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Treating Infertility in Older Women

By: Ian Murnaghan BSc (hons), MSc - Updated: 10 May 2010 | comments*Discuss
Fertility Menopause Older Women Young

While the term 'older women' might make us think of the elderly, when it comes to fertility this age is a much younger one. Those who work in the field of fertility and women's health usually consider women who are more than thirty-five years old to be older.

Understanding Your Fertility

Even though we have some values assigned to when a woman is likely to start experiencing reduced fertility, it is still very much an individual thing. There is no one number or age range that is true for every woman when it comes to her fertility.

But overall, most women can expect that their fertility begins to decline after age thirty. Once a woman is thirty-five years old, this decline tends to be a larger one and for a woman in her 40s, becoming pregnant is almost always more challenging than it is for a younger woman. In particular, a woman who has begun to experience menopause symptoms will likely find it very difficult to become pregnant, although it is still possible.

Why Does Fertility Decline?

When the topic of fertility comes up, some people tend to picture a woman's organs such as her uterus failing. This, however, is not quite the case. You are born with all of the eggs you will have in your lifetime. As you get older, this number diminishes.

What it means is that your ovarian reserve continues to deplete. The reserve will vary from one woman to another. As such, even if your age is only thirty, for instance, in biological terms you may be older.

Issues in Older Women

Even where an older woman wants to conceive, there are still issues she needs to bear in mind. The risk of having a baby with birth defects is higher in older women. This is primarily because ageing eggs are more likely to have chromosomal errors. Fortunately, screening today is quite advanced and can often detect these errors prior to birth.

An older woman will also have a higher risk of complications, both during the pregnancy and the childbirth. Older women don't always show a good response to ovarian stimulation and any treatment in this fashion won't have a high pregnancy rate.

In Vitro Fertilisation (IVF)

IVF is a procedure that involves fertilising a woman's eggs with sperm outside of the womb. Hormones are used to control the ovulation process and after, the eggs are removed from the woman's ovaries. These eggs are then fertilised with sperm within the laboratory. The fertilised egg is transferred to the woman's uterus with the aim of her successfully becoming pregnant.

The treatment is aimed at couples where there is a difficulty in the egg being fertilised by the sperm. This could be due to any number of reasons such as a blockage or problem with the fallopian tubes. While some older women do find success with IVF, it is still more difficult than in younger women. Older women have fewer eggs and may not respond as well to ovarian stimulation. Pregnancy rates are generally lower than those in younger women.

Hormones and Other Therapies

If an older woman continues to show a weak ovarian response, there are some approaches that can help her produce more eggs. Certain growth hormones can be used although there is debate over their efficacy.

Donor Eggs or Embryos

For older women whose eggs are not viable, there is also the option of using a donor egg or a donor embryo. There are some ethical issues around this option but where all parties are fully informed and in agreement, it can be a positive experience.

The unfortunate aspect of this approach is that it has become somewhat commercialised in some parts of the world. This has made the ethical aspect more contentious. Some people feel that adverts are inappropriately encouraging young women to 'sell' their eggs. The procedure for harvesting the eggs is not without risks and should not be taken lightly.

Egg Banking

Although egg banking still does not show the same effectiveness as sperm banking, it is a promising area of research. At present, scientists are examining better ways to preserve and store a woman's eggs to ensure they are viable in the future. This would mean that a woman could store her eggs when she is still young but then use them later when she is ready to start a family.

Improving Fertility

It is unfortunate for many women that it is only in their older years that they feel financially and emotionally ready to have a family. A focus on career, their partner and other aspects of life in the younger years can mean that an older woman is in an excellent place to raise a child.

The reality, however, is that biologically speaking there are many challenges that can present themselves when older women – particularly those already experiencing menopause symptoms – want to have children. Fortunately, there are options and it is hoped that further research will continue to explore new and better ways to improve fertility in older women.

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