As promised, each Thursday, we will now offer you a piece of educational, science, or research related information. The purpose of our #ThursdayThoughts post is to share with you fact-based content that can enlighten and assist you on your fertility journey. Enjoy our post! Helping to Create New Beginnings…
Taking Control of My Own Fertility: Delayed Childbearing
Deciding on when is the right timing for childbearing can be a tough question to sort through for various reasons. Women delay their childbearing for many reasons including pursuit of career, financial status, current relationship status, medical reasons, and other circumstances that prohibit them from attempting pregnancy. What makes this decision even more difficult is the inevitable decline in fertility with increasing age. Age-related fertility decline is primarily related to poor oocyte quality and diminished ovarian reserve with which worsens as women get older. During the reproductive years, women progressively experience atresia or decrease in the number of oocytes in their reserve pool which occurs at a more accelerated rate after the age of 37. As the number of oocytes decline, the quality of oocytes also decreases, leading to higher rates of chromosomally abnormal embryos. Chromosomally abnormal embryos can yield higher rates of miscarriage and lower chances of pregnancy (Chung &Smith, 2020). According to the American College of Obstetricians and Gynecologists (2014), the percentage of IVF cycles that resulted in live birth was 41.5% in women younger than 35 years which significantly decreased by 5% in women aged 43-44 years and 1% for women older than 44 years. Fertility preservation can assist with cryopreserving oocytes or embryos at a younger age and increase the chance of pregnancy for patients who plan to delay childbearing.
Although there is no single factor in deciding who should be preserving their fertility, patients in the age 30 to 37 years are generally considered ideal candidates as they most likely have good quality oocytes to freeze and have higher probability of utilizing the frozen eggs in the near future. Women who are outside of the mentioned age group can also be considered as candidates. Their ovarian reserve markers and planned age for childbearing should be discussed with the fertility specialist. Markers of ovarian reserve include AMH concentration, antral follicle count, day 3 FSH and estradiol concentrations. Evaluations of each of these values help guide providers on how to counsel their patients during fertility consultations. In addition, the evaluation findings and the age a patient is planning to conceive are also deciding factors as to whether oocyte preservation is a good idea. Possible risks to oocyte preservation include ovarian hyperstimulation, bleeding, pain and infection. However, the probability of complications are generally low and patients are monitored very closely throughout the course of their treatment to prevent any complications. There is also a chance that number of oocytes retrieved may be low with one stimulation cycle, and multiple cycles may be recommended in order to increase the probability of pregnancy using the frozen eggs in the future. A survey that looked at women who underwent oocyte preservations between 2012 and 2016 reported that about 88 percent of the women felt increased control over their reproductive planning, and 89 percent stated they were happy with the decision even if the frozen eggs were never used (Chung & Smith, 2020).
ACOG. (2014). Female age-related fertility decline. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline#:%7E:text=The%20study%20found%20that%20pregnancy,older%20than%2035%20years%206
Chung, K., & Smith, M. (2020). Fertility preservation for deferred childbearing for nonmedical indications. UpToDate. https://www.uptodate.com/contents/fertility-preservation-for-deferred-childbearing-for-nonmedical-indications?search=fertility%20preservation&source=search_result&selectedTitle=2~88&usage_type=default&display_rank=2