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Archive for the ‘advanced maternal age’ tag

When Should I Freeze My Eggs?

By Dr. Michael Zinger

August 4th, 2016 at 3:43 pm

 

image credit: stockimages/freedigitalphotos.net


Every woman is born with a limited supply of eggs.  As this supply ages, the likelihood of each remaining egg to have the capability to become a baby diminishes.  However, this loss of potential is not spread evenly over the years, rather it is a shallow decline that usually continues into the mid-30’s, followed by a steeper loss that typically happens from the late 30’s into the early 40’s.  Over a matter of 5 years, the odds of one egg having the potential to make a baby decreases by about 80%.  Of course, not every woman is typical and the age at which this transition starts can vary quite a bit.

 

The only way to effectively protect the potential of eggs over time is cryopreservation, also known as egg freezing.  Once frozen, the capacity of the eggs to create a successful pregnancy is maintained through the years.

 

Gynecologists often ask me at which age to refer their single patients to me to discuss egg freezing.  The answer is not simple.  Certainly we do not want to put a patient through this process if it is likely that she will meet the right partner and form a family without ever using those eggs.  It would have been an unnecessary medical procedure with associated expense and lost time and effort.

 

On the other hand, we have to weigh the risk that the steeper decline in the eggs’ potential will happen before the woman has met her future partner and completed her family.  If we could predict when that decline will happen in each woman then this question would be much easier.  Unfortunately, our testing is only accurate in identifying this steeper decline when it is already occurring, at which point we have already missed the opportunity to freeze high-potential eggs.

 

Most of my egg-freeze patients are in their mid-30’s.  On average, at this point, only subtle changes in the potential of eggs have occurred, whereas within a few years, more drastic changes usually start.   Therefore, this timing does make sense for most women, but not everyone.

 

A concern about waiting until the mid 30’s is the possibility of an earlier decrease in egg potential.  While that is unusual, it tends to also be unpredictable.  Factors that contribute may include a history of smoking, a history of ovarian surgery or conditions that may lead to such surgery (e.g. endometriosis), or having a mother or older sister that experienced either an earlier menopause or infertility due to loss in egg potential.  Women with these factors should consider freezing eggs in their early 30’s or even late 20’s.    But, most often, if an early decrease occurs, it is without any predisposing factors and with no known cause.  Therefore, even without predisposing factors, cautious women, who want to minimize the risk of missing the opportunity, should also consider freezing their eggs in their early 30’s.

 

Of course, just as some women unpredictably have an earlier loss, some also have good potential that persists even past 40.  This can be determined at an initial visit with a fertility specialist through sonogram and blood tests.  So, for women who have not yet frozen eggs, even at 41 or 42 it makes sense to come in for evaluation and determine if this could still be worthwhile.

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An Infertile Woman’s Advice to the New Grad

By Tracey A. Minella

June 21st, 2014 at 6:19 am

 

credit: david castillo dominici/freedigitalphotos.net

How innocent you look there in your cap and gown, your broad smile gleaming in the sun. Another educational milestone met. Another diploma for the wall.

You’ve got grand plans for your bright future. Another advanced degree, or maybe your first big job, waits. Visions of the good life fill your mind. Having it all. The career with its promotions, the marriage with romantic vacations. The first house. And then…eventually… the baby. The one you’ve decided will arrive in May of some yet undetermined year. Right on schedule. Exactly as planned.

Today, your foot is poised on the ladder to success.

And as I see you, my mind screams “Put it in the stirrups!”

I was you, long ago. Innocent, with no reason to suspect my life’s lofty goals would not turn out exactly as planned. And as it turns out, I’d trade all my degrees, romantic vacations and big empty house in a heartbeat just to have some of that time back. Just to have thought to start trying to conceive sooner. Or to have budgeted money better. And sadly, I’m in good company feeling this way.

I never thought I’d be married 13 years before I finally conceived. Or that my journey to the crib would take 6 years and 6 IVF cycles and then another IVF four years later. Or that the costs…financial and emotional… would be so great and still have an impact on my life for so many years.

There’s something about graduations that brings out the cynic in me.  It’s that innocent optimism of the grad and the sense that they have all the time in the world before having a family that makes me want warn them that a rude awakening may await them. But who am I to shatter their dreams?

