Advanced Age
Age plays an important role in a woman’s ability to become pregnant and carry a pregnancy to term.
With advancing age, many biological changes take place that work against conceiving and carrying the pregnancy to term. From age 30 to 35, there is a gradual decline in the ability of women to become pregnant; after age 40, there is a sharp decline. Also, the chance of miscarriage and chromosomal abnormalities, such as those that cause Down’s syndrome, increase with age. Even the success of in vitro fertilization (IVF) and other similar procedures decreases with advancing age.
Why does age play such an important role in fertility? One reason is that as women age, they are less likely to ovulate regularly. In addition, they are more likely to have medical problems that can cause infertility, such as endometriosis. However, the more important reason relates to the condition and decreasing number of the woman’s eggs. As the eggs age, they become
more resistant to fertilization. Also, more of the eggs tend to have chromosomal abnormalities — oftentimes, this may result in miscarriage.
Diagnostic tests for advanced-age infertility
Your evaluation is likely to begin with your medical history and a pelvic exam. However, other tests are needed to determine whether your age is affecting your fertility. You may need one or more of the following tests:
- Follicle-stimulating hormone (FSH) blood level—a blood test that measures the amount of FSH in your blood; a high level of FSH in your blood in the beginning of your cycle may mean that your infertility is age-related
- Estradiol blood level—a blood test that measures the amount of estradiol (estrogen) in your blood; a high level in the beginning of your cycle may mean that your infertility is age-related
- Ultrasound—a scan that uses high-frequency sound waves to see if your ovaries have a normal appearance
Questions & Answers
Q. How does my age influence the timing of tests, procedures, and treatments?
A. If you are over the age of 40, it is extremely important to talk with your doctor as soon as possible about the options that are available to you. Unlike younger women who may have more time, women over 40 may need a more aggressive and faster approach. Your tests and procedures may be scheduled over a shorter time than usual. Also, your doctor may want you to consider procedures that may increase your chances for pregnancy, such as intrauterine insemination (IUI), IVF, or gamete intrafallopian transfer (GIFT). If you decide to use one of these “assisted reproductive technologies,” your doctor may recommend that you begin as soon as possible.
Q. How does my age influence the types of treatment available to me?
A. As you approach age 40, the quality and number of your eggs tends to decline, ovulation may become irregular, and your ovaries may produce less estrogen and progesterone. Progesterone is needed to stabilize the lining of the uterus so that a fertilized egg can implant itself. Your doctor may recommend medication, an assisted reproductive technology procedure, or a combination of the two. Another option for older women is the use of eggs donated by a woman who is in her 20s or 30s. The eggs are mixed with your partner’s sperm and transferred to your uterus or fallopian tubes. Younger eggs are more likely to result in pregnancy and less likely to end in miscarriage.
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