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Saturday, July 20, 2019
Michelle Catenacci is an Infertility Specialist and IVF Doctor, Advanced Fertility Center of Chicago
CHICAGO, Jun 18 2018 (IPS) - Fertility health is an incredibly personal – and often vulnerable – topic. Fertility, infertility, and fertility preservation have gained increased public interest over the past few years. Infertility is formally defined as the inability to achieve pregnancy after one year of unprotected intercourse.
The Centers for Disease Control and Prevention (CDC) reports that approximately 12% of women aged 15 to 44 in the United States have difficulty getting pregnant or carrying a pregnancy to term. Even though a significant proportion of the population suffers from the challenges associated with infertility, awareness of these challenges has historically been limited, as many regarded fertility to be a “taboo” topic.
More recently (thankfully!), couples have become more and more open about their fertility struggles. Stories are being shared on social media, celebrities are discussing their experiences, and physicians are starting the dialogue with their patients about fertility health. This has led to increased “fertility awareness” and a more proactive approach to treating and preventing infertility.
Women experience an age-related fertility decline that impacts both quantity and quality of eggs. Infertility and miscarriage rates also generally increase as women age. Although egg quality is more difficult to decipher, we do have some testing that to look at egg quanitiy, or ovarian reserve.
With regard to egg quantity: unlike men, who produce new sperm throughout their lifetime, women are born with a fixed number of eggs. This pre-set number declines steadily as women age. A woman’s exact egg supply and her rate of egg depletion are unique to each woman and are likely related to her genetics. Environmental factors, such as smoking, have been shown to deleteriously affect egg quantity as well.
A physician can get a general sense of a women’s egg quantity, or ovarian reserve, through various hormonal tests and an ultrasound evaluation. Women will typically get blood test to measure a day three estrogen and FSH (follicle stimulating hormone). FSH is the brain’s stimulating hormone for the ovaries.
As the egg supply decreases, the brain has to work harder to produce an egg, and thus we see an elevation in FSH levels. Another hormone frequently checked is AMH (Anti-Mullerian Hormone). AMH is secreted from small follicles in the ovary. Lower AMH numbers indicate a lower number of follicles.
A pelvic ultrasound is also frequently used to assess egg quantity by measuring the antral follicle count (2-9 mm follicles in the ovary), which also typically decreases with age. Having lower egg reserve does not necessarily cause infertility; however, it can make treating infertility more difficult as women with lower reserve tend not to respond as robustly to the stimulating medications used by fertility specialists to promote egg production.
Many women are now requesting fertility evaluations, even when they are not actively trying to become pregnant. These women may be considering fertility preservation techniques and want to see what their current ovarian status is, or they may simply wish to learn more about their reproductive health.
Although getting your ovarian reserve tested when not trying to get pregnant will usually not tell you for certain whether or not you will eventually have difficulty getting pregnant, these tests can provide some insights to prepare for possible future struggles.
Women who are concerned about their future fertility health may elect to undergo an egg freezing cycle to be used in the future, just in case they do have difficult conceiving. Fertility preservation via egg freezing had previously been recommended primarily for cancer patients, however in 2013, the American Society of Reproductive Medicine opened up this option for anyone wishing to preserve fertility.
Egg freezing for fertility preservation has been growing over the past several years due to increased fertility awareness, decreasing costs, and even insurance coverage. The Society for Assisted Reproductive Technology reports that in 2016, 3.7% of the 237,385 Assisted Reproductive Technologies cycles done in the United States were for egg freezing for fertility preservation and they expect this number to continue to rise.
Ideally, women should be freezing their eggs in their 20s or early 30s when egg quantity and quality are superior, but women of any age may elect this option after appropriate counseling.
As women gain a better understanding of their fertility health, more and more women have chosen to undergo egg freezing cycles to preserve their fertility or “stop the biological clock”. Although no procedure can guarantee a baby, improved egg freezing techniques have dramatically increased the success rates seen by women having babies from frozen eggs.
This has given women more options and the flexibility to build a family using their own eggs on their own timeline. Women interested in learning more about their reproductive health should contact a reproductive endocrinologist to receive fertility testing and interpret results to assess overall fertility health.
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