So the best advice I can give new grads is to look ahead optimistically, but keep one eye on the mirror and keep your ear on the biological clock because time moves faster than you think. Whether you have a partner or not, see an RE periodically for a complete fertility evaluation as your eggs may be older than you think. Rule out or treat any issues found early…before you’re ready to conceive.  Consider egg freezing, if indicated. A simple semen analysis is an inexpensive test that yields a lot of information. These exams will let you know if you should consider changing your original family-building timing.

Being book smart is great, but there’s more. Be smart about your body and your fertility. Know your options because knowledge is power.

Now, go out and conquer the world.

* * * * * * * * * * * * * * * ***

What, if anything, would you do differently in terms of timing your education, career, and family planning?

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Is Your Biological Clock Running Out?

By David Kreiner, MD

January 10th, 2014 at 10:35 pm

 

image courtesy of photo stock/freedigital photos.net

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions.

When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis.

Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

* * * * * * * * * * * * * * * * *

Did you realize that aging is not the only factor in the biological clock race? Did you know that certain conditions, like endometriosis, can play a part, too?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10049499

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Infertility Podcast Series: Journey to the Crib: Chapter 31: When Are You Too Old to be a Mother?

By David Kreiner MD

November 24th, 2013 at 9:44 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-One: When Are You Too Old to be a Mother? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=143

When Are You Too Old to be a Mother?

 

Over the years, there have been reports of women as old as in their 70′s having babies as a result of In Vitro Fertilization (IVF) performed using donated eggs from a young fertile donor.  Immediately after these reports appear, I am bombarded with questions and criticisms about how wrong it is that we (somehow I am included as part of the responsible party as an IVF practitioner) allow women to have children beyond that which is not just natural but also reasonable. Those of us in IVF have had many experiences with making the news as this medical technology pushes to the edges of what society views as acceptable.

 

We are often put in the position of making decisions with our patients that have even larger implications to society than the individual patient.  I do my best to look at each patient and each situation as unique and treat them accordingly.  Regarding the age of a prospective egg recipient however we are dependent on the patient’s honestly reporting such to us.  Unfortunately, there are circumstances where patients have misled their doctors and in the case of one 70 year old mother, she had reported to the clinic that she was in fact 53.

 

Even so, it is the responsibility of the IVF provider to ensure that a woman is healthy and capable of bearing the pregnancy, giving birth and being a mother.  There is not an absolute age cutoff at which point a woman is universally unfit to undergo IVF and become pregnant.

 

My personal oldest woman I helped achieve a pregnancy was a 53 year old who delivered at age 54.  She had a normal stress test, EKG and was cleared by an internist, perinatologist and psychologist.

 

Some point out that beyond a certain age, it is unnatural to become a mother and that it puts the family at risk that she may not be around to help raise the child or that perhaps the woman lacks the energy and stamina to raise the child properly.  I personally struggle to separate my own feelings about the proper age to have a child which may be inappropriate for others who have a different perspective.  My responsibility as the physician is to the health of my patients, the well-being of the child and for the good of society.

 

Many women in their 50′s have the health and energy to carry a pregnancy and bear a child with no more risk than many women 10-20 years younger.  That being said, what about the risk that the mother may not be around to raise the child to maturity?   There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal to raise a family.  But, happy, successful families can take on many different faces.  Single parent families exist, survive and often thrive.  One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity.  In addition, at least 50% of couples in the U.S. become divorced.  One can argue that couples at risk of divorce should not get pregnant.

 

I apologize that I cannot offer an answer to this question, when are you too old to be a mother.  For me personally, it is more a question of health …for the mother and baby… which needs to be evaluated individually for each case utilizing testing and experts to make the best assessment.  Otherwise, I feel it is an individual’s right to choose as long as society is unaffected or supports the individual in those cases where the pregnancy has a significant impact beyond the immediate family.

 

 

* * * * * * **  * * * *

Was this helpful in answering your questions about what fertility doctors might consider when questioning if an older woman may be able to conceive and carry a pregnancy?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 31: When Are You Too Old to be a Mother?

By David Kreiner, MD

September 24th, 2013 at 11:08 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-One: When Are You Too Old to be a Mother? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=143

When Are You Too Old to be a Mother?

Over the years, there have been reports of women as old as in their 70′s having babies as a result of In Vitro Fertilization (IVF) performed using donated eggs from a young fertile donor.  Immediately after these reports appear, I am bombarded with questions and criticisms about how wrong it is that we (somehow I am included as part of the responsible party as an IVF practitioner) allow women to have children beyond that which is not just natural but also reasonable. Those of us in IVF have had many experiences with making the news as this medical technology pushes to the edges of what society views as acceptable.

