Age and Fertility- Written by a specialist.

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Age and Fertility- Written by a specialist.

According to research over the last 40 years, a healthy 30 year old woman has about a 20% chance of getting pregnant each month. A healthy, ovulatory 40-year-old woman’s chance per month is 5% (1,6). The decline is slow and steady up until the age of about 35. After that the decline becomes steeper. These ranges and time frames have been established through multiple studies and have been consistent for the last 30+ years. The decline in fertility is attributed to depletion of ovarian oocyte (eggs) reserve and is determined by genetic, environmental, and lifestyle factors.(2).

Now, for the good news. Age at conception does have bearing on time to pregnancy in a healthy, ovulatory woman. In general, fecundity (a woman’s physiological ability to have a child) is reported as age ranges because it is difficult to correlate a specific age to a specific chance of success. There are also factors that can affect reproductive aging. These include other medical conditions that can have an effect such as endometriosis, fibroids, genetic conditions (errors in number of chromosomes), environmental influences, obesity, smoking, thyroid gland dysfunction, history of sexually transmitted diseases (STDs), and ovulatory dysfunction, to name a few (2,3).

PCOS stands for Polycystic Ovarian Syndrome, it is the most common form of ovulatory ovarian dysfunction.  The pathology of PCOS makes ovulation irregular and unpredictable, making the timing of intercourse for conception difficult. 

There could also be issues with male fertility such as erectile dysfunction and sperm quality issues. Male evaluation initially consists of a semen analysis and potentially other endocrine blood testing to evaluate any severe sperm abnormality.

HOW CAN ASSISTED REPRODUCTIVE TECHNOLOGY HELP?

Most of the factors other than extreme reproductive age are usually treatable. When you get started, the first step is a comprehensive evaluation of both you and your partner (if applicable). We test your ovarian reserve to gauge likelihood of adequate number of eggs produced per cycle, prolactin levels since the elevated levels can affect regularity of ovulation, and PCOS testing. If there are any positive findings, we can offer prescription medications or supplements beneficial for conception (5).

There are supplements that both partners can take that have been shown to be beneficial for conception.  Lifestyle modification and diet changes (such as following the Mediterranean diet) can also positively impact your chances.  Controlling your stress and regular moderate exercise also confer benefits (3,4).

Please click the link below for a consultation with an experienced Reproductive Endocrinologist. You can also follow us on Facebook or return to our website for updated information about your fertility journey.

References

1.   Menken J, Trussell J, Larsen U. Age and infertility.  Science. 1986;233:1389-1394.

2.   Utting, D., & Bewley, S. (2011). Family planning and age-related reproductive risk. The Obstetrician & Gynaecologist, 13(1), 35–41. https://doi.org/10.1576/TOAG.13.1.35.27639

3.   Collins GG, Rossi BV. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract. 2015 Jul 25;1:11. doi: 10.1186/s40738-015-0003-4. PMID: 28620516; PMCID: PMC5424364.

4.   Dimitrios Karayiannis, Meropi D Kontogianni, Christina Mendorou, Minas Mastrominas, Nikos Yiannakouris. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Human Reproduction, 2018; DOI: 10.1093/humrep/dey003

5.   Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International journal of endocrinology, 2016, 1849162. https://doi.org/10.1155/2016/1849162

6. Sozou PD, Hartshorne GM (2012) Time to Pregnancy: A Computational Method for Using the Duration of Non-Conception for Predicting Conception. PLOS ONE 7(10): e46544. https://doi.org/10.1371/journal.pone.0046544

Can women have children at any age?

In general:

🔸women are most fertile before the age of 30
after 30
🔸women’s fertility starts to decrease
🔸after 35 fertility declines more significantly
by 40
🔸a woman’s fertility is about half the level it was before she was 30.

A study compared women’s ability to conceive, in different age groups. It showed that, compared to women aged 30-31, the chance of conceiving was:

🔹14 percent lower for women aged 34-35
🔹19 percent lower for women aged 36-37
🔹30 percent lower for women aged 38-39
🔹53 percent lower for women aged 40-41 years

Women younger than 30 have about a 20 percent chance of getting pregnant naturally each month. By age 40, the chance of pregnancy is about five percent each month.

So make sure you start your treatment ASAP in case you have infertility.

What doctor is right when you have infertility?

🔶Who is #OB-GYN?
OB-GYN refers to the two fields of #obstetrics and #gynecology, so most people use the abbreviation OB-GYN to refer to their obstetrician and gynecologist. Gynecologists specialize in women’s health, and generally treats medical and surgical conditions associated with female anatomy. Obstetricians care for you during pre-conception, pregnancy, childbirth and immediately after delivery. An OB-GYN does all these things. This doctor prescribes birth control and sees you through childbirth and menopause. This person also screens for cancer, treats infections and does some surgeries.

🔶Who is #REI?
REI stands for reproductive endocrinology and infertility. Doctors who work in REI train in the medical and surgical treatment of issues dealing with a woman’s reproductive tract and conditions causing infertility. REI specialists are skilled in helping women who are struggling to get pregnant. REI specialists work with genetic counselors and dietitians to help couples achieve their dream of having a child.

REI doctors work with those coping with things such as:
-Endometriosis
-Polycystic ovarian syndrome (PCOS)
-Male factor infertility
-Tubal factor infertility

Your OB-GYN might send you to an REI specialist if you’ve been trying to conceive for 6 to 12 months without success or if you have a history of miscarriages.

