| As a woman ages, her reproductive capacity decreases. While the likelihood of naturally occurring pregnancy is about 20-25% per month for a woman in her twenties and thirties, that possibility has decreased to 5% for a woman in her early forties. Increased reproductive age is also associated with increased miscarriage rate and increased risk of chromosomal abnormality such Down syndrome. The decreased fertility and increased miscarriage and genetic abnormalities, all result from decreased quality of the eggs as the woman gets older. Even though women continue to ovulate into their fifties, very few women experience a successful pregnancy at that age. It is very important therefore for women older than forty to see a fertility specialist if not pregnant after about three cycles of trying to conceive. |
| Two blood tests most commonly used to evaluate the woman’s ability to produce good quality eggs are the FSH (Follicle Stimulating Hormone), Inhibin and Estradiol performed on the third day of the menstrual cycle. Elevated levels suggest poor quality eggs and significant decrease in chances for pregnancy. |
| Another helpful test to evaluate the quality of the eggs is the Clomid Challenge Test. In this test, FSH level is measured on day 3 of the menstrual cycle and a repeat level is obtained after taking Clomid for 5 days. An abnormal test suggests a decreased likelihood of a successful pregnancy. |
| The decline in fertility is noted most acutely in IVF therapy. In fact, age is the most important factor in IVF success rates. For women under 35, each fertilized embryo has about a 30% chance of implanting in the uterus. By the age of 43, that possibility has dropped to less than 5% per embryo. (Since generally more than one embryo is transferred per IVF cycle, the actual success rate can be higher than this.) |
| The poorer IVF outcome is directly related to the decrease in egg quality. And while nothing can be done to improve the quality of the eggs, individualized ovarian stimulation may improve the ovarian response increasing the number of eggs available for fertilization. With more eggs, a greater number of embryos can be implanted, and the odds of pregnancy therefore increase. |
| Assisted hatching which involves microscopically removing part of the casing around the embryo just prior to transferring it to the uterus has not been shown unequivocally to improve pregnancy rates and is still under investigation. |
| For women whose ovaries are no longer producing good oocytes (eggs), adoption, surrogacy or donor egg IVF using anonymous or known donor eggs are often considered. |
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