Age and infertility

Age of female partner is an important factor in fertility. As the age increases the chance of getting successful pregnancy and live birth decreases.
Ovarian reserve is aggregate of quantity and quality of oocyte. These parameters start declining long before the actual menopause. The declining ovarian reserve can vary but in majority the decline starts around the age of 35 and a steep fall is seen after the age of 39years and on.
The decreases can be attributed to the reduction in the ovarian reserve, which is due to the decrease in the number and quality of primordial follicle pool. The primordial follicles are around 1-2 million at birth, which falls to 250,000 at menarche; this loss is sharp after the age of 37-38years.The ability of the ovary to respond to gonadotropin stimulation is central to success in achieving pregnancy.
The natural rate of loss are determined genetically and has familial tendency, it also depends on what was the original pool size. The rate of loss can be accelerated in following conditions/disease process; Ovarian auto immunity, diabetes, endometriosis, smokers, repeated pelvic infections, Radiation, chemotherapy and few drugs.
The age and regularity of menstrual cycle is unreliable indicator in predicting the ovarian response to stimulation and having successful pregnancy.

Why is age so important???? 

There is age related decline in stimulation with Gonadotropins the reason being:

  • Reduction in number of oocyte
  • Fall in the quality of available oocyte
  • Decrease in the fertilization rate and consequently lower number of available embryos.
  • Poor embryos/chromosomally abnormal embryos.
Female age is one infertility factor that one can do little to combat without resorting to using donor eggs.
The other alternative approaches are:
  • Early cessation of GnRH a
  • Use of antagonist
  • Use of aromatase inhibitor
  • ?use of growth hormone