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A female fetus maximizes its egg number (6 million) half way through the pregnancy. By the time that she is born only 1 million remain. Egg release starts during puberty at which time less than one half million eggs remain. At menopause 30-40 years later egg maturation ceases.
During reproductive life egg loss is continual and not affected by birth control pills, pregnancy or breast feeding. Chemo-therapy, radiation therapy, cigarette smoking, rare ovarian infections and some medical conditions can lead to precipitus egg loss. However, for most women the length of their reproductive life is predetermined by the number of eggs deposited during fetal life.
Not only are the eggs laid down during fetal development, but they arrest at a critical point, not fully maturing until ovulation, decades later. This make the eggs prone to insult with advancing time. For this reason, women further in their reproductive life are more apt to yield chromosomally abnormal eggs than women early in their reproductive life.
By age 25, a women’s fertility potential peaks holding steady up until age 30. Beyond age 30 it begins to decline, initially gradually, then picking up beyond age 35 so that by age 38, her chances of conceiving are roughly 33% reduced from her peak. By age 40 her fertility potential is at least half of what it was at peak. Along these lines, with age, the risk of miscarriage or birthing a child with a chromosomal abnormality is increased. Fifty percent of clinically recognized pregnancies conceived by women 45 years of age will miscarry and 1/42 babies delivered to women at age 42 will have a chromosomal abnormality like Down Syndrome.
With age, a women is more likely to develop endometriosis, uterine polyp and fibroids. However, the most significant contributor to the reduction in fertility is a loss of egg with time. This egg loss results in a reduction in ovulatory cycles and a lower likelihood of fertilization.
Several tests have been devised in an attempt to identify women who have deficient egg numbers independent of their age. Other than IVF these are all indirect tests and include the Day 3 FSH level, day 3 estradiol level, day 3 inhibin B level, clomiphen citrate challenge test, gonadotropin stimulation test and GnRH stimulation test. These tests are open to broad interpretation and are specific to the center at which they are performed. Unfortunately, they are frequently used as a single determinant to exclude couples from treatment, despite the fact that their predictive value is very limited. Your doctor may order one of these tests in an attempt to help you decide on the treatment that serves your needs. We will allow you to decide.
Your age may encourage your physician to offer more or less aggressive treatment options. For those more advanced in their reproductive age, delaying aggressive treatment may lead to a loss of their advantage.
