Infertility over 35

At what age does fertility start to decline?

A woman’s fertility begins to decline in her late 20s, when egg quality and quantity begin to drop. This decline becomes more rapid after age 35. Approximately one-third of couples in which the woman is 35 or older will have problems with fertility, and it is estimated that that number increases to two-thirds when the woman is 40 or older!

Why does fertility decline with age?

The decline in reproductive function in older women seems to be directly related to the number and, more importantly, the quality of eggs remaining in a woman’s ovaries. A woman is born with all the eggs she will ever have. The number of eggs begins to decline in childhood and continues through adulthood. While monthly ovulation contributes to this decline, most eggs are absorbed by the body. In addition, the quality of remaining eggs declines as a woman ages. The eggs may not fertilize or implant in the uterus as frequently as eggs from younger women, and spontaneous miscarriage is more likely.

Are there tests that can help determine whether my fertility is declining?

Yes. The amounts of certain hormones in your blood at specific times during your menstrual cycle are a good predictor of your fertility potential. A doctor measures the amount of follicle stimulating hormone (FSH) and estradiol on Day 3 of your cycle. Elevated amounts of either of these hormones is associated with lower pregnanc rates.

Another test that may be used to determine hormone levels is the clomiphene citrate challenge test. A doctor measures the FSH in your blood before and after administration of clomiphene citrate pills. Clomiphene citrate stimulates the body to produce FSH and luteinizing hormone (LH). Elevated FSH is associated with lower pregnancy rates.

Does male fertility decline with age?

Although a man’s fertility does decline with age, the change is not as pronounced as it is in women. Sperm production and sperm motility can decline with age.

What can be done to increase my chances for conceiving?

Treatment depends on the cause of infertility. A complete examination of both partners should be completed before treatment begins. Based on that examination, the following treatment may be recommended:

·       Medications may be prescribed to induce ovulation, unless your doctor determines that your supply of eggs is exhausted.

·       Insemination, which is the placement of sperm directly into the reproductive tract, may improve the success rate of ovulation induction.

·       Surgery can correct fertility problems such as endometriosis or obstructions in the reproductive organs.

·       Assisted reproductive technologies such as in vitro fertilization (IVF), in which egg and sperm are united in a laboratory and transferred back to a woman’s uterus, may be recommended.

·       IVF with donor eggs can help overcome the problems associated with older eggs. Older women who undergo IVF with donor eggs have about the same pregnancy rate as older women.

You and your partner should talk to your doctor about which treatment options are most appropriate for you.