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Houston Fertility Journal

    At What Age is It Too Difficult to Conceive?

    [fa icon="calendar"] Feb 14, 2019 10:00:00 AM / by Center of Reproductive Medicine   

    Center of Reproductive Medicine

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    Infertility can be deeply isolating, but it’s actually very common. Sixteen percent of couples are unable to get pregnant after a year of trying. Eight percent are still struggling after two years. One of the most frustrating aspects of trying to get pregnant is the age factor. Remember learning to ride a bike or read?

    With most things in life, the longer you try the more likely you are to get it right. Getting pregnant is just the opposite. Fertility declines with age, and in your forties, the decline is a rapid one. This means that the longer you delay treatment, the more your chances of a successful pregnancy decrease.

    Fertility is different for everyone. Some people struggle to get pregnant in their 20s and 30s, while others are able to have one child after another well into their forties and fifties. Without fertility testing, there’s no way to know how age and other factors will affect your individual chances of having a biological child.

    We’ve all heard stories of men who father children in their seventies and eighties--often with much younger women. The oldest woman ever to give birth was 67. Don’t let these outliers color your expectations. For most women, pregnancy becomes difficult in their forties and nearly impossible by 50 or so. For men, the decline is slower and less predictable. The risk of birth defects increases by the time a man hits 40 and greatly increases when a man is 50.

    Fertility and Age for Women

    The age factor in women’s fertility is undeniable. Fertility declines more sharply and rapidly with age among women. And as you know, once a woman hits menopause, she can no longer get pregnant at all. The average age at which a woman enters menopause is 51. During perimenopause, a period of a few years before menopause, a woman ovulates less regularly and therefore is much less likely to get pregnant. This means that, for most women, the chances of getting pregnant diminish and then vanish between ages 45 and 50.

    Even well before menopause, a woman’s fertility begins to steadily decline. The best odds of getting pregnant are in a woman’s twenties. By her thirties, fertility begins slowly declining. After 35, the decline is faster. While it’s true that a healthy lifestyle may help slow this decline and reduce the risk of birth defects and bad pregnancy outcomes, nothing can change the reality that fertility declines with age.

    At age 30, the average woman has a 20% chance of getting pregnant with each cycle. By 35, the odds decline slightly to 15-20%. Around age 37, the decline becomes more rapid, and by 40, the odds of a pregnancy per cycle are just 5%.

    These are just averages. Some women experience much earlier declines in fertility. One of the most common causes of infertility is a diminished ovarian reserve. This happens when a woman loses her supply of viable eggs. Even very young women can suffer from this condition.

    Even when a woman is able to get pregnant, the chances of birth defects and bad pregnancy outcomes increase with age. Most estimates suggest the risk of having a baby with birth defects is about 1 in 400 at age 30, but 1 in 100 by 40.

    Fertility and Age for Men

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    Men don’t go through menopause and continue producing sperm for their entire lives. So they can theoretically get a partner pregnant for their entire lives. Yet fertility does decline with age.

    Age affects men’s sperm in several ways:

    • Sperm count can decrease.
    • Sperm quality may decrease. This can make it more difficult to impregnate a partner. Lower sperm quality is also linked to a higher risk of birth defects.
    • Sperm motility -- a measure of the sperm’s ability to swim to the egg -- can decrease.

    Additionally, age-related health conditions can compromise fertility. Cardiovascular disease can undermine sexual function. Conditions such as diabetes, coronary artery disease, and other degenerative disorders may also affect fertility and sperm quality.

    If an older man attempts to have a child with an older woman, both partners’ ages play a factor. When a man’s partner is younger, by contrast, the odds of a successful pregnancy may be higher.

    For most men, fertility begins declining rapidly at about 40.

    Understanding Fertility and Age

    Age is just one factor playing a role in fertility, so it’s important not to assume a one-to-one correlation between the two. Young people can and do struggle with fertility issues. Older people can and do get pregnant without an issue. Age is a statistical factor, but the role it plays in any given couple’s attempts to get pregnant will vary. The only invariable role of age is that, after a woman reaches menopause, she cannot get pregnant unless she has frozen her eggs.

    Age also affects fertility in indirect ways. Consider the following:

    • Age can compound pre-existing fertility issues. A subfertile woman will struggle even more as she gets older. For example, if a woman only ovulates six times a year because of PCOS or a similar condition, then age lowers the probability of getting pregnant with each of these cycles.
    • Age is linked to a number of health issues. Many people gain weight as they age. Others develop degenerative conditions that require medication that can affect fertility and pregnancy. Declining health is an independent factor affecting fertility.
    • Pregnancy becomes more dangerous as a woman ages. Women over 35 are more likely to suffer pregnancy-related complications, including miscarriage and stillbirth. After 40, the risk of pregnancy-related issues greatly increases.

    Just as everyone’s face ages at a slightly different rate, so too does everyone’s fertility. There is no way to know how fertile you are based on age alone. Even if you feel healthy, youthful, and vibrant, you could have a fertility condition or could be suffering from age-related infertility. This is why it’s so important for people with fertility issues to act quickly. Each month that you delay treatment is another wasted chance.

    Signs That Age May Be Affecting Fertility

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    If you have a prior history of infertility or a condition such as PCOS that is known to affect fertility, be mindful of the way that these conditions can interact with age. As you get older, you may need help to get and stay pregnant.

