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Age and Fertility

April 11, 2014

I had a great discussion with someone this week regarding why fertility declines with female age and I thought it would be a great topic to review. Women are essentially born with all the “eggs” that they will ever have and these “eggs” decline in number throughout life. Women are born with anywhere between 1-2 million eggs and by puberty are down to approximately 300,000 to 500,000. These eggs decline whether or not a woman is ovulating, on birth control pills, etc.

The theory is that the eggs that remain in the late thirties to mid forties are those that are within follicles (the structure in the ovary that surrounds the egg or oocyte) that were slightly more resistant to the stimulus from the brain which promotes maturation and growth. We believe this is associated with reduced egg quality. This is why the pregnancy rate is not only lower, but miscarriage risk and chromosomal risk is higher. Based on the available literature, natural fertility begins to decline at the age of 32 in women. This is why it is recommended to undergo a fertility evaluation after 6 months of unprotected intercourse that doesn’t result in a pregnancy in women 35 years old or older.

There is also testing that may be performed to assess “ovarian reserve” and these tests are frequently performed on women that are 35 or older, have endometriosis/ovarian surgery or other additional factors. These tests may allow a fertility specialist to select certain directed treatments. Please don’t hesitate to ask questions regarding this topic.

Christopher W. Lipari, M.D.
Jacksonville Center for Reproductive Medicine

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