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Archive for the ‘egg age and miscarriage’ tag

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?

 

 

http://www.freedigitalphotos.net/images/Younger_Women_g57-Young_Woman_Holding_Clock_p49428.html

 

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Infertility Podcast Series: Journey to the Crib: Chapter 12 What Do You Know About Your Fertility?

By David Kreiner MD

May 13th, 2013 at 8:16 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twelve: What Do You Know About Your Fertility? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=74

What do you know about your fertility?

Women have a biological clock.  Everyone knows that.  However, life seems to get in the way sometimes; whether it be school, career or failure to find Mr. Right.  Most people assume that if they are healthy then there should not be a problem conceiving.  Unfortunately, general health and fertility are not always related.

Women are born with their reproductive lifetime supply of eggs.  That means the body doesn’t produce new ones.  With each menstrual cycle one egg is released and an additional thousand eggs simply are lost in the body’s natural process of selecting one for ovulation.  As a woman approaches 50, she typically runs out of her store of eggs.

Additionally, there is the issue of the effect of aging on the eggs.  Older eggs are more likely to have chromosomal abnormalities making them unlikely to become viable embryos.  Fertilized eggs with abnormal chromosomes are the most common cause of miscarriages, running about 40% by age 40.

Furthermore, not everyone’s ovaries/eggs age at the same rate and again it is not necessarily reflective of how old you look either.  Often very young looking women have very old acting ovaries and eggs.  You can be screened to evaluate your fertility status with an ultrasound examination of your ovaries performed by an experienced reproductive endocrinologist as well as by blood hormone screening looking at your FSH, estradiol and AntiMullerian Hormone levels.

I urge every woman of reproductive age who has not completed her childbearing to be evaluated and make plans based on knowledge about her own fertility.  Aggressive fertility treatment might be needed depending on your age, how long you have been trying to conceive, and your fertility screening.  Women who do not have a partner should explore the possibility of freezing their eggs while the likelihood of them still being healthy is high.  Remember, fertility treatment has a high success rate that decreases significantly as time passes on the biological clock.

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Was this helpful in answering your questions about your fertility?

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

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