You’ve wanted a family, but the timing never worked out. You’ve been focused on your career, or maybe it took you a while to meet Mister (or Miss) Right.
Whatever the reason that you’ve waited, you want to grow your family. However, after six months of trying you’ve been unable to get pregnant, or you’ve had pregnancies end in miscarriage.
Causes and Concerns
For a woman, fertility gradually declines in her thirties, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. By age 40 that chance drops to less than 5 percent per month.
Additionally, women who are older than 35 years may find that they are able to get pregnant, but lose pregnancies in the first trimester.
This may be due to a decline in:
Since women are born with all of the eggs (contained in follicle cysts) they will ever have, the pool of waiting follicles is continually and gradually used up over the course of their reproductive lives. In fact, only a fraction of our eggs have the potential to result in a pregnancy during our fertile years. Most eggs shed from the ovaries without ever having the chance to mature (ovulate) and be fertilized.
Menopause, which happens on average at 51 years of age, occurs once all the eggs are depleted. However, women lose their reproductive function years before this time, though the exact age this happens within any one woman is difficult to predict.
The decreasing quantity of egg-containing follicles in the ovaries is described as “loss of ovarian reserve” and happens continually from the early 30s and increases in pace as a woman enters her late-30s.
In addition to the dwindling number of eggs associated with aging; egg quality decreases over time. Though a woman’s uterus is often healthy enough to maintain a pregnancy well into her 40s, the embryos created from women who are in their late-30s and 40s are often chromosomally nonviable. This is because as we age, the eggs are less healthy and fail to produce embryos with the correct number of chromosomes. An example of a chromosomally abnormal embryo is Trisomy 21 (having three copies instead of two for Chromosome 21), which causes Down’s Syndrome.
Though, in general, fertility declines as we age, the pace of decline varies between women. Luckily, there are methods to help evaluate a woman’s ovarian function relative to what we expect at a particular age.
While there is no maximum age where men are incapable of conceiving a child, changes in fertility and sexual functioning occur in men as they grow older, particularly after 40 years of age. Sperm issues can include reduced sperm count, abnormal sperm shape, and decreased motility.
Solutions and Treatment
If you are older than 35 and are trying to get pregnant, you may face additional challenges, but the good news is that you’re not alone. Approximately, 1 in 4 U.S. women are having their first pregnancy after the age of 35.
Increasingly, women are starting families later in life, and treatment options are available to make it easier for them to prepare, achieve, and maintain a successful pregnancy.
These can include:
- Induction of ovulation or superovulation with Clomid or Femara pills and/or Gonadotropin injections (FSH shots)
- Intrauterine insemination (IUI) (also called artificial insemination (AI))
- In vitro fertilization (IVF) / Intracytoplasmic sperm injection (ICSI)
- Comprehensive Chromosome Screening and Pre-Implantation Genetic Diagnosis to determine whether an embryo is viable (CCS/PGS and PGD)
- Family planning / building – embryo banking
If you are concerned about maintaining your fertility for the future, you may also wish to consider fertility assessment and planning.