It is an incredibly sad and frustrating fact of life but the age of a woman can and does play an important role in conception. Due to societal and cultural changes, the average age of motherhood is increasing – there are many different reasons as to why women start their families later on in life; career, meeting the right person and sometimes the struggle of previous unsuccessful and ongoing fertility treatments over the course of many years.
In this webinar, Dr Ulijana Dorofeyeva – the Medical Director at the Ukrainian Intersono IVF clinic examines the reasons behind female age-related infertility and discusses whether donor conception might be a solution for older couples who have experienced no success in their previous treatments.
In order to understand how a woman’s age can impact the chances of conception, we first need to look at the ovarian reserve. The term “ovarian reserve” describes the ovary’s capacity to produce viable egg cells. A low, or “diminished” ovarian reserve occurs when the ovaries start to lose their reproductive potential; this happens naturally with age, but it can also be caused by illness. A low ovarian reserve isn’t used to simply describe a lesser number of eggs – it also refers to the quality of the eggs. The level of AMH (Anti-Müllerian Hormone) in a woman’s blood is usually used as a benchmark for establishing ovarian reserve by medical professionals.
From what we know about the female reproductive system, it is easy to see how the number of eggs would decrease with age, but it is more difficult to understand why the quality would go down as well.
Findings from the Cochrane database show that the probability of a woman conceiving and then carrying a child to term reduces with age, significantly dropping past the age of 44. In over 18,000 reported IVF cycles in the study, it was discovered that on average, women over 40 needed to harvest between 90-100 oocytes in order to achieve a live birth via IVF. However, we should also remember that while statistical analysis can provide us with medical and scientific insights; each woman and each situation is completely individual and unique.
The elevated difficulty in conceiving and carrying a baby to term is, in part, due to increased rate of aneuploidies found in the embryos of older women. An aneuploidy is the presence of an abnormal number of chromosomes in a cell – this abnormal number is known to be a factor in embryonic developmental abnormalities. Aneuploidies are understood to increase with the age of the woman – it is estimated that in women over 42, over 85% of embryos will have aneuploidies.
Other factors are also thought to impact conception likelihood in women of advanced maternal age including less energetic mitochondrial function, and oxidative stress from lifestyle and environmental influences. Male factors also have an impact on embryo euploidy; Dr Dorofeyeva advises it’s important to test for DNA fragmentation and any other issues in the sperm being used.
While some problems encountered in conception will be due to embryonic factors, women failing to conceive should also have their endometrium checked. Implantation is a key component in IVF success and can be affected by uterine factors. Endometrium screening, biopsies, and scans are used to look for issues, which medical teams are then able to correct – in most cases – with surgical procedures or medication.
Screening of the immune system is also recommended and can be crucial, especially in cases of unexplained infertility and in IVF where the embryo quality has been good, yet treatments keep failing.
Dr Dorofeyeva concludes that when looking to conceive, naturally or with IVF, quality is key. It’s been well established that the conditions of both the sperm and the eggs have an impact on the quality of the embryo and its ability to implant. It’s therefore important to use high quality oocytes, either the patients’ own (if possible) or those of a donor for the best chances at success. The medical history of clients is also immensely important, and time should be spent by a reputable clinic to analyse the patient’s fertility journey in order to gain a full understanding about how best to proceed in each case.
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