Many women are delaying pregnancy and childbirth these days as they strive to pursue a career or other life adventures. Long-acting reversible contraceptive options have helped to make this possible by providing long term, effective birth control (more on that later!). When it comes time to start a family, many women feel nervous and worried about the possibility of infertility. Although it is true that fertility declines with age, there are many women who have successful pregnancies in the older age range. Awareness about the effect of age on fertility can help women make family planning decisions, and seek appropriate care when needed. Unfortunately there is not a way to predict or test your fertility prior to attempting to conceive.
Why does fertility decline with age?
- Women are born with a finite number of eggs in the ovaries. The number of eggs decreases throughout a woman’s life, from 1-2 million at birth to 25,000 at age 37 and 1,000 at age 51 (the average age of menopause).
- In addition to the falling number of eggs, the quality of eggs also declines. This is why a donor egg from a young patient is more successful in an older patient.
- Changes in circulating hormones
- Sexual activity declines with age
- As age increases, the risk of medical disorders that may hurt fertility increases (fibroids, endometriosis, problems with fallopian tubes)
When does fertility start to decline?
- The decline in fertility starts at about age 32, and decreases more rapidly after age 37.
Factors that can negatively impact fertility
- Smoking tobacco (in both female and male partners)
- Being overweight or obese
- Moderate to heavy alcohol consumption (> 2 drinks/day)
- History of gonorrhea or chlamydia
Factors that DO NOT affect fertility
- Prior birth control use of oral contraceptive pills, intrauterine device, Nexplanon, etc. Depo provera shots may affect cycles for multiple months after cessation and cause a delay in return to fertility
- Moderate caffeine consumption (example: 1-2 cups of coffee per day)
When should you see a doctor for infertility?
- If you are under age 35, after trying to conceive for 12 months
- If you are over age 35, after trying to conceive for 6 months
- If you are older than 40, immediate evaluation and treatment is acceptable
- If there are other specific clinical problems (example: no periods, or very irregular periods, history of ovarian or tubal surgery in the past)
Who should you see for infertility?
A general OB/gyn can start your workup and evaluation, and often treatment as well. There are certain tests that are routinely checked for patients with infertility, and these can be done with your general OB/gyn. These include blood work, semen analysis for your partner, and possibly imaging to evaluate your fallopian tubes. If you have a complicated medical or gynecologic history, you may need to be referred to an infertility specialist, REI doctor (Reproductive Endocrinology and Infertility). You can make an appointment with an REI doctor on your own as well at any point, but keep in mind the general guidelines above. Consultation, evaluation, and treatment of infertility are often not covered by insurance, and can be very costly.
1. American College of Obstetricians and Gynecologists (2014, March). Female Age-Related Fertility Decline. Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Female-Age-Related-Fertility-Decline
By Loriana Newman, M.D. - Expert Obstetrician/Gynecologist