Age & Fertility
Age & a Woman’s Ability to become pregnant
A woman’s age is one of the most important factors affecting whether she is able to conceive and give birth to a healthy child. This is due to several changes that are natural part of aging:
- The number and quality of eggs (ovarian reserve) decreases naturally and progressively from the time a woman is born until the time she reaches menopause. This decline is gradual until her early 30s but accelerates quickly after her mid-30s.
- It is not only more difficult to get pregnant (conceive) but miscarriage and chromosomal abnormalities in the child (such as Down syndrome ) are more common in older mothers,
- Fibroids, endometriosis, and tubal disease are more common and can affect fertility.
- Women who become pregnant at an older age have a higher risk of complications during the pregnancy, such as gestational diabetes and preeclampsia.
Age & a Man’s ability to produce a pregnancy
A decrease in a man’s fertility appears to occur later in life than in a woman’s fertility. In their mid-to-late 40s, men experience changes in their sperm that can cause issues with fertility and chromosomal/development problems with offspring.
When to start asking questions?
Couples where the woman is younger than age 35 should ask for a fertility evaluation if they have not been able to conceive after one year of trying (unprotected intercourse). Couples where the woman is older than 35 should seek evaluation if they have not been able to conceive after six months.
Other factors that can cause a decline in fertility
If you have any of the following risk factors, you may consider seeking advice earlier than described above:
- Family history (i.e., mother or sister) of early menopause (before age 51)
- History of cigarette smoking in either partner
- Previous ovarian surgery
- Exposure to chemotherapy or radiation to treat cancer in either partner
- Shortening in the time between periods
- Skipped or missed periods
- History of injury to the testicles
- Exposure to toxic chemicals (certain pesticides or solvents
If a couple has obvious medical problems affecting their ability to conceive such as absence of periods (amenorrhea) or irregular periods, sexual dysfunction, a history of pelvic disease or prior surgery they should begin the infertility evaluation immediately.
The number and quality of your eggs (ovarian reserve) can be estimated using blood tests for Estradiol (E2), follicle-stimulating hormone (FSH) and Anti-mullerian hormone (AMH) levels. Additionally, an ultrasound is used to count the number of follicles (antral follicle count [AFC]). However, there is no single test that measures ovarian reserve perfectly.
Testing the count and quality of sperm
During semen analysis, a man’s ejaculate is examined to measure the number, shape, and movement of sperm.
Slowing down or reverse reproductive aging
Eating well, exercising regularly, getting enough sleep, avoiding smoking, and adopting a lifestyle that reduces stress can improve your overall health. Studies suggest that smoking, diet, and stress may have an impact on the quality of eggs/sperm and may accelerate menopause. However, despite our best efforts to slow down or reverse the process, improved health does not offset the natural age-related decline in female fertility which can take place much sooner than most women expect.
Sperm is being made continuously and takes about 3 months to mature. Changes in lifestyle and exposure can show in the quality of sperm within a few months. Unlike men, a woman is born with all her eggs, so there are no methods/treatments to grow more or new eggs or preserve the quality of those eggs that remain. Therefore, it’s important to talk about family planning with a healthcare provider even if you are not thinking about getting pregnant right away. This might decrease the chance of having difficulties later.
Medical Approach to improve fertility
There are medical strategies that can maximize the chance of conceiving. They are focused upon getting the egg and sperm together at the best time for conception to occur. These strategies can include “washing” sperm, Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) or taking fertility medications. These approaches may be helpful but they cannot reverse the natural aging process of the egg or sperm.
Other Options Available
Men and women who want to delay having a child until their late 30s or early 40s may consider methods to preserve their fertility. One way is to freeze sperm, eggs or embryos. In men, sperm collection is usually a quick, noninvasive, simple process and cryopreservation of sperm is well established. A woman must undergo an egg retrieval like in IVF with the unfertilized eggs cryopreserved for later use. Embryo freezing is well established and is equally successful as freezing unfertilized eggs but it requires that the woman have a male partner or use donor sperm.
The only other option for men and women who already infertile is to use sperm, eggs, or embryos donated by another man, woman, or couple. Using donated gametes or embryos makes the chance of successful pregnancy the same as for the person who donated the gametes.
your healthcare provider early in order to plan for your future reproductive health.