Age and Infertility

Over 15% of couples in Australia have difficulty conceiving a child; and delayed childbearing has resulted in more women in their late 30s and early 40s attempting conception than ever before. In fact, about 20% of women now have their first child after age 35.

Some women seeking to conceive after age 40 have no difficulty in achieving a pregnancy. For those who do, prompt and thorough evaluation and aggressive treatment are crucial. The probability of having a baby decreases 3-5 % per year after the age of 30 and at a faster rate after 40. Unfortunately, as women age they also have a higher chance of miscarrying.

At birth, a woman has all the eggs she will ever have. As an egg ages it is more likely to develop a chromosomal abnormality. A fertilised egg with abnormal chromosomes is the single most common cause of miscarriage: at least half of all miscarriages are due to abnormal chromosomes. A woman in her 20s has only a 12-15% chance of having a miscarriage each time she becomes pregnant. On the other hand, a woman in her 40s faces on average a 50% risk of miscarriage. Trying to conceive for one year before an infertility evaluation may not be appropriate in women over 40. If a woman is over 40 and the couple has been trying to conceive for over six months, a basic infertility evaluation is indicated.

A basic infertility evaluation includes a thorough history focused on fertility factors, physical examination and laboratory evaluation. The evaluation should determine if the partner can produce normal semen, if the fallopian tubes are open and the pelvis is normal, and if the ovaries are able to produce eggs that are likely to result in a pregnancy. The three most important laboratory evaluations are a semen analysis, a baseline (day 2 or 3) FSH to determine the “ovarian reserve” and a laparoscopy to assess the tubes and pelvis.

Aggressive therapy in mature women is indicated because time is of the essence.

Many doctors use fertility medications to try to increase the chance of pregnancy. Fertility medications increase the number of eggs that develop in a given month and enhance the chance that at least one of them might be able to be fertilised and develop into a pregnancy. Although fertility medications seem to offer some hope, the pregnancy rates are generally poor in older women. The older a woman is the more likely it is that your doctor will adopt aggressive techniques and pursue treatments such as IVF to achieve pregnancy.

The only consistently successful method to improve pregnancy rates in women with agerelated or “elevated FSH-related” infertility is egg donation. Indications for egg donation include advanced age, persistently high FSH levels at any age, poor response to fertility medications at any age, and consistently poor quality embryos at in vitro fertilisation.

In Summary:

  • Fertility declines significantly after age 40.
  • Miscarriage rates are higher for older women.
  • A decreased ovarian reserve suggests a poor prognosis for fertility.
  • In women over 40, a fertility evaluation should be given after 6 months of unprotected intercourse.
  • Aggressive treatment may be indicated to capitalise on the “window” of fertility.
  • Oocyte donation is most likely the best option for the woman over 40 who have an elevated basal FSH level.

For more information or queries regarding any of the services offered at Life Fertility Clinic, please contact us.