Unlike generations before us, women now have several options and many choose to delay starting a family until their 30’s and 40’s. While this is an alternative, it also presents challenges as fertility significantly declines with age. Therefore, it may take a longer time and require more medical intervention before she conceives.
It is recommended that women seek treatment promptly if there are possible contributing factors such as endometriosis, fibroids, or irregular periods. Women without a specific problem who are or over 35, should seek fertility treatment if they have not conceived after 6 months of unprotected intercourse. Besides evaluating general reproductive health, a woman’s ovarian reserve (number and health of remaining eggs in the ovaries) can be evaluated as well. Each woman is born with a finite number of eggs that decline over time and tests can determine the potential remaining reserve. One commonly used test is the FSH (follicle stimulating hormone) test done on day 2 or 3 of the menstrual cycle. If the result is elevated, it indicates that conception will be difficult with in vitro fertilization and the risk of miscarriage may increase. Another test, the Clomiphene Citrate Challenge Test, is also used and the FSH and estradiol levels are tested on day 3, clomiphene pills are taken day 5-9, and another FSH level is taken on day 10. Elevated levels of FSH levels on either day 3 or day 10 again will indicate that conception will be difficult. Your physician will explain specific numbers and thresholds, as each lab may have different levels.
There is no way to reverse the effects of the aging process on eggs, but treatments such as ovulation induction and IVF can increase the chances of a successful pregnancy. For those whose ovarian reserve shows that conception may be difficult, alternatives include donor eggs or adoption.
If you have questions or concerns about being able to start your family, please contact us to discuss your reproductive health and options.