fertility news

In June 2008 the American Society of Reproductive Medicine (ASRM) updated their definition of infertility. The newest definition reads as follows, “Infertility is a disease, defined by the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse. “They go on to say that for women 35 years old and older evaluation may be justified after only six months of unprotected intercourse based on physical findings and medical history.

The American Society for Reproductive Medicine (ASRM) in a committee opinion on aging and infertility in women suggest that tests to evaluate fertility provide information about the current status on one’s fertility but do not predict when the age-related decline will happen. For this reason, they recommend earlier evaluation in women over 35.

This difference is especially relevant in the 21st century when more women are delaying marriage and childbearing to further their education and pursue careers. Thirty-five in today’s society doesn’t seem “old” and for many women menopause may be years away however research shows fertility begins to decline significantly in most women after age 35. To compound the problem of lower pregnancy rates there is also a greater risk of spontaneous miscarriage and lower birth rates caused by, according to the experts, abnormalities of the egg or oocyte.

These abnormalities, the result of missing or extra chromosomes or parts of chromosomes, result in serious problems- some that are incompatible with life. Consider the following statistics from the American College of Obstetrics and Gynecology (ACOG) that describe the risk of having a baby with a chromosomal abnormality based on maternal age:

Many women turn to assisted reproductive technologies when faced with these statistics or diagnosed with infertility. The Society for Assisted Reproductive Technology (SART) is the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States. This group, a part of ASRM, publishes a yearly report of clinic success rates. The most recent national summary from 2006 underscores the current trends:

SART 2006 Clinic Summary Report. Available at: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0

More than 48,000 cycles of in vitro fertilization were done in 2006 on women 35 and older. The percentage of cycles resulting in a live birth for women under 35 was 38.8% compared to 30.6% for women 35-37 and 10.9% for women 41-42. Based on the SART statistics it is clear that even the newest technology cannot “turn back the clock” and totally overcome the effects of ovarian aging. Seeking help from a qualified professional as soon as possible offers a woman the best chance of diagnosing and treating infertility, especially if she’s over 35.

Once the physician has completed a thorough medical history and physical exam, tests to check a woman’s ovarian reserve are routinely done. These can give the physician an indication of the reproductive potential of the ovaries- the walnut shaped organs that produce the eggs each month. Reproductive potential is both the number of eggs in the ovaries and the quality of the eggs.

Eggs grow in follicles or fluid-filled sacs. The number of small follicles present in the ovaries in the early part of a woman’s menstrual cycle is an indication of ovarian reserve. Physicians routinely perform trans-vaginal ultrasounds around day three of the menstrual cycle to count the number of follicles present. This is known as a basal antral follicle count (BAFC). Along with the BAFC blood tests are also done in the early part of the menstrual cycle. The levels of the hormones estradiol (E2) and follicle stimulating hormone (FSH) are also indicators of ovarian reserve.

While the results of ovarian reserve testing in one woman may suggest a poor prognosis she may still become pregnant. On the other hand the results of ovarian reserve testing on another woman may be normal and she may not conceive. These tests along with others are necessary to give the health care provider all the information needed to guide their patients to the preferred treatment options. In the “older” patient a more aggressive approach such as in vitro fertilization may be recommended sooner or instead of conventional therapies such as timed intercourse or intrauterine insemination used in conjunction with fertility medications.

Some women may be unaware of the effects of delayed childbearing and believe they can “have it all.” This may seem improbable in today’s world when information is so readily available in so many forms. The media however may share some responsibility for this misperception. For example, pictures of 48 and 53 year old actresses splashed on magazine covers or discussing their pregnancies in television interviews reinforces the idea that women can reproduce with their own eggs whenever they’re ready. That is not accurate and does a disservice to the public. If you have been trying to get pregnant and have been unsuccessful schedule an appointment with your health care provider as soon as possible to get a true picture of your fertility potential.

For more information on this topic visit the following websites:

ACOG

Later Childbearing. Available at: http://www.acog.org/publications/patient_education/bp060.cfm

ASRM

Frequently Asked Questions About Infertility. Available at: http://www.asrm.org/Patients/faqs.html

Prediction of Fertility Potential (Ovarian Reserve) in Women. Available at: http://www.asrm.org/Patients/FactSheets/Older_Female-Fact.pdf

Reproductive Aging in Women. Available at: http://www.asrm.org/Patients/FactSheets/reproaging.pdf

References:

ACOG Patient Pamphlet Later Childbearing. Available at: http://www.acog.org/publications/patient_education/bp060.cfm

ASRM Practice Guideline-Definitions of infertility and recurrent pregnancy loss. Available at: http://www.asrm.org/Media/Practice/infertilitydef.pdf

ASRM Practice Guideline- Aging and infertility in women. Fertil Steril 2006;86(Suppl 4):S248-52. Available at: http://www.asrm.org/membersonly/practice/ageandinfertility.pdf