Like many women today, you may be waiting later to start your family than your mother’s generation did. While it seems that everyone has a friend who conceived over 40, and celebrities seem to do it regularly, the truth of the matter is that every woman’s fertility declines with age.
To make matters even more challenging, success with fertility treatment follows the same pattern. Even couples that have no other factors for infertility have a harder time becoming pregnant with IUI and IVF treatment as the age of the female advances.
“But you don’t need to panic,” says Melissa A. Esposito, MD of Shady Grove Fertility’s Frederick office. “There are lots of ways fertility specialists can help. You just might want to be a little more proactive about knowing when to seek help and what your options are.”
The Chances of Pregnancy Decline for Every Woman as They Age
From the time a woman is born, the number of eggs within her ovaries begins to decrease. That decline continues throughout the aging process. “Not only does the number of eggs continue to decline,” explains Dr. Esposito, “but the health of the remaining eggs also declines, so that by the age of 40, approximately 60-70% of a woman’s eggs are abnormal. That’s why the miscarriage rate and the chances of chromosomal abnormalities in the offspring, like Down Syndrome, increase as a woman ages.”
It’s just not that easy to get pregnant each month- for instance, for a woman in her 20s, her chances of becoming pregnant naturally are about 20-25% each month. That number declines gradually through her late 20s and early 30s. Once in her mid-to-late 30s and early 40s, the natural pregnancy rate drops to less than 10% per cycle.
“A lot of women think that because they lead a very healthy lifestyle they have healthier eggs than other women their age,” says Dr. Esposito. “Unfortunately, this decline happens to every single woman regardless of those factors. There’s really nothing we can do to stop it.”
Don’t Wait Too Long to Seek Fertility Help from a Specialist
Though you may not be able to control the effects of aging on your fertility, you can improve your odds of success by seeking help in a timely manner. “Lots of patients say they wish they had come in sooner,” says Dr. Esposito. “Every month, the aging process is progressing, so it’s best to follow the recommended guidelines about when to seek an evaluation.”
Those guidelines say that couples in which the woman is under 35 should have a complete infertility workup after 12 months of unprotected intercourse without a pregnancy. Women over 35 should be evaluated after only 6 months.
“Even if you haven’t been actively trying, if you were having unprotected intercourse and didn’t get pregnant, you should count that time.” says Dr. Esposito. If you don’t have regular periods then you should seek help sooner since in that instance you will likely not be able to get pregnant on your own.
Find Out Your Specific Chances of Having a Baby
Being evaluated means having a basic infertility workup. This set of tests provides a helpful picture of you and your partner’s chances of becoming pregnant. One important component of that picture is the health and number of eggs that remain in your ovaries, called ovarian reserve. “Ovarian reserve is where we see the effects of aging most clearly,” says Dr. Esposito.
Traditionally, two tests have been used to determine ovarian reserve:
- Follicle Stimulating Hormone (FSH) Level: This is a blood test that is usually drawn on the 3rd day of your menstrual cycle (but can be done between cycle days 2-4). FSH is a hormone secreted by the pituitary gland that stimulates the growth of the follicles, which are the fluid filled sacs that contains the eggs in the ovaries. There is one egg per follicle, and usually one egg inside each follicle which is stimulated to grow monthly under the FSH hormonal stimulation. An elevated FSH level may indicate a decrease in egg quality and/or number and usually denotes a low ovarian reserve.
- Antral Follicle Count (AFC): This test is performed during an ultrasound on a specific day of your cycle (also done between cycle days 2-4). The follicles that are seen in your ovaries on that day are counted. Dr. Esposito explains, “The more follicles we see, the better. If there are 10 follicles or more between both ovaries, the patient generally still has a good ovarian reserve. However, if there are only a few follicles between both ovaries, that is often a sign of decreased ovarian reserve.”
In addition to FSH hormone and AFC testing, there is a new test that is available which is providing more information into the ovarian reserve picture:
- Anti-Mullerian Hormone (AMH) Level: This is a blood test that measures a hormone called Anti-Mullerian Hormone (AMH). “The nice thing about this test is that it can be checked on any day of the cycle and it doesn’t vary from cycle to cycle like an FSH level can,” says Dr. Esposito. “In the case of AMH, the higher the level, the better. If we see a level of AMH greater than 1, it usually means the patient still has good ovarian reserve.”
Fertility Specialists use the results of all three FSH, AFC and AMH tests along with the age of the patient to get a better understanding of their ovarian reserve. Decreased ovarian reserve in a young patient is often not the same as decreased ovarian reserve in an older patient because the young patient has age on her side. Although the younger patient may have lab criteria suggestive of decreased ovarian reserve and may have less eggs to work with, often the eggs that she has are still of decent quality because she is young. In older patients, generally patients over 35, this is often not the case.
Fertility Treatments That Work
Once you have a complete diagnosis, your doctor can talk to you about how likely different treatments are to work for you. Data shows that success rates decline as the female partner ages, but treatments can still be successful depending on your specific fertility testing profile.
“For example, a patient who is in the mid to late 30’s is at the age where we start to see age-related decline in fertility, but if she has a good ovarian reserve and no other issues, it would be reasonable for her to start with a low tech treatment like superovulation with IUI,”
“If her ovarian reserve were beginning to decline, then I would recommend going directly to a more aggressive treatment like IVF,” adds Dr. Esposito. IVF is the most successful treatment a couple can do using their own eggs and sperm.
Using Donor Eggs
If you find out that you have a low ovarian reserve or you are unsuccessful conceiving with your own eggs, using donor eggs may be the answer for you. Donor eggs offer one of the highest pregnancy and delivery rates of any fertility treatment and allow you to carry and deliver a child that is genetically linked to your partner.
“When I see patients in their 40s or those with low ovarian reserve, I always tell them about our donor egg program,” says Dr. Esposito. “It’s such a wonderful option for patients, and I’m so glad it’s becoming a more well-known and accepted form of treatment.”
Donor egg treatment used to be unaffordable for the vast majority of patients. However, Shady Grove Fertility has developed innovative solutions, such as shared donor egg and shared risk, to overcome the cost and donor availability issues commonly associated with traditional donor egg programs. These programs allow more patients the ability to pursue treatment than before.
Preserving Your Fertility with Egg Freezing
What about women who aren’t ready to conceive but are still worried about aging affecting their fertility? For these women, freezing eggs for later use can provide a great peace of mind. The official name for this process is Fertility Preservation, and it’s the only way to pause your biological clock.
The best age to preserve eggs is between 30-38 and optimally between 32-38.
When a woman uses her frozen eggs in the future, even if a number of years has passed, the pregnancy rate and the incidence of miscarriage and genetic abnormalities will be based on the age of the woman when the eggs were frozen, not her age when she uses the eggs.
“This option is becoming more and more popular with women,” says Dr. Esposito. “The great news is that now, with new and improved techniques for freezing, Shady Grove Fertility is having success rates with frozen eggs that are similar to the success of IVF with fresh eggs.”
Step by Step Approach
If you’re concerned about your fertility, it might be a good idea to schedule an initial consultation with a fertility specialist. During this appointment your physician will review any completed testing you have or make the necessary arrangements to get your testing started. For many patients the initial appointment along with the basic fertility testing is often covered by your insurance provider.
Knowing where you stand today, will help both you and your physician learn what steps to take first on the road to parenthood. “Age is one thing we can’t reverse, and I want women to be aware and proactive if possible,” says Dr. Esposito, “but I also want them to feel hopeful and know that there are now many ways to help overcome infertility.”
