Health & Fitness
What An OB-GYN Wishes People Knew About Their Fertility Sooner
Photo by Seventyfour/Adobe Stock
Health & Fitness
What An OB-GYN Wishes People Knew About Their Fertility Sooner
Your most common fertility questions, answered.
In an ideal world, getting pregnant is a smooth process: You decide you want to have a child, you conceive, you experience childbirth, and you embark on a new journey as a parent.
But for many, this isn’t the reality.
About one in six couples struggle with infertility in Canada, according to the Canadian Medical Association. Others face systemic barriers, ranging financial and geographic to racial and gender-based.
Since becoming an obstetrics and gynecology specialist in the early 2000s, Dr. Marjorie Dixon has made it her personal and professional mission to level the playing field for fertility care.
“We allow everybody to have the right to the family they’ve always dreamed of,” says Dr. Dixon, the founder, CEO, and medical director at Anova Fertility in Toronto, Ont. "We can grow life, transfer when there has been illness or surgery, and help families build in different ways.”
With constant groundbreaking reproductive technology—not to mention the confusion that often surrounds questions of women’s health—comes natural uncertainty. What is a fertility check? Why should I freeze my eggs? When is my peak fertility?
We sat down with Dr. Dixon to learn her most frequently asked questions and get the scoop on what she wishes more people knew about their fertility health.
You’ve worked in the fertility space for over 20 years. How has the way that we talk about fertility changed?
It has become so much more inclusive and culturally sensitive. But cultural sensitivity is not cultural competency.
I grew up Jamaican and Anglo-Protestant in a French-Catholic environment where I was always like, ‘I'm here. I'm not like anybody else, but I'm still here.’ That voice inside of me really made me a tremendous empath for my patient population.
“It’s one thing to be mesmerized by the science and the beauty of being able to bring women’s health to women,” says Dr. Dixon, “but it’s another to also be a voice for people who otherwise didn’t have a voice or couldn’t have a family, or who didn’t have access to care.”
When I started practicing, I felt like I didn't see myself in my patients. My patients looked very different from me and were socioeconomically able to access care. At the same time, I saw those who couldn't access care not have the ability to get the treatments that they needed. It really felt like the haves and the have-nots.
I became very vocal with the Ministry of Health and with policy makers about doing a better job of levelling the playing field, and getting more people to help mitigate those issues.
Let’s say someone is thinking about getting pregnant. What are the first things they should consider?
I often hear from people—especially in the 35 to 40 range—who are under the impression that because they’re generally healthy, their reproductive ability should be just as healthy and functional. Unlike other systems in the body, your ovaries do not benefit from a healthy lifestyle in the same way. You can’t modify the reproductive lifespan of your ovaries with a healthy lifestyle alone. Fertility naturally declines over time, and egg quality cannot be rejuvenated.
We’ve done a wonderful job of teaching people about contraception. We’ve done an abysmal job of teaching women about their reproductive ability and the limitations of reproductive lifespans. I wish people knew that even with all the fancy reproductive technology we have, I can’t supersede or recreate your fertility health.
For some women, fertility decreases faster, for others it’s slower. You won’t know where you are on the bell curve until you get your fertility checked.
So, how exactly does egg quality change as we age?
Think of our ovaries as egg storage units. We are born with the greatest number of eggs that we will ever have. On average, we have depleted our ovaries of 90 percent of their eggs by the time we’ve reached the age of 30.
In your 30s, the eggs that remain can still be viable, and many women conceive naturally during this time. By the time we reach the age of 40, most women have depleted their ovarian reserve by 97 percent.
You mentioned that with a fertility check, you can get a better sense of your own personal reproductive timeline. At what age do we typically hit peak fertility?
Research shows that Black women’s optimal time for conceiving is in their late teens by virtue of exposure to societal stressors related to the experience of systemic racism. These differences are complex and not purely biological.
In general, most women, regardless of ethnicity, reach peak fertility in their 20s. This is the time when you want to have your fertility check. Nobody’s saying you need to have a kid, but it gives you opportunities. If you’re young and you see that your ovarian reserve is diminishing, you have something you can do proactively: you can freeze your eggs.
"It’s like insurance planning. The sooner you do the screening, the sooner you have the information. Knowledge is power, so empower yourself so that you’re not eventually at the mercy of your biology."
How much does a fertility check cost?
Fertility checks are covered by OHIP in Ontario. For other provinces, it’s advised for you to speak with your healthcare professional.
What about egg freezing?
For all fertility procedures, pricing is individual to the client. (At Dr. Dixon’s clinic, Anova, egg freezing costs $8,999)
Beyond freezing your eggs, what are other things you suggest people think about when planning for their future fertility?
The basic pillars of health are also good for your fertility health. A healthy diet, quality sleep, and avoiding substances like alcohol and cannabis all support your reproductive health. If you are working to support your overall health, your reproductive health will benefit and vice versa.
Are there any myths about fertility that you often encounter?
The big one is that if you’re healthy, your fertility should be okay. I must hear this every day—not just from patients, but from their partners.
Another one is, ‘My mother had babies into her forties, so I don’t understand why this is happening to me.’ Fertility is not guaranteed to be inherited in that way. While genetics can play a role in ovarian reserve, other factors such as health, lifestyle, and medical conditions also influence fertility outcomes.
The other is ‘If I fail a cycle of in vitro fertilization (IVF), I’ll never have a baby.’ The reality is, it might not happen on the first cycle. Although it is unfortunate and hard, it is also encouraging that the scientific literature tells us that sometimes it takes two or three cycles.
When we’re talking about fertility, there’s the scientific side, the financial side, the emotional side… It's a very complex process. How do you help your patients along on their journey?
With tender love and care. Many of us have been patients ourselves, and we know that sometimes it can feel like walking on eggshells—at times we feel encouraged, then other times it feels like a rollercoaster. We answer the questions that we can with the knowledge that we have and validate their feelings.
Even the most pragmatic individuals can become frustrated and irrational throughout the process. They just need reassurance that they can get through it and that we’re there to guide them every step of the way.
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