We are often put in the position of making decisions with our patients that have even larger implications to society than the individual patient.  I do my best to look at each patient and each situation as unique and treat them accordingly.  Regarding the age of a prospective egg recipient however we are dependent on the patient’s honestly reporting such to us.  Unfortunately, there are circumstances where patients have misled their doctors and in the case of one 70 year old mother, she had reported to the clinic that she was in fact 53.

Even so, it is the responsibility of the IVF provider to ensure that a woman is healthy and capable of bearing the pregnancy, giving birth and being a mother.  There is not an absolute age cutoff at which point a woman is universally unfit to undergo IVF and become pregnant.

My personal oldest woman I helped achieve a pregnancy was a 53 year old who delivered at age 54.  She had a normal stress test, EKG and was cleared by an internist, perinatologist and psychologist.

Some point out that beyond a certain age, it is unnatural to become a mother and that it puts the family at risk that she may not be around to help raise the child or that perhaps the woman lacks the energy and stamina to raise the child properly.  I personally struggle to separate my own feelings about the proper age to have a child which may be inappropriate for others who have a different perspective.  My responsibility as the physician is to the health of my patients, the well-being of the child and for the good of society.

Many women in their 50′s have the health and energy to carry a pregnancy and bear a child with no more risk than many women 10-20 years younger.  That being said, what about the risk that the mother may not be around to raise the child to maturity?   There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal to raise a family.  But, happy, successful families can take on many different faces.  Single parent families exist, survive and often thrive.  One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity.  In addition, at least 50% of couples in the U.S. become divorced.  One can argue that couples at risk of divorce should not get pregnant.

I apologize that I cannot offer an answer to this question, when are you too old to be a mother.  For me personally, it is more a question of health …for the mother and baby… which needs to be evaluated individually for each case utilizing testing and experts to make the best assessment.  Otherwise, I feel it is an individual’s right to choose as long as society is unaffected or supports the individual in those cases where the pregnancy has a significant impact beyond the immediate family.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about what fertility doctors might consider when questioning if an older woman may be able to conceive and carry a pregnancy?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

How Old is Too Old to Get Pregnant?

By David Kreiner MD, and Tracey Minella

January 17th, 2012 at 11:44 pm


I’m the first to admit it would’ve been easier on many levels if infertility hadn’t delayed motherhood for me. I’d have a kid in college instead of a third grader. Sure some days I feel like I’m aging in dog years… but on others I’m sure chasing him keeps me young.

I can make judgments about myself. We all do. But if someone else were to judge whether or not I was too old to become a mother…now that’s a whole different story!

We can probably all agree that, say 65, is too old. But is 60? Or even 55? As we slide that scale downward, we get into a gray area. But what’s a fertility doctor to do?

Read on for Dr. Kreiner’s thoughtful post on how he has handled this controversial issue:

When I saw that Maria de Carmen Bousada (the oldest mother to conceive at the time with donated eggs and the help of an IVF program) had died, my first thought was to extend my sincere condolences to her family and in particular to her two year twin boys. My heart truly went out to them. It is a great tragedy when a death occurs especially when it is the mother of such young children. I hope and pray that Maria’s family and friends find the strength to replace the love and nurturing typically given by a mother to her child. My second thought as a fertility doctor was that once again – the world of infertility was making the news because we continue to push the edges of what society views as acceptable.

This is one of the hardest things about being a doctor in a cutting edge field such as reproductive medicine. We are often put in the position of making decisions with our patients that have even bigger implications to society than the individual patient. I do my best to look at each patient, and each situation individually, but I do rely on my patients to treat me as honestly as I treat them. It is a two way street – and unfortunately, Maria lied to the clinic about her age, telling them she was only 53 years of age.

Questions are being raised regarding the responsibility of the IVF program to verify the veracity of information supplied to them by their patients in addition to confirming their health condition to carry a pregnancy.

Others add that beyond a certain age, it is unnatural to become a mother and it puts the family at risk that she may not be around to help raise the child as what occurred in this case, or even if she is perhaps she lacks the energy and stamina to raise the child properly.

At East Coast Fertility, we had a cutoff of age 50 which was admittedly random and that limit was often broken when faced with an energetic couple with a woman who passes her stress test, medical and high risk maternal fetal medicine clearances. We recently celebrated our latest 54 year old patient’s delivery of a healthy baby that was highly reported in the press.

