Fertility changes with age for both males and females. In females the beginning of their reproductive years is marked by the onset of menstruation and ovulation.
It is a common perception that after menopause women are no longer able to become pregnant but it is important to understand that the reproductive potential decreases as women get older, and fertility can be expected to end 5 to 10 years before the actual cessation of menses.
Nowadays age-related infertility is becoming more common as, for a varied number of reasons, many women wait until their 30s to begin families.
Fertility declines as a woman ages due to the normal age-related decrease in the number of eggs that remain in her ovaries. This decline may take place sooner in some women.
A woman’s best reproductive years are in her 20s
Each month a healthy, fertile 30-year-old female has a 20% chance of getting pregnant which means that for every 100 fertile women trying to get pregnant, 20 will be successful and the other 80 will have to try again. By 40, a woman’s chance is less than 5% per cycle.
Women are unable to become pregnant much before menopause. The average age for menopause is 51, but most women are unable to have a successful pregnancy sometime in their mid-40s. This is true for natural as well as conception using fertility treatment, including IVF.
Although stories in the news media may lead couples to believe that they will be to able use fertility treatments such as IVF to get pregnant, a woman’s age affects the success rates of all infertility treatments.
The loss of fertility happens as both the quality and the quantity of eggs gradually decline with age.
INFERTILITY EVALUATION AND ADVANCED MATERNAL AGE
Infertility is usually diagnosed if a woman has not become pregnant after 1 year of unprotected intercourse. However, if she is 35 or older, the evaluation should begin after 6 months of trying. If a couple has an obvious medical problem affecting their ability to conceive, such as absence of periods, sexual dysfunction, a history of pelvic disease, or prior surgery, they should begin the infertility evaluation immediately.
Fertility tests may include follicular studies and evaluation of the tubes, cervix, and uterus.
The male partner will have a semen analysis.
Preconception counseling is often beneficial. Children born to women over age 35 have a higher risk of chromosomal problems thus comes the role of Prenatal testing.
TREATMENT OPTIONS AND ALTERNATIVES
If a cause for infertility is identified, the clinician may suggest a specific treatment. E.g.
- Super Ovulation (SO)
- SO + IUI (intrauterine insemination) with husbands or donor semen
- And many other procedures best explained by your clinician
With any treatment, a woman’s age affects the chance for pregnancy. In women>40, the success rate of SO/IUI is generally less than 5% per cycle. This compares to success rates around 10% for women ages 35 to 40. IVF is more effective but also has relatively low success rates in women 40 and older, generally less than 20% per cycle.
If you are older, especially if you’re over 42, and have not succeeded with other therapies, or if you have premature ovarian failure (POF), your treatment options are limited.
Egg donation, which involves the use of eggs donated by another woman is highly successful. The high success rate with egg donation confirms that egg quality associated with age is the primary barrier to pregnancy in older women.
Counseling is important in egg donation programs so that all parties understand the ethical, legal, psychological, and social issues involved. Because success depends heavily upon the quality of eggs that are donated, women in their 20s with proven fertility are ideal donors.
Women who wish to delay childbearing until their late 30s or early 40s may consider methods of fertility preservation such as freezing of embryos or freezing eggs for later use.
The success of embryo freezing is well established, but it requires that the woman have a male partner or use donor sperm.
Egg freezing is a new technology that shows promise but age remains a problem. As the age of women undergoing egg freezing increases, the outcomes of ART cycles utilizing their frozen eggs become less favorable.
PREIMPLANTATION GENETIC SCREENING
With preimplantation genetic diagnosis (PGD), a small number of cells are removed from each embryo and genetically evaluated. Embryos for transfer to the mother’s uterus would be selected from the chromosomally normal embryos. The hope is that this procedure will result in improved successful pregnancy rates and avoidance of transmission of an embryo with a genetic disorder.
Fertility naturally declines with age. Generally, fertility begins to drop in late 20s or early 30s and falls more rapidly after 35. By learning about all options and being aware of their needs and goals, couple will be prepared to make the best decisions.
Dr. Sonu Balhara Ahlawat
M.B.B.S, D.G.O, DNB
Reproductive Medicine Unit
Artemis Health Institute
Sector 51, Gurgoan