Women are born with all the eggs in their ovaries that they can ever have. With starting of menstrual periods, they start losing these eggs and with age, eggs start to diminish in quantity as well as quality.
What Do Statistics Tell Us about the Correlation of Age and Fertility?
Female fertility is considered to be on its peak in 20s. Most of the women are considered to be most fertile between the ages of 23 to 31, though the conception rate starts to go down in late 20s. When a woman hits her 30s, fertility starts to decline more rapidly at about 3 percent per year till the age of 35. After 35, this rate of decline further goes up and by the age of 40 it has fallen to half for most of the women. Age is in fact considered to be most important factor influencing the chances of conception.
Does The Risk of Miscarriage Also Increase with Advanced Maternal Age?
As the egg quality deteriorates with advancement of maternal age, there is rapid increase in chromosomal abnormalities in these aging eggs. Poor egg quality is directly related to poor embryo quality which may pose as a challenge for successful pregnancy and successful outcome of the same. Not only it is difficult to achieve pregnancy with abnormal eggs, also there is high risk of miscarriage and giving birth to a baby with genetic abnormalities. Thus the egg quality is very important in successful outcome of a pregnancy. Age is one factor but at the same time egg quantity and quality can actually vary in individual women, which means some can have average for their age, some better than average and some even worse than average.
Can Assisted Reproductive Techniques Help with Age-Related Fertility Issues?
Fertility specialists use a variety of tests to estimate the egg supply or ovarian reserve. Anti-mullerian hormone or AMH test is a very good predictor but other tests are conducted along with to accurately assess the situation.
- Depending upon individual patient’s condition protocols for IVF can be customized to achieve best outcome.
- Several protocols can be used to boost ovaries so as to maximize the production of follicles and eggs. Without any stimulation, ovaries are capable of producing only one egg per menstrual cycle. Ideally the goal of stimulation protocol remains to procure 8 to 15 quality eggs for retrieval. The ovarian stimulation has to be balanced in a way that neither it is insufficient not there is no ovarian hyperstimulation syndrome.
- Specialist infertility doctors design proper medication protocol and dosing regimen which is best for the patient.
- Progress of stimulation is monitored regularly and carefully so as to adjust the medication protocol accordingly.
- HCG trigger is done at an ideal time to ensure success and avoid overstimulation.
Is there any test to find out about ovarian reserve?
Anti-mullerian hormone or AMH is considered to be one potential test for finding out ovarian reserve in a woman. AMH (anti-mullerian hormone) is produced by cells present in ovarian follicles. The production is highest when follicles are at small antral stages and then decreases to stop as follicular size grows. So there is no AMH produced in follicles which are greater than 8 mm in size. Hence, the levels of AMH remain fairly consistent and the AMH test can be done on any given day of a woman’s cycle. Blood AMH levels are thought to be accurate predictors of remaining egg supply or ovarian reserve as it is technically called.
Importance of AMH level when considering IVF
- Though AMH cannot really reveal much about the egg quality but having higher number of eggs increases the likelihood of successful pregnancy as there are more eggs to choose from and the best one is chosen.
- Women with higher AMH typically have better response to ovarian stimulation during IVF and thus end up having higher number of eggs retrieved. Higher number of eggs generally corresponds to higher success rate with IVF.
- At the same time, research has shown that only presence of low AMH levels in women below 35 do not actually predict low success rates of IVF. Thus, couples should not be refrained from IVF only on the basis of low AMH levels.
Day 3 FSH
Follicle stimulating hormone or FSH is a very important hormone that is involved in natural menstrual cycle as well as during assisted reproduction for medication induced stimulation of ovaries. This hormone is responsible for production of matured eggs in ovaries.
The baseline value of FSH is measured to get an idea about the ovarian reserve. Women nearing menopause have higher FSH hormone level which increases gradually over years and when the follicles are no longer there, in presence of high FSH they stop having their periods. Though high FSH is predictive of low egg quantity but at the same time, women with normal FSH might also have decreased egg supply. This is the reason why day 3 FSH is usually done along with AMH and antral follicular count. FSH is the hormone which is present in injectable gonadotropins used for stimulating ovaries to produce multiple eggs in an IVF cycle.
Antral Follicular Count
- Antral follicles (also known as resting follicles) are small follicles that can be seen, measured and counted on an ultrasound. Transvaginal ultrasound is used for accurate assessment of these.
- These are considered to be quite correct in estimating ovarian reserve as well as expected response to ovarian stimulation and hence successful outcome of IVF.
- The number of antral follicles indicates primordial follicles which contain immature eggs that have potential to develop and ovulate in future. If there are fewer antral follicles visible, it is considered to be indicative of low ovarian reserve.
- With average or higher number of antral follicles, there is typically good response during IVF with a lot of mature follicles.
- Poor response is expected when antral follicular count is low as fewer mature follicles develop with stimulation.
- With intermediate follicular count, the response to stimulation during IVF cannot be predicted and it can be either low response or good response.
How can a fertility predictor help you in choosing the most fertile days of the months?
Fertility calculators or fertility predictors are available on various websites; all you need to do is to fill in the blanks and figure out the days. You can understand this in the form of a mathematical formula as well. We normally devise this formula in order to figure out the ‘fertile window’ of the month or the days of the month when a female is most fertile. The menstruation cycle of a lady may vary from 23 days to 31 days. When you want to calculate the most fertile days of the month, you should start counting them from the day you’re your menstruation bleeding starts. Add 14 days to the date and next seven days are the most fertile days for you. This concept is also known as the fertility predictor as well. Ideally, the couple should have sex every second day during the period of this “fertile window”.
Fertility experts recommend that women who are above 38 and want to conceive should undergo aggressive treatments and proceed towards IVF in order to have better success rates. In fact, a lot of clinics have upper limit defined to about age of 43 after which they will not perform IVF with woman’s own eggs and instead consider using donor eggs.