The world’s first in-vitro fertilization baby was born in 1978 in the UK. Since then, 8 million babies have been born worldwide as a result of IVF and other advanced fertility treatments, an international committee estimates.
- More than a half a million babies are born each year from IVF and other methods, according to estimates
- More than 2 million IVF cycles are made each year
- Many women are under the impression that pregnancy can wait- when in fact, there is evidence to support aging plays a direct role in delaying pregnancy
- What can a woman do at each age and stage? Thanks to advances in modern medicine, including IVF, women have more options than ever before
- In addition to IVF, options also include freezing your eggs until you’re ready to start a family, there by preserving your eggs in your “prime”
As more and more celebrities get pregnant later in life, the average woman is left thinking that she too can wait until her late 30s or 40s to start planning a family. According to Dr. Elizabeth Barbieri of Oregon Reproductive Medicine, that’s not always the case. “Many celebrities are inadvertently setting unrealistic expectations for many women that it will be easy to get pregnant naturally in their 40s, when in fact a lot of these celebrities have struggled, and have had a little assistance along the way, including IVF.”
According to the American Society for Reproductive Medicine (ASRM) a woman’s best reproductive years are in her 20s. Women in their 30s have a 20% chance of getting pregnant and by age 40, a woman’s chance of getting pregnant is less than 5%.
With many women delaying pregnancy until their 30s and 40s, fertility issues are becoming a growing topic of concern. According to Dr. Barbieri, women need to think ahead and have a game plan, as there’s many things women need to consider in their 20s, 30s and 40s.
“Whether you’re a new college graduate that is just starting out on your career path, or if you’re in an established relationship in your 30s and trying to get pregnant without success, there’s a variety of options available to women on their journey to parenthood. Knowing more can help people take control of their fertility so they can start a family when the time is right for them.”
Things to consider in your 20s:
Women’s eggs age as we age. We are born with all the eggs we will ever have. The number of eggs actually peaks while we are a fetus, and by birth, we have about 1 million eggs left. When a girl begins her menstrual cycle during puberty, she has about 500,000 eggs left….and she hasn’t even had a chance to use one yet!
As women get older, our eggs do not function as well – meaning they are less likely to result in a pregnancy, and that if a pregnancy occurs, the risk of miscarriage increases as well.
How to Live Life
At any age, ways that a woman can optimize her ability to successfully conceive includes having a healthy lifestyle. Do not smoke. Limit alcohol intake to 4 or fewer drinks per week (for both partners). Maintain a healthy weight as women who are underweight or overweight can take longer to conceive. Take a daily prenatal vitamin (or folic acid supplement). Monitor your menstrual cycle as having regular periods (which is defined as occurring every 24-35 days) to ensure you are ovulating so that you have a chance to conceive when you are ready.
What To Do If Something Is Off
If a woman’s menstrual cycle is irregular, she may not be ovulating, and therefore, it will be harder (if not impossible) to get pregnant. Seeing your OB-Gyn to evaluate for causes of an ovulation/irregular periods can help identify and treat the reason you are not ovulating to help restore regular menstrual cycles.
Things to consider in your 30s:
The chance of getting pregnant each month declines progressively throughout a woman’s 30’s. In the early 30’s, the chance of pregnancy each cycle is approximately 20%. At 35 years old the chance of pregnancy each cycle is 15% and decreases to 5% as a woman approaches 40 year old. The age related decline in fertility is accompanied by a significant increase in the risk of miscarriage.
The risk of miscarriage for women under 35 y/o is approximately 15% and increases to 30% at 40 years old
When should women in their 30s get help if they can’t conceive?
Honestly, it is never too early for a woman to begin a conversation with her health care provider about her fertility. Women who are under 35 years old should seek evaluation if they have failed to conceive after 12 months of regular, unprotected intercourse. Given the age related changes in fertility, women over the age of 35 years old should seek help after 6 months of trying.
What risk factors may make it more difficult to become pregnant?
There are several factors that can affect a woman’s ability to become pregnant. Some of these are modifiable and some of them are not. It can be more difficult to conceive if a woman has irregular menstrual cycles or issues with the uterus or fallopian tubes. The uterus can be affected by the presence of fibroids or scar tissue, whereas, having a history of pelvic infections or endometriosis can affect the fallopian tubes.
Lifestyle factors can also affect fertility. For example, women who are either overweight (BMI>35) or underweight (BMI < 19) can have difficulty conceiving.
Tobacco use and heavy caffeine use can also affect fertility. Women trying to conceive maintain a healthy diet, avoid tobacco and use caffeine in moderation (<250 mg caffeine per day).
Twenty percent of the time the reasons for infertility are due to male factors. It is important that the male partner be included in the evaluation!
What can be done if a women in her 30s is facing infertility?
The first step is to have a conversation with a healthcare professional. This can be a primary care provider, general OB/GYN or a Reproductive Endocrinologist.
