Twitter Linked-in Infertility Youtube Pinterest Google Plus Facebook

Dr. Lipari’s article in the Times Union!

May 7, 2015

The average age of first-time mothers has risen significantly over the last three decades. That’s happening all over the world and is probably related to a variety of factors, including educational and career choices.

Should women be concerned about delaying conception?

Is there any truth to the theory of the “biological clock”?

If there is concern, is there anything that can be done to improve overall success?

The answer to each of these questions is a definite “YES.”

The American Society for Reproductive Medicine published data that highlights an increase in the risk of childlessness from 5.7 percent at 20-24 years old to 63.6 percent at 40-44 years old.

This is based on the theory that women are born with a maximum number of eggs or oocytes. Each month brings a significant oocyte loss, even in women taking hormones or contraceptive pills that essentially “block” oocyte release or ovulation. This constant egg decline is the greatest hurdle for women to overcome if they wish to delay conception.

In fact, the decline in natural fertility begins in a woman’s early 30s and becomes much more pronounced in the mid- to late 30s. Not only do pregnancy rates decline, but miscarriage and chromosomal risks increase as well.

Live birth rates at 42 years of age, even with the most aggressive form of fertility therapy known as in vitro fertilization (IVF), are approximately 8 to 10 percent. It is for these reasons that fertility specialists encourage couples to attempt to conceive at a younger age if possible.

So what can be done if it’s not the right time for a baby, or a woman has not yet found the right partner?

The most important first step is identifying any particular issues that may hinder natural conception, even if fertility is not immediately desired. Sometimes, a basic history can direct a physician to a diagnosis that not only impacts fertility, but may also influence long-term health.

Irregular menstrual cycles, for example, may indicate a hormonal or metabolic problem. Painful periods or a history of them as a teenager may correlate with the presence of endometriosis, a condition that sometimes causes pain, infertility or both. Hot flashes and night sweats can signify a reduced egg reserve.

A basic history, exam and hormonal evaluation will identify many problems that may reduce fertility. A blood test is also available that is used to determine ovarian reserve or whether the number of eggs remaining in the ovary is where it should be for a given age. These issues may be addressed even before fertility is desired, so once building a family becomes the focus, the physical environment will be optimal.

Several more aggressive options are also available. The technique of cryopreservation or “egg freezing” was born out of the fact that pregnancy rates, miscarriage and chromosomal risks are based on the age of the oocyte when it is obtained.

Cryopreservation of eggs that are used years later may result in a significantly improved fertility potential. Many single women choose to undergo oocyte cryopreservation so that if difficulties are encountered when they meet the right person, they may fertilize the oocytes with their partner’s sperm and transfer the resulting embryo back into the uterus.

Oocyte cryopreservation is still deemed experimental by the American Society for Reproductive Medicine because long-term data is still lacking. But many healthy babies have been born following oocyte cryopreservation. Women seeking this treatment for fertility preservation should understand the benefits, risks and alternatives through extensive counseling.

In addition, embryo cryopreservation, as the name implies, is performed after fertilization and is a very effective option for women with a serious partner. Couples go through the process of IVF and the resulting embryos are “frozen” for later use. Embryos have greater survival rates during the thawing process and result in slightly improved pregnancy rates over cryopreserved eggs.

The concept of the “biological clock” is indeed real, but does not mean that a woman cannot intervene and influence the desire to build a family whenever that time may be.

Even if oocyte or embryo cryopreservation is not an option, a fertility assessment may be a great place to start, especially in women who have additional symptoms, such as pelvic pain, irregular menstrual cycles or a history of pelvic infections. Many of these conditions can be rectified without necessarily requiring advanced reproductive technologies.

Furthermore, if more advanced therapy is desired, it is important to know that such methods have helped millions realize their dreams of having healthy children and building a family.

Christopher W. Lipari is a board-certified reproductive endocrinologist and infertility specialist at Jacksonville Center for Reproductive Medicine. He has authored several abstracts and papers in his field and is a member of numerous professional organizations, including the Duval County Medical Society.

 

http://jacksonville.com/news/health-and-fitness/2015-05-05/story/doctors-are-there-biological-clock-it-can-be-reset

   
Go back to category:
[ssba]

Comments are closed.