We’ve heard it again and again. Thirty is the new twenty, forty is the new thirty. With longer life expectancy, older age for retirement, improved healthcare and even products that help us defy the look of aging it’s easy to see why we seem to be a decade younger than we actually are. Unfortunately, our ovaries didn’t get the memo and it is shocking to many young women to learn that by their 30’s, their fertility and chances for natural conception have decreased dramatically. “Forty is the new thirty except when it comes to female fertility”, says Dr. Ania Kowalik, of Fertility Solutions in Dedham, MA, “The only thing that happens as women get older is that it becomes more difficult to conceive. This is a direct result of a decline in the number and quality of the eggs remaining in the ovaries. This decline may happen even before any change in a menstrual cycle characteristics or any change in ovulation.”
According to the American Society of Reproductive Medicine (ASRM), about 20% of women wait until after the age of 35 to start a family. It is easy to see how and why that is, as many of us have always dreamt of starting a family after graduating college. _After _starting a career. After getting married. _After _buying that house. After gaining financial security. After … well, you see where this is going. The problem with the after, is after 35, where a sharp decrease in fertility happens (and can happen even sooner depending on your particular genetic makeup). Sure, infertility affects men and women of all ages; however, it eventually affects every woman with age. It is recommended that if you are 35 or older and have been unsuccessful at conceiving after 6 months of trying, you contact a specialist to pursue an infertility evaluation and treatment.
The Biological Clock: Evaluating Fertility
A woman is born with all the eggs she will ever have in her ovaries, unlike men who continually produce sperm throughout their lives. As a woman ages, there is a natural decline in the quality and quantity of those eggs. Dr. Kowalik informs us, “Without testing, it is near impossible for a patient to know if they are experiencing a decline in their ovarian reserve. Therefore, if it is taking longer than expected to conceive, (6 months for women over 35, one year if you’re under 35), a full evaluation and possible treatment would be recommended. All of the currently available treatments tend to be more effective in younger patients thus making a diagnosis of a potential problem early in the process is of critical importance to ultimate success.”
If you are thinking about conception, there are a few simple tests that your OB/GYN may perform to test your fertility. An FSH (follicle-stimulating hormone) blood test, performed on cycle day 3 of your menstrual cycle is a good indicator of ovarian reserve. An FSH level below 12 mIU/mL is desired when trying to conceive. The higher the FSH level is the more difficult conception becomes, even with treatment. Unfortunately, there is no way to reverse a high FSH level, just as there is no way to turn back the clock, but there are assisted reproductive technologies that may help. Other hormones that may also be tested include TSH (thyroid-stimulating hormone, prolactin and Estradiol levels, hormones that play an important role in female reproductive health. An ultrasound to assess antral follicle count (how many potential eggs are in the ovary) may also be helpful in determining fertility and to ensure there are no cysts or obvious anatomical anomalies present. An HSG (hysterosalpingogram) procedure can be performed to ensure the woman’s fallopian tubes are open (crucial to ensure the egg and sperm can meet) by introducing radio-contrast dye into the uterus and tubes, and performing an X-ray. A simple semen analysis can be performed to evaluate male fertility. Many facilities (including Fertility Solutions lab) allow at- home collection of semen in a sterile container, so that privacy is preserved and the sample can just be dropped off in the lab for testing, simplifying the process and helping to alleviate patient anxieties.
A high FSH level, single or dual blocked fallopian tubes, abnormal semen analysis or low antral follicle count can indicate trouble in the conception arena and your OB/GYN may refer you to a board-certified fertility specialist at Fertility Solutions. It is important to keep in mind, however, even with a normal fertility evaluation, you don’t know how hard-or easy-conception will be until you try. Never rely on ‘normal testing’ as a certificate of promised fertility, or abnormal testing as a sign of insurmountable infertility, either. “Not all patients in their late thirties or early forties will have difficulty conceiving, but for those that do, there are lots of options. Helping patients to navigate through them and to find their own path to building a family is what the doctors at Fertility Solutions hope to achieve,” says Dr. Kowalik.
Try and Try Again
Once you’ve got babies on the brain, every month can seem like a year, so understanding your cycle is important to optimize the chances of natural conception. This is especially important when an age factor is involved, as you want to enhance your chances as much as possible to limit the time spent waiting for conception to occur. The average cycle lasts 28 days, with ovulation occurring around days 12-15. If you have shorter or longer cycles, count two weeks after your first day of bleeding (menstruation), this is approximately when ovulation will take place. It is helpful to keep a strict calendar so that you can track your periods and ovulation, and even pick up on whether or not your cycles are following a normal pattern. Ovulation predictor kits, sold in almost every drug store, can help you pinpoint your three most fertile days for intercourse. Even if conception does not happen the first or second month of trying, don’t lose hope, the best things in life do take some time! If you are over 35, do not wait more than 5-6 months before seeking help. Age isn’t our friend when it refers to infertility. For women under 35 years the pregnancy rate can be as high as 46% or more but it drops to less than 5% for women over 42 years of age.
No matter what your age, if you notice irregular cycles, or feel like it is taking too long or that there may be an underlying issue, talk to your doctor. When and if you need it, Fertility Solutions is here to help every step of the way. Together with your OB/GYN, we will assist you in finding the right path to building your family.
While age does play a big role in fertility, it is important to remember that there is help, there is hope, and you are not alone.
-Amy Asakli-DaSilva, MLT(ASCP)
-original May 2011, revised February 2021