As I said, it is a struggle to separate my own personal feelings about the proper age to have a child which may be inappropriate for others who have a completely different perspective. My responsibility as the physician offering assistance to patients in need of help with procreation is to the health of my patients, the well being of the child and for the good of society.

Many women in their 50’s have the health and energy to carry a pregnancy and bear a child with no more increased risk than many woman 10-20 years younger whose interest in achieving pregnancy we would never consider questioning. That being said what about the risk that the mother may not still be around to raise the child to maturity.

There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal for raising a family. But, happy, successful families can take on many different faces. Single parent families exist, survive and often thrive. One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity. We do not know that a healthy woman of 30, 40 or 50 may not develop a lethal disease before a child has grown up. In addition, at least 50% of couples in the United States become divorced. One can argue that couples at risk of divorce should not get pregnant. I do not think that society is ready to conclude that any of these women should not be allowed to procreate.

So, what about the clinic’s responsibility regarding confirming that a patient is giving them truthful information? We have been deceived in the past that a couple who is requesting fertility assistance was unmarried when in fact at least one partner was married to someone else. This issue is especially acute as it can raise potential liability to the clinic. As in the case of Maria de Carmen Bousada, she lied about her age and perhaps was beyond the limit the doctors and society was comfortable assisting.

For me and for our program we have raised our bar to do the proper due diligence realizing that we will not be able to get the truth in all cases but minimize the risk that we missed picking up a crucial lie. But I don’t want to be “The Fertility Police”. I am a fertility doctor – and my job is to help people have families no matter how different those families may look to you and me.

* * * * * * * * * * * *

What’s your opinion? Should there be an age limit? Or should it be determined on a case-by-case basis?

no comments

Is Your Biological Clock Running Out?

By Tracey Minella and David Kreiner MD

January 6th, 2012 at 12:00 am


So, we just counted down the minutes on the regular clock, ringing in a brand new year. Did that remind you of anything? Maybe some other clock that is ticking down and causing you to fidget a bit?

You know which clock I mean: THE BLASTED BIOLOGICAL CLOCK!

I’ve always hated this term. Probably because I used to hit its SNOOZE button for years. It used to nag at me in the back of my mind as I pursued my education and got settled in my career…especially since I married young. And when it wasn’t in the back of my mind, it was being shoved smack in my face by the rude comments of nosy jerks, collectively known as “the masses of asses”. We’ve all got ‘em.

If you’re wondering whether your biological clock is really running out, this post by Dr. David Kreiner may be enlightening:

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions.

When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis.

Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

* * * * * * * * * * * * * * * * *

Did you realize that aging is not the only factor in the biological clock race? Did you know that certain conditions, like endometriosis, can play a part, too?

no comments

IVF and the Single Ladies

By David Kreiner MD

August 23rd, 2011 at 12:00 am

No knight in shining armor? No Mr. Right? Biological clock pounding in your ear?

Dr. Kreiner of East Coast Fertility helps the single ladies out there who’ve found themselves at a “reproductive crossroads”:

Last week a patient presented to my office with a question that made me feel like I was responding to a Dear Abby letter requesting help to make some crucial life decisions that were related to her reproductive health.  As I pondered her query that I had heard so many times before I wondered how terribly nerve racking it must feel like for this woman.

Dear Fertility Doc,

“I am 39 years old, single and I enjoy my career.  However, I always dreamed I would have children.  Unfortunately, I have not yet met a man that I would feel comfortable with to marry and with whom to have a baby.  What should I do?”

Signed,

At Reproductive Crossroads

The issues that this woman brings up are universal in my practice.  She basically has to weigh her desire to have children now rather than delay, using her own eggs or potentially with an egg donor or to adopt.   She needs to consider the ramifications of taking time off from her career as well as creating a child with donor sperm.  She expressed concern to me that if she were to meet Mister Right how will he respond to this child?  Are there any tests that I can perform that can help this woman make a decision?

First of all, it is imperative in cases like this to do a full fertility screen so that we understand from a fertility perspective how much time she has left and how urgent this patient needs to make a decision. 

To assess her fertility I do a Day 3 serum Estradiol and FSH, an AntiMullerian Hormone and a sonographic antral follicle count.  The FSH is regulated by negative feedback from serum Estradiol and inhibin both of which are produced by the granulosa cells of the ovarian follicles.  With diminishing ovarian activity there are fewer follicles, less estradiol and inhibin so with less feedback, the FSH level is high.  Occasionally, in patients with low ovarian activity, often called reserve, a patient may have an ovarian cyst that produces estradiol.  This will lower the FSH level to otherwise normal activity levels even when there is minimal ovarian activity and inhibin.  One would misinterpret the low normal FSH in the presence of higher estradiol which is why this must be measured concurrent with FSH.

