home, and raise a family, or they can pursue a career and decide not to have children. Or they can choose to do a little of both. So when a woman who's put off pregnancy to pursue a career decides she wants children, she wants them now! That has created a world of impatient women hoping to become pregnant, and fearing they can't. Jean Twenge is well known for her book, documenting increases in narcissism in the young in such books as Generation Me. Now she's out with a book called the "Impatient Woman's Guide to Getting Pregnant." Welcome back to the program.
TWENGE: Thank you so much.
CAVANAUGH: Also joining us is Sanjay Agarwal, director of fertility services at UCSD, thank you so much for being here.
AGARWAL: Thank you, Maureen.
CAVANAUGH: Now, this Sunday, of course, is mother's day, and the genesis of this book was your own desire to start a family several years ago, Jean. How impatient were you?
TWENGE: Oh, I was very impatient.
[ LAUGHTER ]
TWENGE: I was 34 at the time when we first started trying to get pregnant with our first child. But I am a little bit of a type A personality. And I love research, so I wanted to find out, well, these days, the way dollars tell you, is you're either trying or you're not. So once you start trying, you want it to happen right away. So I wanted to read and find out as much as I could about how to make it happen as fast as possible. And mostly so I could stop worrying about it.
CAVANAUGH: Were you at that point bombarded by advice about conception tactics and all of that from friends and everyone who you told?
TWENGE: Sure. So I was reading things online and reading as many books as I could get my hands on. But as a researcher, I wanted to find out where did this stuff come from? So I went and read some of the medical journal article, and was surprised to find that they had some really great information, which I wasn't seeing anywhere else. One of the reasons I really wanted to write the book was to bring that useful information to women.
CAVANAUGH: Women are often quite concerned about their fertility in their late 30s, and they're warned it will be hard harder to conceive.
TWENGE: I saw a statistic everywhere, in books, online, and so on, that said about 1/3 of women over the average of 35 would not get pregnant after a year. So 2/3 of them would, but one out of three would not. And that's a pretty high statistic. Elsewhere it said 30% wouldn't ever have a child at all if you start trying to get pregnant over 35. So I traced this back to the original journal article, human reproduction, but the guy got his data from birth records from 17 hundreds France. Now, that can give us some information, but obviously things are a little bit different now with modern medicine, and ovulation prediction, and all these other things, like soap.
[ LAUGHTER ]
TWENGE: So we've got more opportunities, and we can make the most of our chances now. It's a different picture than it was on a farm in France in 1750.
CAVANAUGH: Doctor Agarwal, what's the real story about women's fertility after let's say 35?
AGARWAL: Well, a woman's fertility is related to the number of eggs she has. She's born with the number of eggs she has and over time the number goes down. It's not a black and white situation, it's a gradual change. As she ages, her chances of conception goes down. And it's for this reason that the standard recommendations are that a couple try for about a year, if the woman is under 35, to conceive naturally before going ahead with fertility therapy. For women over 35, they spend about six months. Again, it's a guide, it's not an absolute.
CAVANAUGH: Exactly. And I think a lot of women do look at these things as absolutes and don't realize the difference between statistical information and how it applies to the individual. For instance, Jean, you make the point in your book that trying to get pregnant is not just medical. It involves a whole world of emotions and hopes and fears. Do you think that's sometimes ignored in pregnancy advice?
TWENGE: It is often. When I first started trying to get pregnancy, and I was reading books, there wasn't a whole lot of attention paid to coping techniques and how much you might be worried about your fertility. Sometimes worried before you even started trying just because it's such an important life goal. So in the impatient woman's guide, I have a whole chapter for coping techniques, just things that you can do backed up by research throughout the process to help you feel better. Being stressed out may not affect your fertility, per se, but it doesn't feel very good. It's not as much fun to have stressed out all the time. And fortunately there are some things you can do to feel better.
