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Are you trying to have a baby after forty and seeing all these celebrities pregnant? So why are you having so much trouble conceiving?
Well, the media is really good at showing us pictures of their beautiful babies, but their story of how they conceived is not always open to the public. Here are the secrets of conception after forty. According to the American Society for Reproductive Medicine (ASRM), the chance of conceiving naturally after 40 years of age is only about 5 percent per month.
For women ages 40 to 44, 29 percent are infertile, compared to only 15 percent of women ages 30 to 34 and 7 percent of women ages 20 to 24. Not only is it harder to get pregnant after forty, but it is also harder to stay pregnant. Data from the ASRM suggests that miscarriage rates for women over forty is 34 – 53% compared to their younger counterparts at 10% (20- 24 years old) and 12% (30 – 34 years old).
We all know that 40 is the new 30, however, ovarian function continues to decline with age. As we age, follicle stimulating hormone (FSH) level tends to rise and we are much more likely to have chromosomally abnormal eggs that results in lower pregnancy rates. In fact, woman 40 years of age and older have a 1 in 106 chance of having a baby with Down Syndrome compared to a woman who is 35 who has a 1 in 378 chance.
It is important to get a full fertility work-up with a Reproductive Endocrinologist (RE) to find out your individual success rate if you are trying to conceive after 40. Your work-up will include an ovarian function assessment test, including follicle stimulating hormone (FSH), estradiol and perhaps an Antimullerian Hormone (AMH) level.
FSH is produced by the anterior pituitary gland and binds to receptors on the ovary to produce an egg every month. As an egg grows your ovary releases estradiol to thicken the uterine lining for implantation and tells your pituitary gland to stop producing FSH. This is called a negative feedback system. FSH levels are elevated when your FSH receptors on your ovary no longer bind to FSH thus inhibiting estradiol levels to rise.
AMH is expressed by cells (http://en NULL.wikipedia NULL.org/wiki/Granulosa_cells) in the ovary during the reproductive years, and controls the formation of eggs by inhibiting excessive follicular recruitment by FSH. AMH levels start to decline starting at 25 years and will become undetectable at menopause. Your RE will also order a hysterosalpingogram (HSG) test to ensure that your fallopian tubes are open and your uterine cavity is normal.
An HSG test is an X-ray test that involves an injection of contrast medium (dye) through the cervix into uterus that flows through the fallopian tubes (if they are open) into the abdominal cavity. A semen analysis on the male partner will also be required to make sure that the sperm is not impacting conception.
When is it time to entertain the idea of using an egg donor? Every RE is different in their recommendation for using a donor. This decision is made based on each patient’s individual needs, such as medical indication and emotional readiness. If you have a significantly elevated FSH and poor ovarian reserve, then your RE will recommend you to think about using an egg donor.
If you feel you are ready to explore egg donation, your RE will refer you to a number egg donor agencies. Once connected with an agency, you will be able to read about and view potential donors. Egg donation is most commonly anonymous, but if you donor is willing; you may choose to meet each other. You donor will undergo a rigorous screening with your RE to make sure she is healthy and fertile.
Legal contracts need to be signed between you and your donor and your donor must go through a psychological consult, physical exam and blood work. After all this is completed, you and your donor will need to put on birth control to match up your menstrual cycles to start the process of making eggs and preparing your uterus for an embryo transfer.
It is important to have realistic expectations of how our reproductive function in both men and women perform as we become older. Twenty to forty percent of women over 40 years of age are able to achieve pregnancy with help of assisted reproductive techniques (ART) using their own eggs. Sixty to Eighty percent of women over 40 years of age are able achieve pregnancy with the help of ART using donor eggs.
Egg donation increases pregnancy rates and allows women to experience pregnancy and child birth. This process is a journey and ultimately it doesn’t matter how you get to your destination whether it be spontaneous pregnancy, ART, egg donation or adoption. Best of luck to you and your partner on your journey!
Notes for this blog:
Dr. Boostanfar, MD., F.A.C.O.G., has special interests in assisted reproductive technologies and oocyte donation in women of advanced reproductive age, selective estrogen receptor modulator effects on infertility and extended release gonadotropin therapy for controlled ovarian hyperstimulation.
Currently practicing at HRC Fertility (http://www NULL.havingbabies NULL.com/) in California, Dr. Boostanfar graduated medical school from the University of Southern California in 1995, completing his residency in Obstetrics and Gynecology in 1999 and his fellowship in the Division of Reproductive Endocrinology and Infertility in 2002 at the University of Southern California, Los Angeles County Women’s and Children’s Hospital.
He is active in well-known professional organizations, including American Association of Gynecologic Laparoscopists, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, as well as the Pacific Coast Reproductive Society
During Dr. Boostanfar’s time at HRC Fertility, he has made multiple television appearances including Good Morning America, CNN, The Learning Channel as the resident doctor on TLC’s “The Little Couple”, KTLA, CBS and has been featured in People Magazine.
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