How can menopause affect our fertility?
As part of our Lunch & Learn series, we were joined by Francesca Steyn, Director of Fertility Services at Peppy Health, discussing what everyone needs to know about menopause and fertility.
Henpicked: What can you tell us about menopause and fertility. We know the average menopause age is 51, and it tends to be between 45-55. But that’s not the whole story is it?
Francesca Steyn: No, some people may reach menopause much younger than this which impacts their fertility. There are also medical reasons, medical treatments and hereditary conditions which can affect fertility. Sometimes conditions can be masked if someone is taking the contraceptive pill – as they don’t realise how irregular their cycles are.
Henpicked: At what point would you say is the ‘trigger point’ to seek help?
Francesca Steyn: This depends on your age. If you’re under 35 and you’ve been trying actively to conceive for two years and nothing is happening, see your GP for hormone tests. Once we are over 35, our fertility does decline quite rapidly. So at this age I’d say after trying for six months to a year.
We’re born with millions of eggs. These start to drop off in our late 20s and then drop off rapidly after we reach 35. At this age, our eggs are also more susceptible to chromosomal damage, and we’re more likely to miscarry due to egg quality.
Some treatments for cancer, such as chemotherapy and radiotherapy, can also impact fertility. If you know you want to start a family beyond treatment, you could speak to your oncologist about egg preservation.
Henpicked: That’s interesting. Is this something that’s helpful for those going through early menopause?
Francesca Steyn: Yes, it’s quite an easy process to freeze eggs, and you can store them for up to 10 years in the UK. However, if you’re freezing eggs because at you’re at risk of becoming menopausal or prematurely infertile you can freeze them for up to 55 years.
For those who go through menopause very early, before puberty, we can freeze ovarian tissues. This preserves the ovary so we can extract immature eggs, and grow and stimulate them. In some cases we can even implant the ovaries back in and encourage the ovarian tissue to grow.
Henpicked: What are the range of options available if you can’t conceive naturally?
Francesca Steyn: It does depend on your medical history, as you need to find what works best for you. If you’re in menopause then it’s unlikely you’ll get pregnant with your own eggs. Your best option here is egg donation, where another woman donates her eggs and you can carry the pregnancy if you have a womb. The eggs are fertilised by your partner or donor and implanted into your womb. You’re the legal parent but a child can access information about their donors when they turn 18. If you don’t have a womb, then you might want to consider surrogacy.
Henpicked: Are there drugs or treatments that could encourage fertility around perimenopause age?
Francesca Steyn: If you’re in perimenopause you can go through an IVF cycle but might need high-dose fertility drugs. We recruit as many eggs as possible, fertilise in the lab and transfer the embryos back. Or you can choose to freeze the embryos until you’re ready.
Henpicked: Are more of us having children later in life?
Francesca Steyn: Yes, many people want to do other things first, like career, travel etc. But our biological clock hasn’t kept up with that, and our eggs still live in the dark ages. However, there’s much more we can do now, in terms of tests and support in fertility clinics.
Henpicked: Is there an element of planning?
Francesca Steyn: Yes, and understanding and awareness. There’s a fertility education initiative in place to educate schoolchildren, so they’re armed with information about what to do and how to go about having the option to have a family in later life.
One in six couples in this country have fertility issues, and these are just the ones we know about that seek help. Others decide not to do anything if they can’t conceive, so the figures are probably higher than this.
Henpicked: Does HRT affect fertility?
Francesca Steyn: The short answer is no, you can still ovulate if you’re taking HRT. It’s important to remember that HRT is not a contraceptive and not the same as a birth control pill. If you’re over 50 when your periods end we recommend one further year of contraception, if you’re under 50 then we recommend two further years.
Henpicked: We’ve talked about freezing eggs before things like chemotherapy. But can you freeze eggs simply to plan ahead?
Francesca Steyn: Yes, social egg freezing is very common with women who want a family but not yet. If you’re freezing eggs for medical reason then the NHS may fund you. For social reasons then you’re looking at costs of around £5-6k, including treatment and drugs, then annual storage fees of £300 ish – and you can store them for up to 10 years.
Henpicked: What would you say to someone with Premature Ovarian Insufficiency (POI)?
Francesca Steyn: See your GP or self refer to a private fertility clinic. They can run investigations to see if there is an ovarian reserve. If not, you could look at other treatments like egg donation. This can be such an emotional area. The Daisy Network do phenomenal work for those suffering from POI.
Henpicked’s Deborah Garlick will be joined by Francesca Steyn is Director of Fertility Services at Peppy – a digital healthcare benefit that supports employees during life’s big journeys, including fertility and menopause. She is also the current Chair of the Royal College of Nursing Fertility Nurses Forum.
Francesca has over 15 years of experience as a fertility nurse specialist in the NHS and private fertility sectors. She was awarded Surrogacy Professional of the Year in 2018 and 2019 and has co-authored highly regarded publications in the fertility space.
Through her work, Francesca leads a team of specialist fertility nurses and connects hundreds of people to fertility practitioners, resources and events on the secure Peppy app.
There’s more information on the Peppy website: