Dr. Prati A Sharma is a fertility doctor double board-certified in Obstetrics and Gynecology and has been in practice for over 10 years. She currently practices out of Create Fertility Centre in Toronto, ON and is an Advisory Board member at Ovry.
The world of fertility is complex, nuanced and deeply personal. As women, it’s a side of our health that is often left unexplored until life comes knocking–by means of gynecological issues, after having trouble conceiving, aging etc. But whether you’re currently trying to conceive, thinking about thinking about having kids, or just want to know your options, now is as good of time as ever to start learning about your fertility.
We had the pleasure of speaking with fertility doctor (and Ovry Board Advisor!) Dr. Prati Sharma all about fertility health. We polled you, our community, ahead of time and asked her all of your burning questions for a fertility doctor. Here’s what she had to say:
“First and foremost, being healthy, and maintaining a healthy lifestyle is important,” says Dr. Sharma. That includes focusing on a whole-food diet, exercise, stress reduction and making overall healthy lifestyle choices. “Same goes for the guy for sperm health if you have a male partner”, she adds. While prenatal supplementation is commonly recommended by doctors, “it's important to look for a prenatal that includes folic acid” states Dr. Sharma, “because the data shows that you should have high enough levels of folic acid when you’re trying to conceive [to prevent fetal development issues and to help lower the risk of pregnancy complications]”. Folic acid is the synthetic version of the B vitamin, folate, one that we generally do not get enough of through diet alone.
From there, couples who are under the age of 35 are recommended to try to conceive naturally at home for a year before engaging a fertility doctor. “Now, that one year is predicated on the fact that you have regular normal menstrual cycles and no obvious gynecological conditions such as endometriosis, family history of low egg reserve, early menopause or any sperm factors that you know of,” says Dr. Sharma. While trying to conceive at home naturally, there are many things you can do to help improve your chances, such as using Ovulation Predictor Kits (like ours!) to pinpoint your fertile window and using an app or menstrual calendar to track your cycle. “If you’ve been trying for 6 months to a year and you’re not having any luck, that would be the time to think about engaging a fertility doctor”, says Dr. Sharma, adding “with the caveat that if you’re over 35, or if there’s anything in your health history that might give us concern–like irregular cycles, painful periods, a family history of fertility problems–then seeing a fertility doctor sooner than later is recommended.”
The Birth Control Pill & Fertility
While the birth control pill is a highly effective and trusted form of contraception, there is a lot of misinformation and backlash floating around about how it may impact fertility or the ability to get pregnant after coming off of it. “With previous high-dose pill formulations, there was this theory that you needed a washout period between coming off the pill and trying to conceive.” says Dr. Sharma. She goes on to say, “nowadays, that simply isn’t true. Pregnancy rates after getting off the pill are equivalent and maybe even higher after you get off the pill, because your body is all revved up to ovulate.”
When it comes to the return of your natural cycle when coming off the pill, it’s not uncommon for it to take a few cycles for your period to return to normal. If that’s the case, “not to worry”, says Dr. Sharma, but advises “once you get to three months and it hasn't returned, it's a good time to get an evaluation and ultrasound, run some hormone tests and see what's going on.”
Traditionally, the way to get a referral to a fertility doctor is through your family doctor. Having your GP share any previous test results can aid the process with the fertility clinic. That said, many clinics will also allow for self-referrals now so if you don’t have a family doctor or are unable to obtain a referral, self-advocacy is an option worth exploring.
What to Expect From a Visit to the Fertility Clinic
Now thanks to the rise in telemedicine, your first consult could be virtual or in person, aiding those who may need to travel to see a fertility doctor. Much like any specialist, the fertility doctor will “get to know your health history, ask about your menstrual cycles, any medications you’re on or any chronic illnesses you have. They’ll also ask about your partner’s health if you have one”, says Dr. Sharma. “We also like to know your general timeline: are you trying to conceive now, or in the future?” adds Dr. Sharma. The information that you share in this initial visit dictates what course of action to take. If you’re not looking to conceive now, then fertility preservation might be the focus, whereas, if you’ve been trying for a year, it might be time to engage in more aggressive treatment.
After the initial consult, an in-person examination follows. “That evaluation includes an ultrasound, where we look at the reproductive anatomy, the ovaries, the uterus, and the fallopian tubes. We also will look at the antral follicle count to see the number of follicles or eggs that are in the ovary, which gives us an idea of how your ovaries are functioning and what their activity is.” She goes on to say, “we'll do a test to see if the fallopian tubes are well connected to the ovaries and confirm that they're open so that the egg and sperm can meet.” In addition to the anatomical testing, Dr. Sharma shares “we do some generalized reproductive hormone testing, we look at the thyroid, the prolactin levels, sometimes we look at male hormone levels, and certain other tests depending on your specific situation…and of course, we test the guy. We do a sperm analysis to look at the count, the motility, the shape of the sperm and run general bloodwork for the male partner”.
Based on the findings of the aforementioned tests, a follow-up appointment is then conducted to review and decide on the best course of action moving forward.
Egg Freezing Process
The premise of preserving your fertility is to give you options, but there are many different scenarios in which someone may choose to freeze their eggs; they may not have a current partner but want to have the option of having a biological child when they’re ready, they could currently be in a relationship but unsure of what the future holds with that person, they might have some life goals they want to accomplish before becoming a parent, or they could soon be undergoing gender confirmation surgery and wish to retain the ability to use their own eggs should they decide to have children in the future–the potentials are endless. But what does the egg freezing process actually look like?
In an initial consult about egg freezing, “we discuss your age, any medical issues you may have, as well as your hopes and dreams for the future” says Dr. Sharma. The focus then shifts to egg health. “We will run an AMH test to check fertility to look at the egg reserve in parallel with the antral follicle count, which gives us a snapshot of your fertility as it stands now” she adds. From there, a round of medication is administered to help the ovaries develop more than one egg (in a natural cycle, only one egg is released per month). Dr. Sharma shares “ideally we like to see that egg count grow to around 15-25, then, ovulation is triggered and an egg retrieval surgery is scheduled”. After retrieval, the eggs are then handed off to the embryologist who freezes the mature eggs. “Post-surgery, we monitor for any signs of overstimulation to make sure you're not making too much fluid, too many eggs or that your hormone levels aren't too high as you return to your natural cycle,” says Dr. Sharma, and “then within a week or two, you get your period and you’re either done, or you can start a second round.”
Whether you’re currently trying to conceive or not, being proactive about your fertility health only opens up more options for your future. So if you’ve been considering seeing a fertility specialist, consider this your sign.