Age and Reproduction

The providers at the Fertility Institute of Hawaii have researched, evaluated and treated women of advanced age with fertility concerns for several years. Most women with advanced age will need an aggressive infertility treatment regimen in order to have success. The Fertility Institute of Hawaii does not discriminate based on age. Instead, you will be given a very realistic assessment of your treatment options (to include In Vitro Fertilization (IVF)) and your potential for success.

Age plays an important role in a woman’s ability to become pregnant and carry a pregnancy to term. With advancing age, many biological changes take place that work against conceiving and carrying the pregnancy to term. From age 30 to 35, there is a gradual decline in the ability of women to become pregnant; after age 40, there is a sharp decline. Also, the chance of miscarriage and chromosomal abnormalities, such as those that cause Down’s Syndrome, increase with age. Even the success of in vitro fertilization and other similar procedures decrease with advancing age.

Why does age play such an important role in fertility? One reason is that as women age, they are less likely to ovulate regularly. In addition, they are more likely to have medical problems that can cause infertility, such as endometriosis. However, the more important reason relates to the condition and decreasing number of the woman’s eggs. As the eggs age, they become more resistant to fertilization. Also, more of the eggs tend to have chromosomal abnormalities – oftentimes, this may result in miscarriage.

Diagnostic tests for infertility associated with advanced age

Your evaluation is likely to begin with your medical history and a pelvic exam. However, other tests are needed to determine whether your age is affecting your fertility. You may need one or more of the following tests:

  • Follicle stimulating hormone (FSH) – a blood test that measures the amount of FSH in your blood; a high level of FSH in your blood in the beginning of your cycle may mean that your infertility is age related.
  • Estradiol – a blood test that measures the amount of estradiol (estrogen) in your blood; a high level in the beginning of your cycle may mean that your infertility is age related.
  • Anti-Mullerian Hormone (AMH) –  Anti-Mullerian Hormone (AMH) is a hormone produced by ovarian follicles and can be tested to check ovarian function via a simple blood test. AMH is one of the most accurate tests we currently have to evaluate the status of the ovaries and oocytes (eggs).  A low AMH level suggests diminished ovarian reserve and a lower chance of pregnancy.
  • Basal Antral Follicle Count (BAF) using transvaginal ultrasound–   A transvaginal ultrasound evaluation is very useful to look at the health status of the uterus, ovaries, and other structures in the pelvis.  The number of small follicles (basal antral follicles) seen on the ovaries can estimate ovarian reserve which correlates with the fertility status of the woman.

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