Declining fertility with age
Several studies of populations that don't use any contraception have shown a clear decrease in fertility with age. In addition to lower pregnancy rates, the rates for miscarriage and having a baby with a genetic problem such as Down's Syndrome increase with a woman's age. This is a concern, as many couples are delaying childbearing and are facing difficulties conceiving.
How does age affect reproduction?
There are several factors that contribute to reduced fertility with age. As men age, there is a modest decrease in sperm counts, though it usually remains within the normal range. Men have established pregnancies well into their 70s and 80s.
The frequency of intercourse also tends to decline with age, but studies of women undergoing artificial insemination with donor sperm still showed reduced pregnancy rates with age.
By far, the most significant factor affecting fertility is the age of a woman's eggs. Older women have a poorer response to stimulation with fertility drugs. The older eggs have a greater chance of being genetically abnormal, decreasing the possibility that the fertilized egg (embryo) will implant in the uterus (womb). A genetically abnormal embryo will usually be miscarried or, if carried to term, will result in a child with birth defects. Since there is no way to correct these genetic problems, the decreased pregnancy rates and increased risks of miscarriage and birth defects persist with all treatments for infertility in older women.
What treatment options are available for older infertility patients?
The basic evaluation and treatment of infertility is the same, regardless of age, in most cases. A semen analysis checks the number, shape and motility of the sperm. A hysterosalpingogram (HSG or X-ray dye test) evaluates the shape of the uterine cavity and whether the fallopian tubes are open. Blood hormone levels assess whether ovulation is normal and if menopause is approaching. An elevated follicle stimulating hormone (FSH) level indicates diminished ovarian reserve and impending menopause. The prognosis for success in these patients is very poor.
Treatment of the specific infertility problems is the same as for younger women, including in vitro fertilization (IVF), but the pregnancy rates are roughly half and the miscarriage rates double. The success rates and advantages and disadvantages of each treatment option are presented to the patients so that they can make an informed decision regarding their care.
Will IVF with donor eggs help?
When standard infertility treatments fail, when the FSH level is elevated, or if patients feel that the disadvantages of the treatment outweigh their chance for success, IVF with donor eggs may be considered. In this case, eggs from a younger woman are collected and fertilized in a dish with sperm from the older woman's partner. The resulting embryos are placed into the uterus of the older woman. The patient then has the same pregnancy, miscarriage and birth defect rates as the younger donor.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health This document was last reviewed on: 1/10/2002
The Cleveland Clinic 2004
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