Article of The Month November 2011

At 42 years old, Sara is a high-powered attorney working at her dream job.  Now she wants to discuss her options.  

Sara was unable to get pregnant using a fresh IVF cycle. Luckily, she had frozen her eggs at age 38, which she used to successfully conceive.

Sara* came for a fertility consultation at 40 years old.  It was the second consultation for Sara and her partner.  At 38 they had been to see another fertility specialist and Sara was found to have an elevated follicle stimulating hormone (FSH).  Discouraged by what she perceived to be a negative view of her success by the specialist, she did nothing for another year.  Now she wanted to discuss her options.  She was a high-powered attorney leaving one position to become the general counsel at another company.  “It’s the dream job” she said, “and I need one year to prove myself before I get pregnant”.  After an assessment of her ovaries, menstrual cycle and repeat FSH and estradiol, Sara underwent two cycles of IVF using her partner’s sperm.  She froze a total of 10 embryos.  Sara was now 41 about to turn 42 and now she is ready to conceive. Sara wanted to try another fresh IVF cycle and keep the frozen embryos for future family building.  But although her parameters hadn’t changed significantly, her age and egg quality had and the latest fresh cycle was not successful. Discouraged but happy about her prior frozen embryos, Sara underwent a frozen embryo cycle with her initial embryos and conceived. 

The 2008 Centers for Disease Control birth data reports that among all reproductive-aged women (15-44 years), birth rates decreased for women in all age groups from 15-39 years, but increased in their 40’s compared with 2007. In fact the birth rate for women aged 40-44 was the highest reported in more than 40 years. The problem is that this trend in delaying childbearing is contradictory to a woman’s natural biology.  In fact, natural conception at ages 40-42 is approximately 10 per cycle and for women that require fertility treatment, in vitro fertilization rates at age 40 are at best 20% per cycle.  This leaves 80% of women 40 and over with the possibility of fertility challenges that may prevent pregnancy using their own eggs.

So what’s a woman to do?

  1. Take a hormone vacation!  Hormones mask changes in your natural menstrual cycle.  If you are on birth control pills or a multitude of other hormonal forms of birth control (patches, injections or intrauterine devices), these hormones will mask many signs of declining fertility.  Antral follicle counts (small sacs in the ovary measuring 2-10 mm that contain immature eggs) and blood tests such as FSH and estradiol will be inaccurate.  Furthermore, changes in your own menstrual cycle will be undetectable.  So, aim to take a hormone break in your early thirties for 1-3 months to assess your fertility.
  1. Obtain a fertility evaluation and learn about your own individual reproductive potential.  Women often report that their primary physicians or other providers discouraged them from seeking advice from a fertility specialist.  But, knowledge is power!  Make an appointment for a consultation with a reproductive endocrinologist for a fertility evaluation.  Have your antral follicle count checked, your FSH and estradiol evaluated, and your history reviewed.  Armed with this information, you and your fertility specialist can develop an individualized plan and timeline for building your family. 
  1. Consider vitrification of your eggs or embryos.  While we cannot stop the aging process and its impact on the female reproductive system, we can preserve your current egg quality by freezing eggs or embryos using a newer technique called vitrification.   This new technology preserves fluid-filled structures such as eggs and advanced embryos (called blastocysts) in a frozen state.  Using vitrification, there is less risk that the egg or embryo will be damaged during the freeze-thaw process.
  1. Where’s the sperm?  For women who have a partner, get your partner’s sperm checked and ensure there are no surprises that will limit your ability to conceive.  Certain medical conditions and lifestyle choices can substantially reduce functional sperm.  If you don’t have a male partner, but are considering moving forward with having a child, start to think about using donor sperm and ask your specialist for a list of sperm bank options.
  1. Do the math! Women who conceive using fertility treatment in their early thirties (before age 35) have a high success rate per treatment cycle. In fact, they are likely to spend approximately $16,000.00 (one cycle and medications) to preserve their fertility and potentially allow them multiple pregnancies.  Compare this with a woman who is 40 or older.  She will typically require more than one cycle of IVF and more medication to ensure even a single pregnancy.  Thus the cost will be closer to $40,000.00 for two cycles and medications.

In 2011 armed with modern technology and reproductive knowledge, many of the society-driven fertility challenges can be averted.  Developing a fertility plan before the age of 35 improves your ability to control your own reproductive destiny!