Is Forty The New Thirty | REACH Fertility Clinic Charlotte
Not necessarily. Although more and more women are "fit and fabulous at forty," ovarian function doesn't follow this path.
Women are born with all the eggs they will ever have--current research into ovarian stem cells aside--and the egg number declines as women age. The best quality eggs are released first, in the teenage years (yes, teenagers do conceive more easily). Egg quality, as well as quantity, declines from then on. Loss of eggs speeds up as women reach their mid-thirties. This is particularly bad news for women who have delayed child-bearing while pursuing their career goals or finding the right partner.
The reports of many prominent women and celebrities having babies in their forties, up to age fifty, have led other women to believe that this will be a possibility for them, too. The reality is that these well-connected women have likely used donor eggs and/or multiple cycles of in vitro fertilization (IVF) to achieve these pregnancies. If a patient comes into her ob/gyn's or fertility specialist's office after age 40, and they suggest donor egg IVF for attaining a pregnancy, she shouldn't be surprised.
We all know women who have successfully conceived in their 40s, without fertility treatments. Many of these women have already had a child, which may increase her chances of conceiving in her 40s. Even if a woman has not conceived a pregnancy before age 40, it is still worthwhile to evaluate her fertility potential.
The basic tests used to do this are the anti-mullerian hormone (AMH) test, the follicle stimulating hormone (FSH) and estrogen levels, along with the antral follicle count potential eggs for a cycle). The AMH can be done at any time in the cycle, but the FSH, estrogen and antral follicle count should be done between cycle days 2 - 4. This is usually while a woman is on her menstrual period. If these results are promising, then the fertility specialist may recommend trying treatments that involve the woman's own eggs:intrauterine insemination (IUI) or IVF.
The chances of success, using a woman's own eggs, are lower than those for women at a younger age, but certainly not zero. It's important to have realistic expectations, and patience, when pursuing pregnancy after age 39. Donor egg IVF has a high success rate (70% or more), if other treatments fail.
How to avoid this undesirable situation? Just knowing the facts, as above, and not assuming that fitness and excellent health imply fertiity, is a good start. By the time a woman reaches her early to mid-thirties, she should be considering the question, "Do I (eventually) want children in my life?" If so, and preferably with her own eggs/genetics, then she needs to be proactive in achieving this goal.
Fertility preservation, with the collection and freezing of her eggs for future use, is a definite option for women who are delaying child-bearing. At REACH we have a successful oocyte vitrification (freezing) and fertility preservation program; this will be covered in a future post.