By: Kathryn C. Calhoun, MD, ACRM
I'm over 35 and I want to have a baby … now what?
Mother Nature's challenge … a finite number of eggs.
The effect of aging on female fertility is well-known. Women begin with 6-7 million eggs before they are even born! The egg number drops to 1-2 million at birth, and by puberty, only 50,000 eggs remain. Approximately 300-500 eggs will be ovulated over her reproductive lifetime before the menopause occurs (~1000 eggs remain, age 51-52.) Fertility is affected well before the menopause, and more women are delaying childbearing into their mid/late 30s.
Age & Fertility
For most women, maximum fertility begins to decline between ages 27-32, with more rapid decline at age 37. Both natural conception rates and fertility treatment conception rates are affected by this decline. This decline results from irreversible, age-related changes in egg quantity and egg quality. As women age, their eggs are more likely to have chromosomal (genetic) abnormalities, which contribute to the decrease in fertility rates and the increase in miscarriage rate.
The good news …. Most women can still conceive healthy babies in their late 30s and early 40s.
But, clearly, time is of the essence.
Advanced Maternal Age & Fertility Treatments
The American Society for Reproductive Medicine (ASRM) and the American College of Ob/Gyn (ACOG) recommend that women over 35 receive fertility evaluation after 6 months of attempting pregnancy, if not before1. At a minimum, this evaluation should include measures of egg and sperm, as well as female anatomy: ovarian reserve bloodwork, semen analysis and hysterosalpingogram (HSG).
Even if all of the initial fertility tests return normal (“unexplained infertility”), women should be offered fertility treatment, and a new study supports aggressive fertility treatment for women over 38 years old2:
Women between the ages of 38-42 years old with unexplained infertility were randomized to treatments with intrauterine insemination (IUI) or immediate in vitro fertilization (IVF), and they were followed for two treatment cycles. Women who did not conceive in the first two cycles were offered IVF next.
- 71% of the couples conceived and 46% delivered a live baby
- 84% of the live births were IVF conceptions
- After two cycles, 49% of the IVF couples were pregnant (31% live birth) and <25% of the IUI couples were pregnant (14% live birth.)
- The immediate IVF group took an average of 2 cycles to conceive, while the IUI group averaged between 3-4 cycles to conception
The bottom line – Time is of the Essence for Fertility
Women over 35 should receive an expedited fertility evaluation, and should be offered the opportunity to pursue aggressive fertility treatments in order to complete their families faster.
- Age related Fertility Decline: a committee opinion. The Committee on Gynecologic Practice of the American College of Ob/Gyn and the Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility, 93 (3): S154-155. Nov 2008.
- Goldman et al, A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T), Fertility and Sterility, in press.
For more information or to schedule an appointment with Dr. Calhoun please call 678.841.1089 or click here.