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It is not a surprise to many that fertility declines with age. Most women have learned early on that as they get older, their chances of becoming pregnant become less and less. Fertility begins to significantly decline after the age of 32 and more rapidly after 37. The average age of menopause in the United States is 51 years old. At this time, it is estimated that women have approximately 1,000 oocytes (eggs). This is down from the original number of 1-2 million at birth. While the news is still heartbreaking, technology has advanced so there is assisted reproduction options available to help many of these women still conceive.
So now you’ve taken the steps to consult with a Fertility Physician and they have run the typical baseline bloodwork and other diagnostic tests. You’re shocked by the news that while you are 45 years old, you have the AMH (anti-mullerian hormone) and FSH (follicle stimulating hormone) levels of a 25 year old! While this would seem like the amazing news you were hoping for, it does not necessarily mean there will be an increased chance of achieving pregnancy. Age is an independent factor and an important one. Just because you look like you are in optimal fertility status on paper, the chances of achieving pregnancy are still very low. Historically, studies have shown fertility rates and sexual activity to decrease with age alone among many populations. Other factors to take into consideration that may appear as we age are fibroids (leiomyomas), tubal disease, and endometriosis. Other risk factors that may cause a decrease in the amount of eggs or decline in the fertility is a history of ovarian surgery, chemotherapy or radiation, smoking, infections in the pelvis, or a family history of early menopause.
As women get older, complications can also arise if they do achieve a pregnancy. The embryo may have chromosomal abnormalities or the pregnancy may end in a spontaneous abortion (miscarriage). According to ASRM (March 2014), rates of miscarriage increased progressively from 13.7% in 35-37 year olds to 36.6% in women over 42 years old.
Taking all of this into consideration, women should not wait too long before consulting with a Fertility Physician. After 6 months of attempting to achieve a pregnancy without success, they should have a complete evaluation done including blood tests and other diagnostic procedures. Women over 40 should come to see the Physician sooner. Many options are available today such as PGD (chromosome analysis based on cells biopsied from an embryo), egg donor cycles and embryo donation cycles. After a careful, thorough evaluation from the Physician, they will discuss with you the best option to help you achieve your goal of delivering a healthy baby.
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Karande and Associates d/b/a InVia
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