Medical Contribution By Dr. Gilbert Mottla

While the majority of public perception of infertility is that it’s a disease that affects women who are in their late 30s and 40s, the truth, says Dr. Gilbert Mottla of Shady Grove Fertility’s Annapolis, MD office, is that infertility is often age-independent.
“Women of any age can have fertility issues,” he says, “and we find that often, younger women wait much longer to seek treatment than they should.”
Physiologically, age does play a major role in a woman’s ability to successfully conceive a pregnancy due to reduction in quality and quantity of a woman’s eggs. But there are other factors that play into a woman’s inability to conceive on her own.

Pregnancy Rates Decline with Age

Women are born with about 1 million eggs and as a woman ages the number of eggs within the ovary begin to rapidly decrease, and by the time she starts menstruating she may only have about 400,000 eggs left. By the time a woman reaches her 20s, the chances of becoming pregnant naturally each cycle is only about 20% each month. That number declines gradually through her 20s and early 30s. Once in her mid-to-late 30s and 40s the natural pregnancy rate drops to less than 10%.  Fertility treatment sucess rates follow the same pattern and often, when women are over the age 40, treatment using their own eggs is often unsuccessful and donor egg becomes the only option.
“Many couples who come see us in their late 30s and into their 40s aren’t getting pregnant largely due to the inefficiency of their age,” said Dr. Mottla. “As a woman ages, the total number of eggs decline as well as the quality. So while a woman maybe ovulating normally, it may be the quality of those eggs and specifically the genetic abnormalities of the eggs that explain unsuccessful conception.”
Dr. Mottla explains that younger women who are in their 20s and 30s who are not successfully conceiving may be facing a different set of roadblocks on their way to parenthood.
“Fallopian tube issues are an example,” Dr. Mottla said. “Blocked fallopian tubes won’t allow the egg and sperm to meet without intervention. But most women won’t suspect that these blockages are present. They’re virtually indiscernible by the patient but present a true physical barrier to conception.”
Some potential causes of blocked fallopian tubes include:

  • congenital, structural problems present at birth
  • previous surgery in the abdominal or pelvic region
  • past non-recognized pelvic infections

And one of the most common causes of infertility — ovulation disorders – may plague a woman at any age.
“If a woman isn’t ovulating, it doesn’t matter how young or healthy she is. To achieve pregnancy, a woman must ovulate,” Dr. Mottla remarks plainly.
One of the “red flags” for an ovulation disorder might be irregular or absent menstrual periods, at any age. But not all women will experience the tell-tale signs of period problems.
Medical history may also play an important role in whether or not a woman should seek an initial consultation for fertility problems. And in this case, patients don’t need to feel like “history” means many years of reproductive maturity. Dr. Mottla presents the example of a 14-year-old girl with appendicitis that may have resulted in a pelvic infection, or a young woman with Crohn’s disease or other intestinal issues, all which can cause damage to the fallopian tubes.
“All of those are medical history markers that warrant a basic fertility evaluation for reassurance,” Dr. Mottla says.
Dr. Mottla says that most causes of infertility are independent of the age variable, so much so that commonly-held notions about infertility being inherited can be mostly put to rest.
“If a woman’s cycles are irregular, or if she has structural conditions like blocked tubes, then infertility becomes unrelated to heritage,” he remarks.

Age-based Diagnosis and Recommendations

Shady Grove Fertility’s recommendations are that women under the age of 35 schedule a basic fertility diagnostic evaluation with an infertility specialist after a year of unsuccessful conception with unprotected intercourse. Women 35 and older are recommended to seek evaluation after six months of trying, while women who are 40 years or older strongly consider scheduling a consultation as soon as they start planning a pregnancy.
While our physicians individualize treatment to meet the many varied needs of each patient, the basic fertility evluation includes the following:

  • a blood test for evaluating hormonal functioning
  • a sonogram to get an image of the pelvic organs, looking for any obvious structural problems
  • a hysterosalpingogram (HSG) or “tube dye test” to determine if the tubes are clear and the interior of the uterus is normal
  • a semen analysis for the male partner

“It’s a pretty focused and unintimidating evaluation that can give anyone a feeling of reassurance that their fertility is intact. Or it may be the way that a couple learns not only why they haven’t gotten pregnant, but what treatment is necessary.”
Once a diagnosis is determined, Shady Grove Fertility physicians will tailor a treatment protocol specifically for the individual patient. Over 50% of the treatments performed at Shady Grove Fertility are low tech, such as ovulation induction and Intrauterine Insemination (IUI), and, depending on the diagnosis, are most commonly the first methods of treatment attempted.
“If we are working with a 28-year-old patient who we have diagnosed with an ovulatory disorder such as PCOS, then we may determine that its best to begin her treatment with a couple cycles of oral medication with either timed intercourse or IUI,” said Dr. Mottla. “This provides the patient and the physician with a good starting point in determining what the most successful method of treatment is for that individual.”
“If we determine that the patient ovulates multiple eggs per cycle on the stimulation medication then we’ll recommend IVF so we can control the odds of multiples by the transfer of a single, high-quality embryo,” Dr. Mottla explains.
An additional benefit to using IVF is that extra embryos can be frozen and then used by a couple as many as years down the road to add children to their family — without an additional cycle of IVF.
The bottom line: There are many options from low tech to high tech treatments with promising success rates for all diagnosis, but they are again age-dependant. The earlier you get started, the greater your chances of success.  Men and women of all ages can increase their chances for successfully having children by having greater understanding of their fertility factors and, most importantly, by not letting the fear of seaking the help from a fertility specialist stand in the way.

If you have questions about age and fertility or to schedule an appointment, please call a Patient Liasion at 888-761-1967.