We all know that at some point in our lives, our ability to have children is going to decline. Most women believe that this happens at menopause, but the truth is that fertility begins to lower on average at age 32!
As women age, fertility declines due to normal, age-related changes that occur in the ovaries. Unlike men, who continue to produce sperm throughout their lives, a woman is born with all the egg-containing follicles in her ovaries that she will ever have. At birth there are about one million follicles.
By puberty that number will have dropped to about 300,000. Of the follicles remaining at puberty, only about 300 will be ovulated during the reproductive years.
The majority of follicles are not used up by ovulation, but through an ongoing gradual process of loss called atresia. Atresia is a degenerative process that occurs regardless of whether you are pregnant, have normal menstrual cycles, use birth control, or are undergoing infertility treatment. Smokers appear to experience menopause about 1 year earlier than non-smokers.
The truth about natural fertility and age
While women under 30 have about a 25% chance of getting pregnant naturally each cycle, that chance drops to 20% for women over 30, according to estimates by the American Society for Reproductive Medicine. By 40, the chance of getting pregnant naturally each month is just 5%.
One study of healthy, fertile women undergoing artificial insemination with donor sperm indicates that the chance of getting pregnant in 12 cycles (or about a year) was 73% for women 30 and under, and dropped to 54% for women over 35.
And national statistics for women undergoing in vitro fertilization using their own eggs of the same age demonstrate that the drop in IVF success is also dramatic: for women under 35, the percentage of successful IVF cycles was 41.5%; for women 35–37, it was 31.9%; for women 38–40, 22.1%; 12.4% for women 41–42; 5% for women 43–44; and just 1% for women over 44. That means that, after age 35, IVF birth rates declined about 10% every 2 years—reflecting a similar relationship between fertility and age as we see in natural fertility.
Women who wish to delay childbearing until their late 30s or early 40s may consider methods of fertility preservation such as freezing of embryos after IVF or retrieving and freezing eggs for later use.
The success of embryo freezing (cryopreservation) is well established, but it requires that the woman have a male partner or use donor sperm. Egg freezing for preservation of fertility is a new technology that shows promise for success.
Age remains a problem faced by women interested in using elective egg freezing. As the age of women undergoing egg freezing increases, the outcomes of assisted reproductive technology cycles utilizing their frozen eggs become less favorable.
But Don’t Give Up Hope Yet!!!
Just because your fertility drops as you get older, does not mean that you won’t be able to conceive a child if you’re over age 35. Here are a few tips to help increase your odds:
Do not wait a year to go see a fertility specialist if you’re having trouble conceiving—go after six months. The rule of thumb you thought you’d heard—to wait a year before seeing a specialist—applies to women younger than 35, not those older. The earlier appointment means potential issues can be spotted earlier, including polycystic ovarian syndrome (which is the most common cause of female infertility), ovulation problems, blocked fallopian tubes, endometriosis or a matter with your partner—one-third of infertility cases are due to the man’s reproductive issues, after all. You’ll also be able to come up with a plan now, instead of later, when the quality of your eggs will have declined further and the odds of getting pregnant are lower.
The six-month appointment can actually be encouraging. Your doctor may find that nothing is wrong and tell you to keep trying the old-fashioned way. Plenty of women get pregnant in their mid-to-late 30s. Either way, the six-month appointment means you’ll know your odds sooner and what you need to do to improve you chances of getting pregnant.
Regardless of your age, you can maximize your chances of conceiving each month by figuring out exactly when you ovulate. The rule of thumb at this age for natural conception is to have sex every other day around the time of ovulation. “You’ll know you’re nearing ovulation when you start producing clear, slippery cervical mucus which starts one to four days before egg release,” says Steven R. Bayer, M.D., reproductive endocrinologist at Boston IVF fertility clinic. Another good predictor is ovulation kit. “When it shows you’re getting ready to ovulate, have intercourse over the next two days to catch the fertile window. You have 24 to 36 hours to have sex to make it in the optimal window,” Dr. Bayer explains.
IUI vs IVF: For women over the age of 40, conservative treatment with inseminations carries a low success rate. The best option is IVF. If a 42-year-old woman has five embryos placed, there is a 10 to 20 percent chance of pregnancy. (If pregnancy is achieved, there is a 20 percent chance of a multiple; this carries its own risks.) For women who have low ovarian reserve and produce only a few embryos, or for women over the age of 43, egg donation is the best choice.
Freezing eggs, something to think about: If you are between the ages of 35 and 40, this is your last chance to freeze viable eggs for use at a later date, should you prefer not to get pregnant right now. “A woman can freeze her eggs up until age 40; then she can come back years later and have a good chance of pregnancy even into her mid-40s,” Dr. Bayer says.
Over age 45? There is still hope!!
At 45, a woman’s likelihood of getting pregnant is no more than 3 or 4 percent. That’s not to say it’s impossible, but assisted reproductive technologies are almost always necessary, with IVF the most common.
“The few eggs you have left may have chromosomal abnormalities, so screening before IVF is critical,” says Alan Copperman, M.D., director of Reproductive Medicine Associates of New York and co-director of the Division of Reproductive Endocrinology and Infertility at The Mount Sinai Hospital in New York City. Success rates are 0 to 1 percent, and most clinics recommend using eggs donated by a younger woman for those who want to conceive between ages 46 and 50.
For a woman in her mid-40s who wants to have a biological pregnancy, using a donor egg is best bet. “It’s fairly easy for a healthy woman to achieve and sustain a pregnancy if the egg is from a healthy 25- or 30-year old,” Dr. Bayer says. “Even if she’s in menopause, success rates are about 60 to 65 percent.” (And yes, via IVF, it IS possible to carry a successful pregnancy AFTER menopause!!! Here’s a great story about a woman in her 60’s!!)
Moral of the story: Don’t give up!!! There are so many routes to becoming a parent. It may not be exactly the way that you planned. In fact, odds are pretty good that it won’t be ANYTHING like what you planned. Kids are good at changing our plans!! But I do know one thing: It will totally be worth it!!
Much love and baby dust!!!
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Hi! This post couldn’t be written any better! Reading through this post reminds me of my good old room mate! He always kept talking about this. I will forward this article to him. Pretty sure he will have a good read. Thanks for sharing!
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