Advanced age plays an important role in a woman’s ability to become pregnant and carry a pregnancy to term. From ages 30 to 35, there is a gradual decline in a woman’s ability to become pregnant; after age 40, there is a sharp decline in conception.
The chance of miscarriage and chromosomal abnormalities, such as those that cause Down syndrome, also increase with age. Even the success of in vitro fertilization (IVF) and other similar procedures decreases with advancing age.
WHY DOES AGE PLAY SUCH AN IMPORTANT ROLE IN FERTILITY?
One reason fertility declines as maternal age increases is because women are less likely to ovulate regularly as they age. In addition, they are more likely to have medical problems that can cause infertility, such as endometriosis. However, the most important reason relates to the condition and decreasing number of the woman’s eggs. As the eggs age, they become more resistant to fertilization, resulting in lower pregnancy rates. More of the eggs also tend to have chromosomal abnormalities, making miscarriage more likely.
DIAGNOSTIC TESTING FOR ADVANCED AGE
TIMING TESTS, PROCEDURES, AND TREATMENTS FOR ADVANCED AGE
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, so to speak, women over 40 may need a more aggressive and faster approach. Thus, your physician may recommend certain tests and procedures and schedule them over a shorter time than he or she does with someone whose age is not as much of a factor.
DIAGNOSTIC TESTS FOR ADVANCED AGE
Your evaluation is likely to begin with your medical history and a pelvic exam. However, you may need other tests to determine whether your age is affecting your fertility, such as one or more of the following:
Follicle-stimulating hormone (FSH)
A blood test 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.
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.
AMH (anti-Müllerian hormone)
AMH is the most accurate predictor of a woman’s egg supply. This test can be more accurate than FSH because there is no fluctuation from month to month and the test is not dependent on a woman’s menstrual cycle, which means women can have the test at any point.
Antral follicle count (AFC)
An antral follicle count is a very good predictor of how a woman will respond to fertility medication. A transvaginal ultrasound can view the uterine and ovarian anatomy and allow a physician to count the small resting (antral) follicles.
TREATMENT FOR ADVANCED AGE
As you approach 40, the quality and number of your eggs tends to decline, ovulation may become irregular, and your ovaries may produce less estrogen and progesterone. Your body needs progesterone to stabilize the lining of your uterus so that a fertilized egg can implant. Your doctor may recommend medication, an assisted reproductive technology (ART) procedure, or a combination of the two in order to help you conceive.
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.