Our society has evolved and many women are pursuing advanced educations and career advancement – and delaying childbearing as a result. However, in general women should be more knowledgeable about the impact of delaying childbearing on fertility potential.

Fertility specialists know this is a problem. We commonly see women in their late 30s and early 40s that are very bright and well-educated who are surprised and very disappointed when told that it may be very difficult (or impossible) to get pregnant and have a baby using their own eggs.

I like to use a “garden” analogy when discussing infertility with patients. The uterine lining is the “garden”  and the embryos are the “plants”. As women age, the garden is rarely the problem – the plant is often the problem. This is why using donor eggs is so successful regardless of the age of the recipient woman.

When an “older” woman switches to using “young” donor eggs, she is much more likely to end up with a high quality “plant”. The ability of the uterus to accept implantation of embryos does not decline significantly with aging (the older garden is receptive).

Sometimes when in vitro fertilization (IVF) is not successful, women ask about using a surrogate to carry their embryos – hoping that would solve the problem. However, it is not an effective solution. We would be switching from her uterus (which is not defective) to using another woman’s equally receptive uterus. There is no point in it.

However, switching to higher-quality eggs from a younger woman is more likely to result in successful pregnancy outcome. If the problem is in the “plant” then we can switch the “seed” and expect a better chance for success. But switching the “garden” doesn’t help because that was not the problem.

So what should women and their primary care doctors do regarding aging and fertility issues?

Women that might want kids (or more kids) in the future should:

• Educate themselves regarding fertility and female age
• Ask their doctors to test their egg supply as they get into their 30′s

Tests of the egg supply are referred to as “ovarian reserve” tests.

Blood tests for ovarian reserve

• Day 3 FSH, LH and estradiol
• AMH, anti-mullerian hormone

Ultrasound tests for ovarian reserve

• Antral follicle counts
• Ovarian volume

However, regardless of the ovarian reserve, female age is a very important consideration.

Conclusions:

• Many women want to have kids – but delay it too long
• Our society is not educating women well about aging and fertility
• Women should learn about declining fertility potential – and be tested for it

In a perfect world:

• Women would be well educated about fertility and aging
• Early screening for ovarian reserve should be done by the OB/GYN, or other MD
• Then women can make well-informed choices about delaying childbearing
• Society should better accommodate childbearing during educational and early workforce years

Related links:

Age and fertility

Fertility after 40

IVF and age

Testing for egg supply – ovarian reserve

Egg donation
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Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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