What to know about fertility in your 20s

Every decade is marked by different milestones and transitions. Your 20s may include several firsts — first full-time job, first time living on your own, and first serious relationship. This may also be the first time you stop to think seriously about your health, including your fertility.

Fertility is based on many factors including age, sex, genetics, and overall health. At birth, ovaries start with all the eggs they’ll ever have, and the quantity and quality of these eggs decline over time. Testes, on the other hand, can produce as many as a million sperm a day starting at puberty. While a person’s sperm production and quality gradually decline with age, it generally doesn’t cause any fertility issues until after the age of 40. Despite these differences, one thing is the same — your overall health can have a significant impact on your fertility health. Building healthy habits in your 20s can help promote optimal fertility for the future.

Ways to promote fertility

Personal health choices can directly impact fertility. Fertility can be positively affected by:

  • A well-balanced diet rich in fruits and vegetables
  • Regular exercise in moderation
  • Consistent sleep
  • Stress reduction

Harmful substances can negatively affect fertility, and it’s best to avoid or limit:

  • Smoking
  • Recreational drugs
  • Excessive alcohol use

Understanding menstrual cycles

Tracking menstrual cycles is a simple way to evaluate reproductive hormonal health. There are many ways to track your cycle, from marking a calendar to app-based trackers. In most cases, when menstrual cycles are regular and consistent (occurring approximately every 21-35 days), it suggests that your hormones are in balance and that you’re ovulating every month. Other symptoms of ovulation include changes in basal body temperature and mild cramps in the middle of your cycle which can also be useful information to help you understand your fertility. If your menstrual cycles are irregular, there may be underlying health issues that can affect your fertility. Your menstrual cycle is an important part of your health that you should discuss with your healthcare provider.

Hormonal contraception and fertility

Some worry that long-term use of hormonal contraception can impact their ability to get pregnant in the future, but while contraceptives like birth control pills help prevent pregnancy while you’re using them, they don’t affect future fertility.

Hormonal contraception works by either regulating or stopping your menstrual cycle altogether. It essentially masks your body’s natural menstrual cycle, so stopping hormonal contraception, in some instances, can reveal underlying health conditions. Some of these may impact ovulation and future fertility. Common health conditions that can affect ovulation include:

  • Hyperprolactinemia (excessive production of the hormone prolactin)
  • Hyperthyroidism (an overactive thyroid)
  • Hypothyroidism (an underactive thyroid)
  • Low body weight
  • Obesity
  • Primary ovarian insufficiency
  • Polycystic ovary syndrome (PCOS)

If you’re ready to stop using hormonal contraception, tracking your menstrual cycle can be an empowering way to understand your body, hormones, and fertility when trying to get pregnant.

Chances of getting pregnant

You have the best chances of getting pregnant in a given month in your 20s, when you have the highest number of quality eggs. A study found that between the ages of 19 and 26, there is a 79% chance of pregnancy within one year of having unprotected sex. If you aren’t ready to grow your family in your 20s but want to extend your fertility, you may consider egg freezing. Egg freezing has become increasingly common, with many deciding to freeze their eggs for personal or medical reasons, allowing them the opportunity to use them in the future.

While less common, people in their 20s can still experience fertility difficulties. Any of the following may indicate fertility problems:

  • Unusual changes to the length or frequency of menstrual cycles
  • Infrequent or absent menstrual cycles
  • Painful or heavy menstrual cycles
  • Pain with sexual activity
  • Painful bowel movements or urination around the time of menstruation
  • More than one unexpected pregnancy loss
  • Signs of hormonal changes such as skin problems like severe acne, new facial hair growth, or unexplained weight gain or loss

If you have been trying to get pregnant for 12 months without success, speak with your healthcare provider.

Sperm health in your 20s

Sperm production is similar throughout your 20s and 30s. However, you may still think about freezing your sperm in your 20s for personal or medical reasons. For example, some may consider freezing their sperm if they work at hazardous worksites or are deployed in the military, where they could be exposed to toxins and chemicals.

People in their 20s can still experience fertility challenges though. Signs of sperm health or delivery issues in your 20s may include:

  • Changes in sexual desire
  • Testicular mass, pain, or swelling
  • Erectile dysfunction
  • Problems with ejaculation
  • Infertility with a previous partner
  • Other chronic medical conditions that are not well controlled

Tests to consider

Generally, your fertility in your 20s is at its peak. So at this point, it may be more helpful to assess and understand your overall health. Through bloodwork, you can measure markers like:

  • A1c (for risk of diabetes)
  • TSH (for thyroid imbalance)
  • Vitamin D (for bone health)
  • HDL, LDL, triglycerides (for heart disease)

These markers provide a whole-body perspective of your health as well as insight into conditions that could impact your fertility in the future. However, if you have been trying to get pregnant and have shown signs of fertility difficulties or are interested in freezing your eggs or sperm, your healthcare provider may recommend additional tests to evaluate your fertility.

If you’re pursuing egg freezing or have experienced some fertility challenges, your provider may work with you to understand your ovarian reserve — the approximate number of eggs in your ovaries. While it’s not possible to count the exact number of eggs in your ovaries, there are ways to estimate how well your ovaries are functioning. Measuring hormones like anti-müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol (E2) can help evaluate your ovarian reserve. Additionally, a provider may also look at your antral follicle count, or the resting follicles before an egg is released This is a simple test completed through a high-quality ultrasound.

A semen analysis is useful to evaluate sperm for those who have experienced fertility difficulties or want to freeze their sperm. This provides information on whether or not there’s sperm in your sample as well as information about semen volume and sperm parameters like concentration, count, motility, and shape.

How Carrot can help

Your 20s may be the first time that you stop to think about your health and fertility. It can be overwhelming at first, but Carrot can break down what you need to know and support you every step of the way. No matter where you are in your journey, we have resources to help.

  • Expert-produced articles: Explore our library of articles on topics like menstruation and ovulation, hormonal contraception, health history, and more.
  • Vetted global network of providers: Find a provider near you with our global network of 3,800+ clinics around the world.
  • At-home testing options: Learn more about your fertility health in the comfort of your own home. Carrot offers at-home testing options so you can get a complete picture of your health.
  • Unlimited expert chats: Schedule virtual chats with experts like reproductive endocrinologists, OB/GYNs, urologists, dietitians, and more who can answer your questions and provide guidance.

If you’re a Carrot member, sign in to your Carrot account and explore your resources.

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