CAVANAUGH: You say that being stressed out as uncomfortable as it is, unless you're absolutely half crazed does not really affect your fertility. And yet people -- that's kind of a common wisdom kind of a thing, isn't it? I'm going to call it a myth, but that's what a lot of people tell you. Just relax. You know? You're going to rock the boat if you get too stressed out about this.
TWENGE: The common advice is just relax, and you'll get pregnant. But it drives couples nuts. That's advice that's difficult to take, second, there are medical issues that can prevent folks and all the relaxation in the world isn't going to help them.
>> We don't know enough about the effect of stress on natural conception. When we do know suggests that it compromises fertility a tiny bit. And so small it may not even be worth paying attention to.
CAVANAUGH: One of the things, in your book, that I don't know if the doctor is going to agree with you about, we'll see, some of the things that women go through to see if that I can get pregnant about tests, let's say, for egg counts. And you say in your book that they're not a very good indicator of a woman's ability to actually conceive.
TWENGE: These tests, things like ovarian reserve, or tests for hormones like FSH, and so on. And they're very important, the outcome of those results. For natural conception though, most of the research suggests that doesn't make much of a difference, because all you need is one. So the number that you have, the quality of the egg is important, but that's mostly based on age. The quantity, how many you have there, vary important for IVF, but for natural conception, probably not as much according to the research I was able to find.
CAVANAUGH: Do people get that mixed up?
AGARWAL: These tests have been evaluated in couples that have had difficulty conceiving so much they're best applied to couples undergoing fertility evaluation and treatment, not just IVF, but other fertility evaluations also. So one can extrapolate and say that it probably does reflect their fertility too. I want to go back for a moment and talk about stress. Not to be too touchy-feely. But those of us that take care of individuals that are trying to conceive commonly come across individuals that have given up fertility, adopted, and then they get pregnant. Although we don't have fantastic studies currently to show that stress impacts fertility, I think there probably is a relationship there.
CAVANAUGH: But we just don't know how -- what level of stress?
AGARWAL: Absolutely. And in severe stress, women actually stop ovulate, and that's an extreme example. So I think stress does matter, more than just quality of life. I think it does affect fertility. And that's why I think it's particularly important not to increase the stress of our patients, but try and reduce that stress. Many couples do things that increases their stress, like timed intercourse.
CAVANAUGH: Well, that's what I was going to say. They go crazy about the timing of intercourse with ovulation. Is it necessary to be that precise, doctor?
AGARWAL: Well, I think fertility does rise for about five or six days before ovulation until one day after. So there's a 6-seven-day window of increased fertility. If a couple is having intercourse a couple days a week, they're going to hit that window. We do know that every other day has increased fertility compared to intercourse. But is it sane to tell a couple you must have intercourse every day as opposed to a couple's natural behavior? And I think telling them to engage in that behavior does increase distress
CAVANAUGH: You debunk a myth on the optimal time when it's recommended to increase fertility.
TWENGE: Some sources suggest that the day. Ovulation is the most fertile, but it's actually not. It's the day before, and two days before that are more fertile. And if you're relatively young, and you're not in any particular schedule, you can do what the doctor suggests. In my book, I call it the lots of sex plan, that's beloved by husbands everywhere.
[ LAUGHTER ]
TWENGE: But if you want to, and it doesn't stress you out too much, and you like having more information, I describe three methods of ovulation prediction, charting OPKs, and the fertility monitor, which if you want to pinpoint those two-day, it won't stress you out too much, then it might help you out.
CAVANAUGH: In your book, you talk about preparing to get pregnant. What does that entail?
TWENGE: Well, first the prenatal vitamins, start those at least two months before you start trying to get pregnant. Folic acid is important, but things like B6, and same thing with diet, there's a number of studies about fertility and diet. I call it the SOS plan, it's a stand-in for all the good foods. So spin itch and olive salmon, which stand in for first the vegetables and the whole grains, then the Mediterranean diet, which has been linked to fertility in some study, so olive oil, and lots of fish, and omega three fatty acids which are really found there in lean protein.
