Female Age and Infertility
Female age is perhaps the greatest enemy of fertility. Many women do not realize how rapidly fertility can decline in their thirties. The American Society of Reproductive Medicine defines infertility as the inability to conceive after one year or regular, unprotected intercourse. To emphasize the impact of age, this definition is shortened to six months in women aged 35 or older.
Women are born with more than a lifetimes supply of eggs and once menses begins, one or more eggs are ovulated each month. Many women delay childbearing until their careers are established and many couples are marrying later.
Many women don’t realize the impact that age can have on fertility success rates and some believe they can have children as late as their forties. Many times there are no symptoms associated with declining egg quality until menopause and some women enter menopause much earlier than normal, a condition known as perimenopause.
When a women decides to pursue children she may find that her FSH is elevated, which is often a first sign of reduced ovarian reserve. Those with slight elevations can pursue treatment usually with IVF, while those with values over 10-12 mIU/ml may require an egg donor. Sometimes the Clomid Challenge Test is administered and a poor result is indicative that assisted reproductive technologies will not be successful.
We now use another predictive test for evaluating ovarian reserve which measures antimullerian hormone levels. This test can be performed at any time during the menstrual cycle. As ovarian reserve decreases it is associated with a decline in antimullerian hormone levels and an increase in FSH. This test is used as an adjunct to the day 3 FSH hormone measurement.
Women aged 35 or older should seek the care of a reproductive endocrinologist/infertility specialist. There may be little time left to conceive a child without using donor eggs. Time can’t be wasted on treatments, such as repeat Clomid cycles.
The ability to freeze eggs when young for use later in life is an excellent means to prolong fertility and facilitate family planning. Egg freezing is also used in women who will undergo therapies such as cancer chemotherapy or radiation that will destroy their ovaries. Eggs are retrieved and frozen prior to the damaging treatment procedure.
While women are suspectable to age related declines in egg quality, most men can father children until late in life.