Age-related infertility

Dr Piya Roy, Consultant Gynaecologist and Obstetrician, AMRI – Mukundapur, Kolkata, elaborates on how woman’s age affects the success rates during infertility treatments

In today’s society, age-related infertility is becoming more common as many women wait till their 30s to begin their families. Juggling a career with the needs of biological propagation is indeed difficult. The best reproductive years are lost in the struggle for an education and an income. When you feel that you are ready, your biological clock is not ready for you. Each month valuable eggs are lost as you fail to get the timing right. Frustration mounts, peer pressure increases and depression sets in. It leads to the first visit to the doctor. What are your chances? Is the battle worth fighting?

Each month, a healthy, fertile 30-year-old woman has a 20 per cent chance of getting pregnant. This means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. By age 40, a woman’s chance is less than fve per cent per cycle, so fewer than five out of every 100 women are expected to be successful each month.

With the advent of technology, one can bank on infertility treatments to support the cause. But contrary to popular belief a woman’s age affects the success rates of infertility treatments as well. For a women over 40, the success rate of ovulation induction or intrauterine insemination is generally less than five per cent per cycle. This compares to success rates of around 10 per cent for women from 35 to 40. IVF is more effective but also has relatively low success rates in women of 40 and older, and generally less than 20 per cent per cycle

As one grows older there is a steady decline in the quality and the quantity of eggs. These changes are mainly noted in the mid-to-late 30s. An important change in egg quality is the frequency of genetic abnormalities called aneuploidy. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriages. This helps explain the lower chance of pregnancy and higher chance of miscarriage in older women. The decreasing quantity of egg-containing follicles in the ovaries is called ‘loss of ovarian reserve.’ Women begin to lose ovarian reserve before they become infertile and before they stop having regular periods

When a woman especially over 42 have not succeeded with other therapies, or have premature ovarian failure (POF), also known as early menopause, the treatment options are limited. Egg donation, which involves the use of eggs donated by another woman who is typically in her 20s or early 30s, is highly successful. The high success rate with egg donation confirms that egg quality associated with age is the primary barrier to pregnancy in older women. If you are over 40, your chance of successful pregnancy is much higher in IVF cycles using donor eggs, but many couples or single women in their early 40s will choose to accept the lower chance of becoming pregnant and use their own eggs. By 43, chances of becoming pregnant through IVF is less than five per cent, and by age 45, use of donor eggs is the only reasonable alternative.

When the age is over 35, getting pregnant is like a military expedition. The key to success is careful planning and organisation with stepwise timed implementation without panicking and leaving the fray midway. The mind controls will and the battle is not lost till the mind has given up. Age may be a handicap in the race but chances of winning is still there if the focus is on the right direction with proper guidance.