Homepage Age and fertility
Category: Diagnoses, Lifestyle and SubfertilityThere are many ways to predict egg quality. But no test or historical marker (like a previous healthy pregnancy) is a perfect indicator of whether or not a woman can still become pregnant.
That said, we stil need to set expectations for ourselves and our patients.
To do so, it often helps to step back and look at the big picture. Broadly speaking, age defines egg quality with greater accuracy than any other parameter. It is for this reason that IVF success rates (Canada, USA), for example, are sub-categorized by the woman’s age.
The oldest patient I helped achieve pregnancy through a fresh IVF cycle with her own eggs was 45 when she delivered; a colleague of mine diagnosed a (very surprised) 51 year old with “stomach flu” as being in her second trimester. So there is a lot more to fertility success than age. But it is an inescapable variable, and such stories remain the exception.
It is worth understanding how age may affect your prognosis.
Studies have shown that cycle fecundity-the odds of conception in a given cycle-has been shown to start to fall from the age of 27 years.
This doesn’t that if you are older you are guaranteed to have trouble. The number 27 is a statistical average. In fact, for nearly all women, when fertility does start to change, it doesn’t fall very fast at all. Most women will have no troubles with egg quality when they are less than 35 years old. (If you are young, and have been told that you have egg quality issues, you may wish to look into the tests associated with POF.)
Once 35 years old, a few women will have difficulties with egg quality. Most won’t-most women can count on good eggs until at least 38-but there are enough 35-year-old women with egg quality issues that we can start to make generalizations based on age. As a population, when comparing women >35 to those <35:
- There is a longer time to conception
- There is an increased chance for early, first trimester losses in those that do conceive
- There is an increased risk for Down’s syndrome
Again, for most women, these effects will not be immediately apparent at first.
However, by age 38, most women will be affected by the realities of decreasing egg quality. The average age beyond which a woman will be unable to have a healthy pregnancy is 42.
Note again that “42″ is a statistical number only: there are many women who can achieve pregnancies age 43 or more. However, these pregnancies are matched by an equal number of women younger than 42 who cannot.
The bottom line is this: over age 38, it is reasonable to assume that age will be playing a role in egg quality. It may not matter, for example, if a woman age 32 decides to put off her family for another two years. But for someone 40 years old, two years matters.
It has been suggested that it may be unethical to offer hope to women over a certain age for pregnancy. Do you think that is true? What age? Why that age? Your thoughts are welcome here, for it is certainly an issue that I face in my practice.
I don’t work with an age cutoff for women who wish to achieve pregnancy with their own eggs, but sometimes I would like to. I don’t like running cycles when I think that there will be a <2% chance for success. And then, once again, someone will achieve pregnancy when statistics suggest that it shouldn’t be possible.
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Mandy
I think it is important for women to remember it isn’t just about having a baby. We need to remember that our children would like us around for as long as possible. I feel that while it is valuable for us to have some life experience to raise a family…it would seem unethical to have a child just to say we did and leave our young child alone because we are too old, became ill due to age and died. Time and unforseen occurance befall us all. However making a choice should always be informed if possible. We need to sit down and count the cost and be reasonable, not selfish.
Andrea
I think referring to population statistics can be very discouraging for women. Therefore, each women should be assessed as an individual. My colleague conceived naturally at 43 (after many failed IVFs performed at leading centres around the world) after being told by leading MDs that she would never be a parent. There is so much that medicine can offer couples with subfertility and yet so much it cannot begin to explain. Age is only one of many factors. If we can help our bodies retain the balance and health of younger women through a holistic approach (TCM, Nutrition ect), our chances may not be a limited as mainstream medicine would like us to believe.
Katy
Men often have children at an older age, yet it is selfish for women to do so? That is a double standard. These days people are taking better care of themselves and esp women are living to an older age, on average longer than their male counterparts. No one can perdict the future. Many people have children at a young age based on very uninformed choices, and these children may have young parents, but they may not have a good life. There are so many variables, in the ideal world it depends on the parents character, not an age…
Kami
To adress your question directly doctor… I think it is the right & responsibility of your patients to self-determine what is too old. I believe your responsibility is simply to inform your patients so that they have the facts they need to make a well-informed choice. Beyond that, i believe that you just practice the best medicine you can. The patient(s) must balace their own desires, resources, motivations, etc. I think you are doing the right thing to offer your service to those with low statistical odds. It may hurt your clinic’s stats, but I think the alternative is much worse.