Advanced Age & Female Fertility
Advanced Age plays an important role in a woman's ability to become pregnant and carry a pregnancy to term.
With advancing age, many biological changes take place that work against conceiving and carrying the pregnancy to term. From age 30 to 35, there is a gradual decline in the ability of women to become pregnant; after age 40, there is a sharp decline.
Also, the chance of miscarriage and chromosomal abnormalities, such as those that cause Down's Syndrome, increase with age. Even the success of in vitro fertilization and other similar procedures decreases with advancing age.
Why does age play such an important role in fertility? One reason is that as women age, they are less likely to ovulate regularly. In addition, they are more likely to have medical problems that can cause infertility, such as endometriosis. However, the more important reason relates to the condition and decreasing number of the woman's eggs. As the eggs age, they become more resistant to fertilization. Also, more of the eggs tend to have chromosomal abnormalities - oftentimes, this may result in miscarriage.
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Diagnostic Tests for Advanced Age Infertility
Your evaluation is likely to begin with your medical history and a pelvic exam. However, other tests are needed to determine whether your age is affecting your fertility. You may need one or more of the following tests:
- Follicle stimulating hormone (FSH) - a blood test that measures the amount of FSH in your blood; a high level of FSH in your blood in the beginning of your cycle may mean that your infertility is age related
- Estradiol - a blood test that measures the amount of estradiol (estrogen) in your blood; a high level in the beginning of your cycle may mean that your infertility is age related
- Clomiphene Citrate Challenge Test - can be used to check ovarian function. An FSH bloodtest is taken on day 3 of the cycle. Clomiphene Citrate is then given days 5-9 of the cycle. Another FSH level is obtained on day 10. If it is significantly elevated, this may indicate problems with ovarian function.
Age Is Significant in Treatment Plan Recommendation
Delaying pregnancy is a common choice for women today for social and economic reasons. Because of this, age related infertility has increased over the last decade.
It is estimated that at least 20% of women will wait until after the age of 35 to have their first child. Additionally, the recent explosion of information about fertility treatment in the media and on the Internet may give women a false sense of security in their choice to delay childbearing.
Although it is well established that fertility decreases with advancing age, many women may not be aware of the critical role that age plays on their ability to conceive.
Peak fertility occurs during the early 20's and begins to decline significantly after the age of 35. By the age of 40, pregnancy potential is reduced by 30 to 50%. Several factors may contribute to this change but by far the greatest impact is the change in the quality and quantity of eggs that remain in the ovary.
Unlike males, who produce new sperm continuously throughout their lives, each female has her lifetime complement of eggs at birth. The total number of eggs at birth is between 1-2 million and by puberty this number has decreased to approximately 300,000. Only 1% of these eggs will be ovulated with the vast majority being reabsorbed by the body.
The loss of eggs accelerates as a woman enters her mid to late 30's and this coincides with her decreased pregnancy potential. Egg quality is compromised as a woman ages and this may impair the eggs ability to be fertilized by a sperm. Additionally, chromosomal problems in the eggs that occur with aging may account for the higher incidence of pregnancy loss and chromosomal abnormalities in children of older woman.
Testing Ovarian Reserve
Ovarian reserve can be tested by measuring a FSH and estradiol level during the early part of the menstrual cycle (day 2 or 3). An elevated level of either unfortunately predicts a poor outcome. A Clomid Challenge test can also be used to assess ovarian reserve (please call for more information on these tests or the protocol). Although these tests may be normal in older women, age is still an extremely important determinant of success.
For these reasons, it is recommended that women 35 or older begin a fertility evaluation after six(6) months of conception delay. If a woman is well informed about the impact of age on fertility, she can then make informed decision about her childbearing future.
Q How does my age influence the timing of tests, procedures, and treatments?
A If you are over the age of 40, it is extremely important to talk with your doctor as soon as possible about the options that are available to you. Unlike younger women who may have more time, women over 40 may need a more aggressive and faster approach.
Your tests and procedures may be scheduled over a shorter time than usual. Also, your doctor may want you to consider procedures that may increase your chances for pregnancy, such as stimulation of the ovary with medications, intrauterine insemination (IUI), in vitro fertilization (IVF), or gamete intrafallopian transfer (GIFT). If you decide to use one of these "assisted reproductive technologies," your doctor may recommend that you begin as soon as possible.
Q How does my age influence the types of treatment available to me?
A As you approach age 40, the quality and number of your eggs tends to decline, ovulation may become irregular, and your ovaries may produce less estrogen and progesterone.
Progesterone is needed to stabilize the lining of the uterus so that a fertilized egg can implant. Your doctor may recommend medication, an assisted reproductive technology procedure, or a combination of the two.
Another option for older women is the use of eggs donated by a woman who is in her 20s or 30s. The eggs are mixed with your partner's sperm and transferred to your uterus or fallopian tubes. Younger eggs are more likely to result in pregnancy and less likely to end in miscarriage.
For more information on Advanced Age please call 1-888-761-1967, or schedule an appointment for an initial consultation with one of our physicians.
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