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Age and Fertility

By David Kreiner MD

February 2nd, 2015 at 4:23 pm

 

credit: photostock/free digital photos.net


You’ve heard the “Reproductive Bell” toll and may question “Is it real?”…

You see celebrities getting pregnant well into their 40’s and think “Then why can’t I?” So, is your reproductive clock as critical as modern doctors say?

I have come across fertility advice from non-physician practitioners, such as acupuncturists and Chinese herbalists, who encourage their patients to “question the Western dogma” when it comes to age and fertility. They claim the effect of aging and fertility is “exaggerated by the Medical profession and can be overcome with a shift in an individual’s health and lifestyle”.

Unfortunately, this advice comes without any cited research or statistics in support of it.  According to the Society of Assisted Reproductive Technology, as published on SART.org, a review of the 2012 national statistics, those most recently published of IVF cycles started, the age breakdown for IVF live birth rates are the following:

 

Age <35= 40.2%

 

Age 35-37=31.3%

 

Age 38-40=22.2%

 

Age 41-42=11.8%

 

Age >42=3.2%

 

It is true that a woman’s health and physiology gets worse as she gets older.  Some of these non- physician practitioners argue that perhaps if this can be improved then the diminishing fertility commonly seen with aging can be reversed. But though improving a woman’s general health may help it is not sufficient in most cases.  Fertility rates decrease with increasing age in large part because there is an increase in genetic abnormalities found in gametes (eggs and sperm) as patients (women in particular) age.  This is the result of long-term environmental exposure to toxins, in addition to the increased likelihood of genetic damage over time.  Miscarriage rates increase with age for the same reason in large part due to the greater likelihood of embryos having chromosomal abnormalities.

Many women as they age also will experience a significant drop in their ovarian activity, referred to as diminished ovarian reserve.  This activity can be assessed by your physician with a blood level of Anti Mullerian Hormone (AMH) and day 3 FSH and estradiol levels.  Women with lower AMH levels and elevated FSH in the presence of a normal low estradiol have fewer ovarian follicles, and hence eggs, that will respond to ovarian stimulation.  Since the likelihood of these eggs being genetically normal is less, then fertility is reduced and the probability of IVF and other fertility treatments resulting in a live birth becomes significantly lower.

The challenge to any practitioner dealing with an aging patient attempting to conceive is to optimize their patient’s chance to have a healthy baby which optimally would include an integration of multiple modalities.  Therefore, ideally a physician specially trained in the fertility process (a Reproductive Endocrinologist), should implement state-of-the-art Western therapies with a complementary holistic approach that aims to shift their patient’s health and fertility.  These holistic approaches include diet and lifestyle changes as well as fertility-directed acupuncture and herbal therapy treatments.

Lifestyle changes that may improve fertility primarily include those that reduce stress and improve diet and activity.  Stress at work, at home, and with family and friends can create pathology from both Eastern and Western perspectives.  Diets that do not support adequate blood production or create Eastern patterns of cold or heat can affect fertility.  Excesses or deficiencies of particular foods…such as dairy, fat, or grains… can create imbalances or pathology that may affect fertility or result in obesity or malnutrition which also impact reproduction.

Inactivity may impair fertility. Therefore some level of exercise, combined with an improved diet directed at improving fertility, stress reduction techniques, acupuncture, and supplements (which may include Chinese Herbs as well as Western supplements) will optimize your chances of successfully building your family.

The first step is to seek help from a reproductive endocrinologist skilled in state-of-the-art fertility therapies who can coordinate a program which is ideal for you. But if you are hearing the “Reproductive Bell” tolling, it is important to take that first step soon, because, while these many complementary approaches can optimize your fertility, they may not be enough to overcome the reality of the negative effect of advanced age in fertility.

Long Island IVF offers complementary holistic approaches to achieving pregnancy (See our Mind-Body Program http://www.longislandivf.com/mind_body.cfm ) as well as a well-respected Donor Egg Program http://www.longislandivf.com/donor_programs.cfm  with no wait for pre-screened, multi-ethnic donor eggs, or Donor Embryos.

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Has the increased visibility of older celebrity moms getting pregnant made you think you have more time? Have you considered combining Western and Eastern medicine in your family-building treatment?

 

 

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Choosing a Fertility Clinic: The Importance of Being an Educated Consumer

By David Kreiner MD and Eva Schenkman MS CLT TS

September 9th, 2013 at 9:16 am

 

image courtesy of Ambro/free digital photos.net

In-Vitro Fertilization (“IVF”) offers the highest chance for success of any fertility treatment.

Pregnancy rates for IVF have improved dramatically over the years. In 1989, the national delivery rate was only 14%… by 2011, it had increased to 30%. To put this in perspective, the pregnancy rate of couples with proven fertility is approximately 20% per cycle. So while 30% nationally may sound low, it is greater than the average fertile couple will have in any given cycle.

