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Reproductive Health

Fertility and Age: What’s the deal?

by DR. LORIANA SOMA, EXPERT OB/GYN

More women than ever are delaying having kids as they pursue their careers and other passions. But, when they are ready to have children, women are worried about their fertility and having trouble getting pregnant. Yes, fertility does decline with age, however; many women still have successful pregnancies at later ages. Education around fertility can help women make more informed family planning decisions, and know when it’s time to ask for help. 

How does age affect fertility?

  • Women are born with all the eggs they will ever have. As they age, the number of eggs decreases. At birth, most women have 1-2 million eggs in the ovaries. At age 37, that number drops to 25,000 and by age 51 (the average age of menopause) most women have about 1,000 eggs. 
  • As the number of eggs declines, so does the quality. Egg donation from a younger woman often helps older women carry successful pregnancies. 
  • As women age, their hormone balance changes and their risk of disorders that contribute to fertility issues increases. These include fibroids, endometriosis, and fallopian tube issues.

At what age does fertility start to decline?

  • Fertility starts to decline around age 32 and decreases more rapidly after age 37

Factors that can hurt fertility

  • Smoking, both for men and women 
  • Being overweight or obese 
  • Moderate to heavy alcohol consumption (> 2 drinks/day)
  • History of sexually transmitted infections like gonorrhea or chlamydia
  • History of endometriosis

Factors that do not hurt fertility

  • Previous use of hormonal birth control, like the pill, IUDs, Nexplanon, etc. Depo provera shots, however, affect menstrual cycles for a longer time and may delay the return of fertility
  • Diet
  • Drinking caffeine (1-2 cups of coffee per day) 

When should you see a doctor about your fertility?

  • Under age 35, after trying to conceive for 12 months
  • Over age 35, after trying to conceive for 6 months
  • Over age 40, evaluation and treatment is appropriate before or shortly after you start trying to conceive
  • If you have other specific issues, like no periods, or very irregular periods, or a history of ovarian or tubal surgeries 

What kind of doctor should you see for fertility issues?

You can start with a general OB/GYN for your initial workup and evaluation, and often treatment too. Blood work, semen analysis for your partner, and imaging to evaluate your fallopian tubes are routinely checked with an OB/GYN. For more complicated medical or gynecologic history, you may need to see an infertility specialist, REI doctor (Reproductive Endocrinology and Infertility). You can make an appointment with an REI doctor on your own, without a referral, but keep in mind the guidelines above. It’s also important to check with your insurance company before you get started. The consultation, evaluation, and treatment of infertility are often not covered and can be very expensive. 


REFERENCES

  1. American College of Obstetricians and Gynecologists (2014, March). Female Age-Related Fertility Decline. Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Female-Age-Related-Fertility-Decline