| |
|
Perhaps the greatest threat to a woman's fertility is advancing age. Many women are now choosing to delay marriage until they are much older and consequently, many are attempting pregnancy in their mid-to late 30s and early 40s. Unfortunately, the biological clock has not changed to coincide with the evolution of our societal values and fertility for women is greatest in the late teens and early 20s. This is contrary to the situation for men, as most men remain relatively fertile throughout their adult lives. However, some degree of male infertility is present in up to half of infertile couples. Women aged 35 or older should not delay consultation with a fertility specialist.
Women are born with a lifetime supply of eggs and during each month of a natural cycle one egg develops in the dominant follicle, and undergoes ovulation. This development is initiated and supported by follicle stimulating hormone (FSH). At the same time, a group of smaller unselected follicles become atretic and are no longer capable of reaching ovulation. As women age, the number of remaining eggs declines; furthermore, those that are available may demonstrate a decrease in egg quality.
Unfortunately, many women have no symptoms or notice any change in their menstrual cycle during the early phase of diminishing ovarian supply. Some women will report a generalized shortening of their cycles, but more commonly cycle length is unchanged. There are several tests that can assess a woman’s ovarian reserve including a vaginal ultrasound to measure ovarian volume/ size and count the number of small (“antral”) follicles, and a cycle day 3 FSH level. In general, ovarian volume/ size decreases with age and fertility. Similarly, the number of antral follicles is correlated with the number of recruitable and possibly fertilizable eggs.
How does a blood test for FSH level early (cycle day 3) in the menstrual cycle assess for ovarian reserve? The hypothalamus (part of the brain) can accurately adjust to stimulate follicle development, but will only produce the minimum amount of FSH needed to ‘get the job done’. Therefore in ‘younger’ ovaries a minimum or low amount of FSH is needed to establish ovulation, and in ‘older’ ovaries, there is an elevation of FSH, often above 10 mIU/ml.
The decline in fertility can be difficult to predict. Because age-related fertility is known to decrease quickly in the mid 30’s, women over the age of 35, who have been attempting pregnancy for six months, with or without an elevated day three FSH level, should see a fertility specialist,Reproductive Endocrinologist. Fertility specialists are acutely aware of age related infertility issues and rapidly move women through available treatments. Studies show that the overall cost of infertility treatments are less when a specialist is consulted.
For many older women, their single best chance to achieve pregnancy is by undergoing in vitro fertilization (IVF) because every step along the conception pathway is maximized. Still, some women will show poor response to fertility medications, and will have a slim chance of pregnancy, even with IVF. These women, who cannot use their own eggs, may choose to enter our donor egg program .
An egg donor is usually a younger woman, who undergoes IVF stimulation and her resultant eggs are combined with the husband’s sperm. The resulting embryo is then transferred into the wife’s uterus. We have one of the most successful donor egg programs in Texas. The IVF success rates for our donor egg program are high, meaning fewer cycles of IVF will probably be required thus helping to control fertility treatment costs. Please see our section on donor egg for more information.
Sometimes older women undergoing IVF opt for PGD to screen for chromosomal abnormalities such as aneuploidy, which is an abnormal number of chromosomes.This types of genetic anomalies are often the cause of miscarriage. We conduct PGD in our Dallas, TX offices.
"Search Our Site"
|
|
