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Age & Infertility

Age and Infertility

There are many causes of infertility, and it also depends on the age factor.

Get Infertility Treatment from Dr. Jasmine Kaur Dahyia - IVF, Infertility, Test Tube Baby & Gynaecology Specialist
Get Infertility Treatment from Dr. Jasmine Kaur Dahyia - IVF, Infertility, Test Tube Baby & Gynaecology Specialist

Relationship Between Age and Fertility

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Delayed child bearing is becoming increasingly common in western societies for several reasons: many couples prefer to rear their children only after establishing a stable relationship and financial security, also, there are increasing numbers of late and second marriages. Although pregnancies in women approaching 50 and beyond are occasionally reported, there is a decrease in fertility (the ability to achieve a pregnancy) with advancing age. The decline is gradual over the reproductive life span of the woman; it is particularly noticeable over the age of 30 and accelerates between 35 and 40 so that fertility is almost zero by the age 45.The risk of miscarriage is also increased with ageing e.g. the risk of miscarriage at age 25-29 years is 10% while the risk at age 40-44 is 34%. Furthermore, advanced maternal age is associated withan increased risk of chromsomally abnormal offspring.

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Why does fertility decline with increasing age?

Ageing of the ovaries is the most prominent factor and is part of the normal ageing changes that affect all organs and tissues. Most women have about 300,000 eggs in their ovaries at puberty. For each egg that matures and is released (ovulated) during the menstrual cycle, at least 500 eggs do not mature and are absorbed by the body. By the time the woman reaches menopause which usually occurs between 50-55 years, there are only several thousands eggs remaining. As the woman ages, the remaining eggs in her ovaries also age, making them less capable of fertilization and their embryos less capable of implanting.

Fertilization is associated with a higher risk of genetic abnormalities e.g. chromosomal abnormalities such as Down syndrome with increasing age. The risk of a chromosomal abnormality in a woman age 20 years is 1/500 while the risk in woman age 45 is 1/20.

Gynaecological problems such as pelvic infection, tubal damage, endometriosis, fibroids, ovulation problems etc tends also to increase with age. As the woman gets older, she has more time to develop these conditions, which will adversely affect her fertility.

Sexual function is also decreased with ageing e.g. libido, frequency of intercourse etc.

The effect of ageing in endometrial receptivity (ability of the endometrium to receive the embryo) is controversial. There is increasing evidence that the receptivity decreases with age.

Ageing does not just affect women, but also men to a much lesser degree. It affects sperm and coital frequency. There is no maximum age at which men are not capable of conceiving a child.

Advanced maternal age increases the risk of autosomal dominant diseases such as Marfans syndrome, neurofibromatosis and achondroplasia.

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Investigations of Infertility in Older Women

It is advisable to seek the advice of your doctor/ specialist sooner than later so investigations and treatment can be started without undue delay.

Several tests may be useful in assessing the fertility potential in older woman e.g. blood tests to examine the levels of the hormones FSH, LH, estradiol and inhibin on day 3 of your menstruation.

You will be more likely to be counselled about the risk of miscarriage and chromosomal abnormalities in relation to your age. In addition to the potential complications of pregnancy such as high blood pressure, bleeding and diabetes.

Age & Infertility: Get Infertility Treatment from Dr. Jasmine Kaur Dahyia - IVF, Infertility, Test Tube Baby & Gynaecology Specialist

Treatment Options for Infertility in Older Women

There are limited options for treating older women who are menopausal or perimenopausal. Older women usually respond poorly to ovarian stimulation and the live birth rates even with IVF treatment are significantly lower than with younger women.

1. Age - 40 41 42 43 44 or Over

2. Live birth rate per egg collection

Data adapted from SART report 2000In addition, older are at increased risk of having medical problems in their pregnancies and deliveries. In order to improve the success rate of IVF treatment in older women, some clinics recommend assisted hatching, blastocyst embryo transfer, preimplantation diagnosis and only transfer normal embryos. Furthermore in some countries the transfer of high number of embryos is recommended. Other options of treatment include:

1. Egg donation using eggs donated by younger woman.

2. Embryo donation if the male partner also has a sperm problem.

3. Surrogacy if a woman (traditional surrogate) agrees to become

4. Pregnant using the male partner sperm and her own eggs.

5. Adoption and foster care.

6. Accepting child-free living.

Department

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Infertility Assessment

Infertility Assesment of Women:

The etiology of female infertility can be broken down into ovulation disorders, uterine abnormalities, tubal obstruction and peritoneal factors.

 

Infertility Assesment of Men:

Evaluation of male infertility starts with a history and physical examination of previous fertility, pelvic or inguinal surgeries, systemic diseases and exposures.

Infertility Investigation: Get Infertility Treatment from Dr. Jasmine Kaur Dahyia - IVF, Infertility, Test Tube Baby & Gynaecology Specialist
Investigation

Investigation of Women:

A review of systems and physical examination of the endocrine and gynecologic systems should be performed.

 

Investigation of Men:

The laboratory evaluation begins with a semen analysis. Instructions for collecting the sample should include abstinence from ejaculation for 48 to 72 hours.

Diagnosis of Infertility: Get Infertility Treatment from Dr. Jasmine Kaur Dahyia - IVF, Infertility, Test Tube Baby & Gynaecology Specialist
Diagnosis of Infertility

Diagnosis Female:

It is very important that the male partner be evaluated during initial work up. A history of genital infections, trauma or environmental exposure.

 

Diagnosis Male:

The diagnosis of infertility begins with a medical history and physical exam by a urologist, preferably one with experience or who specializes in male infertility.