AntiMullerian Hormone is also produced by the granulosa cells and low levels therefore indicate depleted ovaries.  Likewise, few antral follicles seen on ultrasound typically performed during the early follicular phase of the cycle will indicate low ovarian reserve.

Once we know a patient’s relative fertility through this screen we need to decide whether she is prepared to delay her career for pregnancy and motherhood or should she do IVF and freeze her embryos thereby freezing her fertility potential at the current state.

Since she is single without a participating partner we would be using the sperm from an anonymous donor.  The specimens are obtained from sperm banks that are certified by New York State by virtue of their screening and testing for infectious and hereditary diseases.  Patients may review what is available from the sperm banks.  They can review on the internet the donor’s demographic information, physical attributes, educational and occupational histories, etc for the offered specimens.

If a woman does not have any infertility issues I would attempt donor insemination.  However, due to her advanced age, I would progress to more aggressive therapies if we were not successful after a few cycles.

A common concern for women in this circumstance is that they may meet their soul mate in the future and he may not be comfortable with a child produced with someone else’s sperm.  This is an issue that is very individual and I can only offer to support the patients as they decide what is best for them.

As she prolongs the decision her fertility is diminishing, and thereby risks not being able to have a child using her own eggs.  If conceiving with one’s own eggs is crucial then she must weigh the downside of conceiving a child from an anonymous donor and if she does so, the potential problems associated with finding a man in the future who she may want to have a family with.

It is enormously stressful making these decisions at these reproductive crossroads.

I discuss these issues with my patients and help them arrive at the decision that is right for them.

* * * * * * * * * *

Do you go forward with single motherhood, figuring the true Mr. Right would accept this child from your egg and donor sperm? Or do you wait, remain childless, and hope to find Mr. Right only to give up your ability to use your own eggs, having to use donor eggs and his sperm? What would you do?

no comments

Are You Too Old to Become a Mom?

By Tracey Minella and David Kreiner MD

May 12th, 2011 at 12:00 am

I’m the first to admit it would’ve been easier on many levels if infertility hadn’t delayed motherhood for me. I’d have a kid in college instead of a third grader. Sure some days I feel like I’m aging in dog years… but on others I’m sure chasing him keeps me young.

I can make judgments about myself. We all do. But if someone else were to judge whether or not I was too old to become a mother…now that’s a whole different story!

We can probably all agree that, say 65, is too old. But is 60? Or even 55? As we slide that scale downward, we get into a gray area. But what’s a fertility doctor to do?

Read on for Dr. Kreiner’s thoughtful post on how East Coast Fertility handles this controversial issue:

When I saw that Maria de Carmen Bousada (the oldest mother to conceive at the time with donated eggs and the help of an IVF program) had died, my first thought was to extend my sincere condolences to her family and in particular to her two year twin boys. My heart truly went out to them. It is a great tragedy when a death occurs especially when it is the mother of such young children. I hope and pray that Maria’s family and friends find the strength to replace the love and nurturing typically given by a mother to her child. My second thought as a fertility doctor was that once again – the world of infertility was making the news because we continue to push the edges of what society views as acceptable.

This is one of the hardest things about being a doctor in a cutting edge field such as reproductive medicine. We are often put in the position of making decisions with our patients that have even bigger implications to society than the individual patient. I do my best to look at each patient, and each situation individually, but I do rely on my patients to treat me as honestly as I treat them. It is a two way street – and unfortunately, Maria lied to the clinic about her age, telling them she was only 53 years of age.

Questions are being raised regarding the responsibility of the IVF program to verify the veracity of information supplied to them by their patients in addition to confirming their health condition to carry a pregnancy.

Others add that beyond a certain age, it is unnatural to become a mother and it puts the family at risk that she may not be around to help raise the child as what occurred in this case, or even if she is perhaps she lacks the energy and stamina to raise the child properly.

At East Coast Fertility, we have a cutoff of age 50 which is admittedly random and that limit is often broken when faced with an energetic couple with a woman who passes her stress test, medical and high risk maternal fetal medicine clearances. We recently celebrated our latest 54 year old patient’s delivery of a healthy baby that was highly reported in the press.

