Age affects fertility
A more recent study of university students in Sweden found that half of the female students were not aware of the age-related decline in fertility and intended to have children after the age of 35. There is clear evidence of an age-related decline in female fertility. By the time women reach 35 years of age, their fertility is declining markedly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. A study involved in 1000 women in pregnancy showed that 71% of women aged 30 conceived within 3 months whereas only 41% of women aged 36 conceived within 3 months. A negative effect of increasing male age particularly in the late 30s was also found. A study involved 2112 women in pregnancy showed that increasing age for both men and women take longer time to conceive. There were some other studies presented similar results.
There is a significant decline in clinical pregnancy rate, implantation rate and delivery rate per embryo transfer associated with increasing female age in assist reproductive treatment. A recent study of all IVF clinic in Netherland found that the overall live birth rate per cycle decreased by 2% for each additional year of female age. Another study involved in 36483 treatment cycles in assist reproductive treatment reported that women aged 25-29 achieved a live birth rate of 25.9% while women aged 40-44 only achieved 6.1% live birth rate. The poor live birth rate in older women greatly attributes to spontaneous abortion
What is the best marker of reproductive age in normal women?
Study showed that a woman’s optimal fertility age is before 30-31 years. And then fertility decreases gradually and this decline is accelerated towards age of late thirties. It is generally accepted that reproductive ageing is ovarian ageing and the quantity and quality of the pool of follicles in the ovary decreases. There are many tests that are used to measure ovary function. What is the best marker to measure reproductive age? GJ Scheffer et al compared several markers. These include that antral follicle counts (2-10mm), total ovarian volume, total follicular volume, mean follicular volume, and volume of either the smallest or largest ovary; FSH, estradiol and inhibin B and the response of estradiol and inhibin B to exogenous GnRH agonist. They tested these markers on 162 healthy female volunteers aged 25-46 years. These women were proved with normal fertility and regular menstrual cycles. All marker tested excerpt inhibin B were correlated with age, but the number of antral follicles was highly correlated with age. Their conclusion is that the number of antral follicles has the closest association with age in normal women with proven fertility.
Age and mother’s menopause affect women’s fertility
Women are born with all the eggs they ever have. Women are most fertile between the ages of 18 and 31. When women are getting older, their egg quantity and quality are declining. They become less fertile. Research suggested that genetic factor contributes to women’s fertility. Women whose mothers had an early menopause had much fewer eggs in their ovaries than those mothers had a later menopause. These women with fewer eggs have fewer chances to conceive. At present there is no test that can predict women’s fertility accurately. There are two approaches to assess the supply of eggs remaining in the ovary: anti-Mullerian hormone (AMH) and antral follicle count (AFC). Researchers found that both AMH and AFC declined faster in women whose mothers had an early menopause ( before the age of 45) compared with women whose mothers had a late menopause (after the age of 55). Dr Valentine Akande, a consultant gynaecologist and spokesman for the British Fertility Society said that the findings were helpful, but that women should not be overly concerned if their mother did have an early menopause. The variation of egg quantity in women is enormous. The earlier you are trying for a baby the more chances to be successful.
With age disadvantage and high FSH you still have chance to get pregnant
When women reach their forties, their fertility falls down. As mentioned above in humans the follicles in ovaries are fixed at birth and decrease with age. The follicles are constantly disappearing either died or growing to ovulate. From the age of about 35 onwards, fertility declines quickly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. The rate of follicular depletion speeds up resulting in a decreasing number of good qualities of follicles. A protein inhibin B produced by follicles dropped and FSH is elevated in circulation. FSH is a hormone produced by pituitary gland which is located in the brain. FSH stimulates ovaries for eggs growth. If your ovaries don’t function well or you run out of eggs, your ovaries do not respond to FSH like normal ovaries do, the eggs don’t grow well. In this circumstance your pituitary gland works hard to produce more FSH trying to stimulate ovaries function and eggs to grow. As a result your FSH level is high, which means that you have poor ovarian response or poor ovarian function or poor ovarian reserve or ovarian failure. Your egg quality and quantity will be poor. Also endometrial lining became impaired as well. All of these contribute to the declined fertility with aging.