    But what if you have no history of infertility, or don’t know if your reproductive system is in good health? Then you need to know the warning signs of infertility, especially age-related infertility.

    Men may be less fertile if:

    • They have a cardiovascular health condition or diabetes.
    • They struggle to get or maintain an erection.
    • They’ve noticed changes in their urination or ejaculation, such as pain, burning, frequent urination, or premature ejaculation.
    • They cannot easily ejaculate.
    • They are overweight or have a history of high blood pressure.
    • They have been diagnosed with low testosterone, or suddenly notice signs of low-T, such as exhaustion, loss of sexual desire, and weight gain.

    Women may be less fertile if:

    • They have irregular periods. If periods are becoming progressively more irregular, this may be a sign of perimenopause.
    • They have very short or very long menstrual cycles.
    • They do not notice a monthly change in fertility-related symptoms. For example, most fertile women notice a change in vaginal discharge around the time of ovulation.
    • They have symptoms of changing estrogen levels, such as more difficulty getting lubricated when sexually aroused.
    • They are gaining weight or growing more body hair.

    If you have signs of diminished fertility or are concerned about how age might affect your chances of getting pregnant, err on the side of caution and see an infertility specialist now.

    Age-Specific Fertility Advice

    If you’re in your thirties, forties, or beyond and are hoping to become a parent, the single most important thing you can do is understand that time is your enemy. There is nothing you can do to slow the march of time, but a healthy lifestyle may help.

    Some additional strategies to try include:

    • Being more proactive about getting pregnant. Don’t just quit using birth control. Instead, track your cycles so you know how to time sex. Educate yourself about the signs of fertility and ovulation, and time sex accordingly.
    • Stop any fertility-harming habits, such as drinking, smoking, or eating unhealthy foods.
    • Get plenty of exercise. This can reduce the risk of cardiovascular disease and help you maintain a healthy body weight--two factors that can improve fertility.
    • Take a multivitamin. Women should begin taking a prenatal vitamin containing folic acid or folate six months before trying to get pregnant.
    • See a doctor for a fertility consultation and workup, especially if you are over the age of 40.

    How Infertility Treatment Can Help

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    It’s important to be realistic about age and how it affects infertility so that you can be proactive. That doesn’t mean you should panic or give up hope. As long as a woman has not gone through menopause, there is a chance that she can get pregnant. To learn about other factors that might affect your infertility, read more here.

    Women who are concerned about age and fertility may want to freeze their eggs. Egg preservation can help you get pregnant down the road, potentially even beyond menopause.

    Some other ways that infertility treatment can help include:

    • Treating underlying fertility conditions. Such as things that interact with age to reduce your chances of a pregnancy.
    • Helping a woman ovulate more regularly. As a woman’s egg supply diminishes, she may ovulate less frequently. This greatly reduces the chances of pregnancy. Medications to induce ovulation can help.
    • Assessing a man’s sperm quality. Many couples make the mistake of assuming the woman is the problem, but about half of infertility cases are due at least in part to a problem with the man.
    • Working around fertility issues. Procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF) can help you get pregnant more quickly, especially if the cause of infertility unexplained or there is a problem with the man’s sperm.
    • Using donor eggs or sperm. If one partner is not producing eggs or sperm or has serious problems with eggs or sperm, you can still get pregnant with donor gametes. An IUI or IVF procedure can help the sperm fertilize the egg.
    • Monitoring you during early pregnancy to reduce the risk of miscarriage. Some older women experience hormonal imbalances or structural problems that increase the risk of miscarriage. Diligent monitoring can reduce risk. For instance, a woman with low progesterone may be able to safely carry a pregnancy with progesterone treatments. A stitch in the cervix can reduce the dangers of a miscarriage due to a weak or incompetent cervix.

    Perhaps most importantly of all, an infertility specialist can monitor your health and offer personalized recommendations. This might include lifestyle changes, recommendations about when to time sex, and a candid assessment of how likely you are to get pregnant. Knowledge is power, especially when you’re fighting the ticking clock of age-related infertility.

    When to Seek Infertility Treatment

    It is never too early to seek infertility treatment. In fact, couples who hope to get pregnant in their thirties and forties should consider infertility testing before they even begin trying. This greatly reduces the risk of wasting time as a woman’s egg reserve is depleted.

    If you’ve been trying for a while, here are some signs that it’s time to get help:

    • You’ve been trying longer than 12 months at any age.
    • The woman has had two or more miscarriages in a row.
    • The woman is over 35 or the man is over 40 and you have been trying longer than 6 months.
    • One or both partners have a condition known to undermine fertility.
    • Either partner has a history of fertility health issues.

    Infertility can be a difficult experience. Some couples fight more, spend less time together, or even blame each other. It doesn’t have to be this way. Infertility can even bring you closer together, fostering understanding and compassion.

    At the Center of Reproductive Medicine, we know how difficult this journey can be. Let our Houston Fertility Specialists walk alongside you, guiding you to the right treatment for your budget, values, and fertility goals. We’ll listen, offer reassurance, and use all of our resources to help you get what you want most.

    You deserve to stop feeling alone and start working on a fertility plan that works for you. We can show you the way. Give us a call today.

    The Infertility Journey: Your Questions from A to Z

    Topics: Fertility Specialist, Signs of Infertility, Age and Infertility

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