In 2011, Long Island IVF had a 40% live birth rate per retrieval for the 303 patients under 43 years of age.

There have been many advances in IVF technologies over the years, including embryo culture media and environment, improved laboratory air quality, improvements in embryo transfer technique and ultrasound visualization of transfer catheter placement, and advances in fertility medication.  The skills and experience of reproductive endocrinologists and their cycle management, coupled with the highly-skilled and experienced embryologists, have improved IVF success rates significantly.

When investigating prospective IVF clinics, the delivery rate or “take home baby” rate as it is known, is really the only true measure of success. As a patient, you should be aware that many clinics define success in different ways. This may include defining success as a positive pregnancy test or any pregnancy, even miscarriages and ectopic pregnancies. While to a clinic, these numbers may serve as important quality indicators to the patient desiring a baby these successes are irrelevant.

Pregnancy and birth rates from IVF procedures are subject to influences that may vary significantly from clinic to clinic, making success rate comparisons between clinics very troublesome for consumers. These differences between clinics may be explained by a variety of factors that impact a patient’s fertility potential.  Such variables as infertility diagnosis, age of patients, rejecting patients with prior failed cycles and a program’s threshold for performing IVF on patients with diminished ovarian reserve will impact reported success rates..  Cycle cancellation policies and the number of embryos the clinic is willing to transfer likewise will significantly affect reported success rates.

In most cases, these differences reflect the philosophies and clinical practices of the physicians, and are not sinister or purposefully deceptive manipulations. Nonetheless, consumers need to be aware of these differences when comparing success rates, and also, put success rates in perspective when choosing a clinic. Success rates among clinics can vary greatly, so consumers must be careful when investigating prospective programs. Even the Society for Assisted Reproductive Technologies (“SART”), the organization to which IVF practices report their pregnancy rates, cautions consumers that IVF success rate data should “not be used for comparing clinics.”

Given this complexity to interpreting pregnancy rates, how should patients choose a clinic?  Most important, and potentially evident to the prospective patient, is the level of experience and expertise of the physicians and embryologists in the program.  Furthermore, IVF labs that rely on per diem staff that is unable to monitor and manage the embryology laboratory on a daily basis may lead to deficiencies in quality and consistency which may be another potential cause of lower success rates.  

It is important to look at several years’ worth of data rather than just how a clinic performed in one year. If a clinic consistently under- performs, patients need to think strongly before entrusting their eggs in its care.

While IVF success can vary with many factors, the biggest determining factor of success is maternal age. Success rates will decline with a woman’s age, and they drop off dramatically after about age 37. Age can affect both egg quantity and egg quality. While there is no test to assess egg quality, there are tests that can be performed to assess egg quantity. These include:

·                     Day 3 FSH testing

·                     AMH Levels

·                     Antral follicle counts.

The following table shows pregnancy rate, live birth and singleton rates nationally for 2010. This data clearly shows the impact of advancing maternal age on IVF success. As you can see, the curve starts to drop about age 28. It drops faster at about age 34 and even more startling drop after age 38.


*   The dark blue line (triangles) shows pregnancy rates per cycle by age

*   The red line (circles) shows live birth rates per cycle by age

*   The rate of singleton live births per cycle is shown by the green line
*   The difference between “pregnancy” rate and “live birth” rate is due to miscarriages

In this table, the IVF live birth rates per cycle started for different age groups (circled in red). Percent of IVF cycles resulting in egg retrieval, an embryo transfer & a pregnancy are also shown.

              At Long Island IVF, the total combined years of experience of our Senior Embryology team is over 100 years. Most of our Senior Embryologists hold advanced degrees in their field. Our Laboratory Director holds a PhD degree and is certified by both NYS and the American Board of Bioanalysts as a High Complexity Laboratory Director.

             Long Island IVF achieved Long Island’s first successful IVF leading to the birth of a baby in 1988.  Since then, with advances in technology and experience, success rates have skyrocketed.

            At Long Island IVF, from the most recent birth rates available (IVF performed in 2011), patients under 35 had a 51% live birth rate (59 live births/116 retrievals).  As of the summer of 2013 an additional 20 patients achieved live births as a result of 50 transfers from embryos frozen at the time of their 2011 retrieval (40%).  This cumulative success rate from 2011 retrievals as of August 2011 was 68.1% (79 live births/116 retrievals).           

            Not all clinics are created equal and as the consumer you really need to do your homework to find the clinic with excellent success rates that offers the expertise needed to give you the best chance of achieving your dream and bringing that baby home. Do not be too shy to ask the tough questions about not only the physician but the lab.

            The message here is to do your research on all clinics in your area, schedule a consult with several different clinics, and pick the clinic that best fits your needs.

 

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What is/was the most important factor to you when choosing a fertility clinic?

 

Photos credit: Ambro http://www.freedigitalphotos.net/images/agree-terms.php?id=10029569

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