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Age And Infertility
More and more women are having their first child after age 35. This time also coincides with biological decline in fertility potential. One of the most challenging clinical scenarios is the impact of the aging egg on pregnancy chances. The decline in fertility potential, or ovarian reserves, is the natural consequence of the aging process of human eggs.
Each woman is born with a set number of eggs predetermined before birth. This pool of eggs is never replenished. A female fetus has the greatest number of eggs at around 15-20 weeks of pregnancy (6-7 million). At birth, this number decreases to about 2 million, and by puberty to 300,000. This constant and dramatic process of decline continues until menopause. From the reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive years.
Lower pregnancy rates and higher miscarriage rates are both a consequence of the aging process and reflective of the decline in egg quality. Neither fertility medications nor lifestyle changes can halt this.
Besides using age to determine pregnancy chances, we use hormonal testing to obtain better insight into the quantity and quality of eggs. The first of these tests is basal FSH (follicle stimulating hormone) and estradiol. This blood test is performed on the second, third, or fourth day of the menstrual cycle. In general, an FSH value above 10 is elevated and an estradiol value above 70 pg/mL is elevated. Elevation of either one of these values bodes a potential decrease in pregnancy chances.
For some patients, we recommend a clomiphene citrate challenge test (CCCT), which is a more sensitive test for assessing ovarian reserve. For this test, we assess FSH and estradiol values on day 3 and then administer Clomid (clomiphene citrate 100 mg per day) from cycle days 5-9 and then assess FSH on day 10. We sometimes order an antimullerian hormone (AMH) to evaluate egg quanity.
