Should I be concerned?

By: Danielle Lane, MD

The most significant predictor of a woman’s ability to conceive is her age. While societal trends continue to demonstrate delayed child-bearing, reproductive biology has not changed.  Peak fertility in women occurs around age 22, and by age 32 studies have shown a gradual but significant decline in fertility. A more rapid decline occurs after the age of 37.  The result:  an increased number of women and couples who experience age-related fertility challenges and miscarriage. So when should you be concerned about your fertility? Below are some guidelines to help with your thinking.

In general, if you are ready to try and conceive, it is a good idea to let nature take its course initially. Studies have shown that 85% of couples where the woman is under the age of 35 and having regular unprotected intercourse will conceive without assistance. Therefore, if you are less than 35, the American Society for Reproductive Medicine (ASRM) suggests formal evaluation for fertility challenges if you have been trying for more than one year.  But, earlier evaluation should be considered if you: are older than 35, have irregular or no menstrual cycles, have a known problem with your uterus or fallopian tubes, are diagnosed with endometriosis, or if your male partner is known to have a fertility challenge.  In women from 35 years of age up to 40 years of age, formal evaluation is recommended if you have not conceived within the first 6 months. If you are over the age of 40, immediate evaluation is prudent when you are ready to get pregnant.

Fertility evaluation of the male usually parallels the evaluation of their female partner.  Approximately 20% of fertility challenges are solely due to problems with the male partner, and in another 30-40%, the male’s fertility plays a contributory role.  In general, evaluation is recommended when no pregnancy has occurred after one year of regular, unprotected intercourse.  Again, if your partner has a known fertility issue, earlier evaluation is appropriate.

What if you are not ready to have a baby yet?  For couples and women who think that they will not be ready to conceive until their mid- to late-30’s or beyond, a fertility consultation should be considered.  If the woman is single, new techniques for egg freezing (vitrification) should be considered to preserve fertility.  With the current technique of vitrification, studies show that 80% of frozen eggs survive the freeze-thaw cycle and that a pregnancy is obtained for approximately every seven eggs frozen.

For couples, a woman’s eggs can be fertilized with her partner’s sperm and embryos can be frozen. Using vitrification, 80% of high-quality embryos will survive the freeze-thaw cycle, and a pregnancy is typically obtained for every four embryos frozen.  Single men are fortunate since they typically do not demonstrate a reduction in their sperm quality or quantity until much later (mid-fifties). So while a baseline semen analysis will not hurt, it probably isn’t necessary until closer to this age.

It is important to have a realistic outlook on family planning to ensure that you have enough time to achieve the number of pregnancies that you wish.  If it takes you a year to conceive your first child, by the time you attempt to conceive your second child, it will likely take even longer and by then, time will not be on your side.  If your goal is to have three or four children to complete your family, then it is even more important to consider getting started sooner.

The goal of your fertility specialist is to try and determine whether you can expect to conceive on your own without assistance, whether you can conceive using your own eggs or sperm with assistance or whether donor eggs or sperm should be considered. Making this determination is based on an assessment of your eggs, your partner’s sperm, your uterus, and your fallopian tubes.  An initial consultations typically lasts sixty to ninety minutes and includes an extensive history of you (and your partner, if relevant), a transvaginal ultrasound to evaluate your uterus and ovaries, and blood work for both you and your partner.

Armed with this information, you and your fertility specialist can develop a treatment plan that works for your current lifestyle and your family planning.

ABOUT THE AUTHOR

DanielleDanielle E Lane, MD, Reproductive Endorcinology and Infertility Specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh School of Medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a three physician practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.