How old a woman can be to achieve pregnancy with assisted conception approach? Check JH reported a case that a 46 year old woman with high day 3 estradiol and FSH. She conceived on her third IVF-ET attempt. She delivered a healthy full term baby girl. This was believed to be the first case report of a successful pregnancy in a woman of such an advanced age with diminished ovary reserve using her own eggs. This report showed that pregnancy is possible in similar circumstance.
How high is FSH that can be treated to achieve pregnancy? There was a case report that a woman with premature ovarian failure and high FSH 164miu/ml was treated and got pregnant in her ninth cycle treatment and delivered a healthy boy.
Is there other treatment available for high FSH? Estrogen or birth control pills will temporarily suppress FSH to normal level. However this does not improve your infertility
Can acupuncture help if your FSH is higher than normal? Acupuncture can stimulate the nerve ends to the ovaries and improve ovarian blood flow and help follicles grow, as a result this restore hormonal balance and lower FSH. Acupuncture also stimulates the brain and rebalances the hormones.
NHS offers IVF to women in age 40-42
New NHS guidelines state that couples struggling to have a baby should get fertility treatment more quickly and older women should gain access to IVF. The guidelines recommend that women aged between 40-42 should be offered one cycle of IVF if it is their first time and they have enough eggs; women aged under 40 are offered three cycles of IVF. It is widely known when a woman reaches her 30s her fertility begins to decline, and this decline in fertility is speeding up in her late 30s. IVF success rate is going down with increased age. IVF success is rare in women over 45.
Why this is the case? The ovary aging is the cause of this declined fertility. It has become clear that the decline in fertility with increasing female age is largely due to a rapid decrease in egg quantity and quality with a higher proportion of eggs having genetic abnormalities. On the contrary, the reproductive capacity of the uterus does not decrease with age even in late 40s and 50s. This is seen in the use of younger donor eggs, women who are menopausal can achieve very high rates of conception.
Fertility declines with aging in both men and women and acupuncture can help.
Women are born with all eggs in the ovary which cannot be divided into other cells. The egg numbers are only declining with age. The process is speeded after women turn 35 years of age. On the contrary, there are gonocytes or primitive germ cells in the normal men’s testes. These cells can split without limitation. The cells split can become another gonocytes which could further divide; or they can become mature sperm cells. Gonocytes supply within testes can be last very long time and mature sperm cells can be produced. This is the main reason why a man’s fertility does not decrease significantly with age as women’s.
However, fertility in both men and women decreases when they reach certain age. In men semen parameters could begin to decline as early as age 35. Semen volume and motility would decrease and morphology could gradually become abnormal. After age 40, there could be notably DNA damage in their sperm; motility and viability continues declining. With an increase in age in men, the time to pregnancy for their partner increases. In women, fertility is significantly lower in the 30s and 40s. The number of eggs decline, woman’s menstrual cycle become shorter, menstrual irregularity begins 6-7 years before menopause, infertility increases, the time to pregnancy increases and also the chances of staying pregnancy becomes lower. If you start trying to get pregnant and there is still no luck, this could be not because something is wrong, but it could simply because you and your partner’s age. It takes longer for you to get pregnant. In this situation, apart from changing life style and exercises etc that you can help yourselves, why don’t you try acupuncture? Acupuncture is recommended as one of the treatments to encourage fertility by some doctors.
Check JH Clin Exp Obstet Gynecol (2011) 38:209-10
Check ML Clin Exp Obstet Gynecol (2004) 31:299-301
Fotrman EJ et al Maturitas (2011) 70:216-21
GJ Scheffer et al Human Reproduction 18:700-706
Homan GF et al Human Reproduction Update (2007) 13:209-223
Welcome to my blog, discover acupuncture with Dr Maggie Ju
Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.
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