A Reproductive Endocrinologist is an OB/GYN who has completed sub specialty training in fertility. Having this conversation will provide for the opportunity to thoroughly review the medical history and determine if there are risk factors present that may be affecting their ability to conceive. Further evaluation can then be performed to evaluate for these factors. The basic fertility evaluation typically includes evaluation of the health of the women’s eggs, confirming that the fallopian tubes are patent and performing a semen analysis to evaluate the sperm.
Additional testing may be recommended if other risk factors are present.
Between what ages is egg freezing most successful?
Because of the age related changes in egg quality that occur during the 30’s, the earlier the process is completed the greater the chance of obtaining healthier eggs.
What should you keep in mind about risks to mom and baby in your 30s?
The most important thing to remember is that it is absolutely possible for women to have healthy babies throughout their 30’s. Although it may become more difficult to conceive as a woman gets older there are safe and effective treatments to help women grow their families.
Because the risk of chromosomal abnormalities increase as a woman gets older, additional testing may be recommended during a pregnancy to ensure the genetic health of the baby.
This may include a simple blood test or a more invasive procedure, such as amniocentesis. There are also fertility treatments available to evaluate this risk prior to conceiving a baby.
What other kind of fertility care is available to women besides egg freezing?
Egg freezing is a great option for women who are planning to delay child-bearing. Because of the changes that occur with the quality of the eggs as a woman gets older, freezing eggs at a younger age will help increase the chances of having healthy eggs in the future when she is ready.
There are many treatment options available for women and couples who are actively trying to conceive, but having difficulty. The specific treatment is generally determined based on the factors that are contributing to the fertility issues. There are more conservative treatment options available including the use of medications to help the ovaries release more eggs and/or intrauterine insemination (IUI). Some find that they need to utilize more advanced forms of treatment, such as in vitro fertilization (IVF) in order to conceive. IVF is a process where the eggs in a woman’s ovaries are stimulated to mature and then removed through a simple surgical procedure. The eggs are then fertilized with the sperm and embryos are grown in the laboratory for several days.
A healthy embryo can then be returned to the women’s uterus or additional testing can be performed to evaluate the genetic health of the embryo prior to embryo transfer.
This testing is referred to as Preimplantation Genetic Testing. Once the testing has been performed an embryo will be selected and then transferred to the woman’s uterus.
Things to consider in your 40s:
What happens to egg quality once women are older?
The total number of eggs in the ovaries decreases as a woman ages. Additionally, a lower percentage of the remaining eggs will contain the correct number of chromosomes (46 chromosomes). Females are born with all the eggs they will ever have, which is approximately 1-2 million—and at the time of puberty, there are approximately 300,000-500,000 remaining eggs.
When a woman reaches her late thirties, she has about 25,000 eggs remaining—and at menopause, this number likely reaches less than 1,000.
The decline in both the number and quality of eggs can also be influenced by environmental factors including chemotherapy, pelvic radiation, smoking, or ovarian surgery; or by genetic abnormalities such as Fragile X. Despite the multiple tests available to evaluate a woman’s ovarian reserve, the best indicator of egg quality is age.
When should women in their 40s get help if they can’t conceive?
If a woman is experiencing infertility in her 40s, the best initial step is early evaluation. By taking the first step to make an appointment with an infertility specialist, a woman can better understand her overall fertility potential.
At this appointment, a doctor will discuss simple testing that can be used to determine overall ovarian reserve, as well as other diagnostic tests that can evaluate whether she is ovulating, the status of her fallopian tubes, and the semen quality of her sperm source.
Earlier detection can lead to earlier intervention and treatment to increase a woman’s chance of success.
What can be done if a women in her 40s is facing infertility?
After the infertility evaluation is completed, a woman’s provider will often recommend advanced reproductive technologies including standard IVF, minimal stimulation IVF, donor egg, or donor embryo.
There are multiple stimulation protocols for IVF. A woman’s provider will work closely with her to personalize the treatment based on her infertility evaluation, personal and medical history, and desired treatment option.
If a woman in her 40s is facing infertility, she will discuss all the available options with her provider—as there are many different ways to build a family.
If a woman has had her eggs frozen, can she become pregnant in her 40s?
Yes! A woman in her 40s can decide to thaw her frozen eggs when she is ready. An infertility clinic will inseminate the eggs with sperm, and follow them in a controlled environment as they grow from fertilization to a blastocyst (day 5 or 6 embryo).
Embryos can be transferred into the woman’s uterus at this point, or she might choose to have the embryos tested for genetic abnormalities prior to the transfer. It is important to realize that not all embryo transfers will result in pregnancies or live births. In fact, the literature would estimate a 2-5% live birth rate per embryo.
Most importantly, a woman should speak with her IVF clinic to become well informed about her chances for pregnancy.
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