As I said, it is a struggle to separate my own personal feelings about the proper age to have a child which may be inappropriate for others who have a completely different perspective. My responsibility as the physician offering assistance to patients in need of help with procreation is to the health of my patients, the well being of the child and for the good of society.

Many women in their 50’s have the health and energy to carry a pregnancy and bear a child with no more increased risk than many woman 10-20 years younger whose interest in achieving pregnancy we would never consider questioning. That being said what about the risk that the mother may not still be around to raise the child to maturity. There is no question that a young healthy couple with sufficient financial support and emotional maturity is ideal for raising a family. But, happy, successful families can take on many different faces. Single parent families exist, survive and often thrive. One can never be certain that the condition of the couple at the time of conception will continue through the child’s birth or for that matter until the child has reached maturity. We do not know that a healthy woman of 30, 40 or 50 may not develop a lethal disease before a child has grown up. In addition, at least 50% of couples in the United States become divorced. One can argue that couples at risk of divorce should not get pregnant. I do not think that society is ready to conclude that any of these women should not be allowed to procreate.

So, what about the clinic’s responsibility regarding confirming that a patient is giving them truthful information? We have been deceived in the past that a couple who is requesting fertility assistance was unmarried when in fact at least one partner was married to someone else. This issue is especially acute as it can raise potential liability to the clinic. As in the case of Maria de Carmen Bousada, she lied about her age and perhaps was beyond the limit the doctors and society was comfortable assisting.

For me and for our program we have raised our bar to do the proper due diligence realizing that we will not be able to get the truth in all cases but minimize the risk that we missed picking up a crucial lie. But I don’t want to be “The Fertility Police”. I am a fertility doctor – and my job is to help people have families no matter how different those families may look to you and me.

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What’s your opinion? Should there be an age limit? Or should it be determined on a case-by-case basis?

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A Very Merry UnBirthday to You, Not Me

By Tracey Minella

May 4th, 2011 at 12:00 am


Today’s my birthday. After 21, I stopped loving my birthday, but during the seemingly endless infertile years, it was an absolutely unbearable day. I much preferred my 364 un-birthdays.

Speaking of un-birthdays, I never understood or liked Alice in Wonderland and its twisted psycho LSD trip storyline.

In fact, the more I think of that story, the more I wonder if Alice was infertile.

Okay, so she wouldn’t likely have premature ovarian failure and be a donor egg recipient at her young age, but let’s examine the story in a new light.

What’s the fascination with the White Rabbit who is always complaining “I’m late!” Don’t those TTC desperately want to be “late”? It’s one of the first signs of being pregnant, after all. Plus there’s the March Hare, too. Why two rabbits? Aren’t they the universal symbol of fertility and unstoppable reproduction?

And what of the Caterpillar who constantly asks Alice “Whoooo are you?” Then, it’s reborn and metamorphoses into a beautiful butterfly, leaving Alice questioning herself and her purpose in the world. Don’t those TTC feel lost in the world?

How bout that Cheshire Cat taunting “We’re all mad”. Don’t those TTC sometimes feel like they’re losing their minds from the stress and conflicting emotions infertility dumps upon them?

And those nasty Flowers from the Golden Afternoon. All Alice wanted was to be beautiful like them and be part of their club. But those divas called her a weed and excluded her from their group. Doesn’t that remind you of fertile friends, the mean remarks of strangers, and longing to be included in the motherhood sorority?

Remember those fools Tweedle Dee and Tweedle Dum? Maybe they’re just the twins an infertile Alice dreams of having someday.

And who out there TTC doesn’t recognize the villainous Queen of Hearts? She’s the loud mouth, brazen mother-in-law. (Not that mine was like that…)

Like Alice, we move on relentlessly toward our goal, though confused and curious about the things we encounter along the way. And aren’t we like Alice with the fertility meds we take? She drinks from that strange bottle and eats weird cookies that make her tall as a house on minute and then small as a mouse the next. How crazy do our meds make us feel?

But the clincher for me is the Mad Hatter and his UN-birthday party. Nothing is worse for a woman TTC than celebrating her birthday each year and being reminded of being yet another day older and not yet pregnant. And of thinking that if you don’t get pregnant in the next twelve weeks, you’ll have another birthday to suffer through without a baby on your lap.

Yes, birthdays suck when you’re TTC. But someday that wish you make each year is going to come true. And someday there will be a little helper blowing out the ever-growing inferno on your cake. Keep the faith. Make the wish. Eat the cake.

When it gets here, I promise it’ll be a Zippity Do-Dah Day.

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