Some women are treated by both types of physicians: OB-GYN, and an REI doctor.

So, the difference between REIs and OB-GYNs is that REIs focus on both men and women, are more experienced in solving infertility issues, and create more individualized plans. Also usually REIs are more specialized to help you if you have a more complicated reproductive history or have not been successful with your OB/GYN.

Do you really have an unexplained infertility diagnosis?

Many patients come to us saying that they have been diagnosed with unexplained infertility earlier. However, the majority of them end up having another diagnosis.

An unexplained infertility diagnosis may be set after the following tests have been performed:

✅There are no serious uterine fertility issues (Evaluated with a hysteroscopy.)
✅You are ovulating regularly (Evaluated with ovulation home kits)
✅Your fallopian tubes are open and healthy. (Evaluated with an HSG.)
✅Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)
✅Your partner’s semen analysis is normal (Evaluated with semen analysis, including total count, sperm movement, and sperm shape.)
✅Assessment of ovarian reserve, imaging to assess for tubal and uterine factors, transvaginal ultrasound, etc.

We make sure you don’t get treated from a wrong diagnosis🌸

Progesterone and Fertility

Progesterone is an important part of infertility treatment, with fertility specialists often prescribing progesterone supplements to help improve pregnancy rates from IVF. So why is progesterone supplementation used and can it help with natural conception rates as well? Firstly, it helps to understand the role of progesterone in pregnancy.

❓What is progesterone?

Progesterone is a hormone produced by the ovary. It is first detected in the middle of the menstrual cycle when an egg is released (ovulation). One of the most important functions of progesterone is to prepare the lining of the uterus (endometrium) to allow a fertilised egg (embryo) to implant. If a pregnancy does not take place, progesterone levels will fall and you will have your period. If an embryo implants into the lining of the uterus, the resulting conception will produce the hormone Human chorionic gonadotropin (hCG) which in turn will direct the ovaries to produce progesterone until eight weeks into the pregnancy. After that time, progesterone will be produced by the placenta throughout the remainder of the pregnancy.

❓Do I need progesterone if I am trying for natural conception?

There is no evidence to suggest that giving progesterone supplements to otherwise healthy women in early pregnancy has any additional benefits or reduces the risk of spontaneous miscarriage. A recent randomized trial also found no benefit from progesterone supplements in a group of women with repeated miscarriage. However, despite this, there may still be some benefit from this approach in individual cases and you should discuss it with your doctor in the light of your own particular circumstance.

❓When and how should I take progesterone?

Fertility specialists usually prescribe progesterone supplementation to start a few days after the eggs are collected. Progesterone supplements generally come in the form of a vaginal suppository or intramuscular injection. Current research is focussed on improving the effectiveness of oral preparations of progesterone, as past studies have found that only 10% of progesterone is absorbed when taken orally. While both the suppository and injection methods appear to be equally effective, vaginal preparations are preferred by most patients and fertility specialists alike. Alternatively, luteal phase support with intermittent or several hCG injections can be used to stimulate the ovaries to produce progesterone. This is not advisable if more than ten follicles are found on ultrasound, as this may cause an ovarian cyst or ovarian hyperstimulation (OHSS).

❓What are the risks of taking progesterone?

Many studies have been performed to look at the use of natural progesterone during IVF treatment. These studies have shown that progesterone will pose no significant risk to you or your baby. Although, for some women, vaginal preparations can cause discharge and local irritation.

❓What is next?

If you have any questions about taking progesterone and the options available, please to our board-certified reproductive endocrinologist.

IVF is not the last resort

IVF is not the only option

Some fertility clinics oversell IVF as the most effective and final solution. This is simply not true.

IVF efficacy is comparable to that of medication treatment, while the latter could be 20 times cheaper. And most women out there perfectly qualify for it.

🤚But wait: When do I really have a problem?

There is a consensus in the medical community that if you are

  • ✅ younger than 35 years old and can’t conceive for 12 months, or
  • ✅ older than 35 years old and can’t conceive for 6 months,

 then you have to talk to a fertility specialist. Period.

❗️When can’t I avoid IVF?

If you have been unfortunately diagnosed with either of the following:

  • Confirmed obstructed fallopian tubes 
  • Genetic mutation with desire for elimination from offspring
  • Desire for genetic testing or family balancing
  • Using an egg donor or adopted embryos
  • Severe male factor infertility
  • Failed initial treatment with Clomiphene, Letrozole, Gonadotropins

then IVF seems to be a logical next step for you.

❗️If none of these applies to you, then IVF is not your next step at this moment. Please.

❓What can I do to avoid IVF?

Your options at this point are as follows:

  • ✅ Lifestyle changes
  • ✅ Hormones to support early pregnancy
  • ✅ Medication treatment

As for lifestyle, you have probably read tons of materials on the Internet about diet, exercise, supplements, breaking bad habits like smoking, alcohol. Let us leave it right there – we totally agree.

❓But what if it’s not enough?

For most patients lifestyle changes are not enough to get pregnant.

The medication treatment is about stimulating. Most of these drugs have been around for more than half a century, delivering results to millions of happy parents.

Medications and hormones are not just enough. Please add thorough evaluation and an experienced fertility specialist to your formula of success.

Puzzled? We want to hear from you, please send us your questions. Our mission is to provide timely and accurate answers on your fertility journey. It’s free.