CAVANAUGH: And doctor, I know that you wanted to comment on what Jean was saying before about ovulation. What was your comment?
AGARWAL: Well, I do agree that fertility is highest a day or two before ovulation. One of my first research papers was does timed intercourse really help? And I wrote to all the manufacturers of the kit, to show if there are data that if my patients use your product, they're like hoe to conceive quicker, and none of them had the data to back them up. It's different if they have intercourse at that time naturally, but it's a different situation if you tell them they have to.
CAVANAUGH: You say after the age of 35, if a couple has been trying about six months, perhaps they should look into some help with their fertility. It is true though that for most couples, the next option after trying to conceive naturally is not right up to IVF, there are whole levels of interventions.
AGARWAL: Absolutely correct. Absolutely. We generally reserve IVF for those that have failed to succeed or who we haven't been able to help with less aggressive, less stressful, less invasive treatments. If they don't work or if there's a clear indication that IVF is the best options like blocked tubes or a really low sperm count, we'll move on to IVF.
CAVANAUGH: And what about men? Do you test the man in the couple as well at that six month interval?
AGARWAL: We do. But I tell testimony you that men get very stressed by it.
[ LAUGHTER ]
AGARWAL: I try and relieve their stress, and I tell them half jokingly, but very accurately that the guy is almost irrelevant in reproduction these days. With today's technology, men that have very sperm in their ejaculate can often have their own biologic genetic child. No donor sperm necessary. And that's science fiction.
CAVANAUGH: It is. How is that sperm then created?
AGARWAL: Well, sperm can often be retrieved from the testicle or epididymus by a urologist, and injected into the egg to lead to their own genetic child.
CAVANAUGH: That is amazing. And I think it's amazing to hear what science can do, but in your book, it's basically sort of amazing to hear what couples can do on their own without any help. Sometimes I think we medicalize everything in our culture. And this book is I think an attempt not to do that.
TWENGE: Right. That you can make the most of your chances at home. Although I do advise after six months of trying that going to see a medical professional is a good idea. I also give the advice, I sometimes say this as being a bit of a mean wife, but to have your husband or partner get a semen analysis before you even start trying. Because 40% of infertility is linked to male issues. And it is true that you can solve them easily, and we have these great techniques now. But it does involve using IVF, and if you can find out that this might be an issue, that's a great piece of information to have from the outset.
CAVANAUGH: When you were embarking on this journey, what was the best piece of advice you got?
TWENGE: Ah, that's tough. I would probably say the stuff that I read about -- I got to choose two.
[ LAUGHTER ]
TWENGE: I hate to go against the doctor, but using the fertility monitor really did wonders. I didn't to worry about it anymore. And comes across the fact that that we know about natural conception after 35 does come from these odd sources so not to worry so much.
CAVANAUGH: So you have two beautiful children?
TWENGE: I have three now.
CAVANAUGH: Three! Oh, my goodness. I lost count. Congratulations. I was wondering, when I was reading your book, in a world with seven billion people, you do so many books about people who are growing up, being told all the time they're special, they're special, they develop narcissistic qualities in a world with seven billion people. Do you think we could be spending too much time worrying about our own fertility, Jean?
TWENGE: Well --
[ LAUGHTER ]
TWENGE: Here in the first world, we have a very low fertility rate. So I don't think we have to worry about that too much as long as we can love and provide for the children that we do have, I don't think it's a big concern.
CAVANAUGH: On our side of the world, we're okay.
[ LAUGHTER ]
CAVANAUGH: Okay! Will your next book be about motherhood?
TWENGE: I would love to write the impatient woman's guide to being pregnant. I would advise them not to be too impatient, because that has to last at least 39 books. But that would be fun.
CAVANAUGH: Professor condition Jean Twenge will be at Warwick's doing a reading from her book, in La Jolla this Wednesday at 7:00 PM.