When you should consider a Fertility Test & Treatment – A Complete Guide
Seeking help as early as possible once you suspect there is a problem gives you and your doctor more time to consider all possible treatment alternatives including non-IVF modalities.
Many people I meet as fertility patients who ultimately require medical interventions, find out the information they really need to know quite late in their journey. This can mean that they embark on necessary treatment at a time where advancing age makes their problems even more difficult to overcome. For some, waiting too long to seek help can mean missing opportunities completely and closing doors.
80% of fertile couples conceive in 6 months and 90% by 12 months. After 1 year, your monthly chance of getting pregnant is statistically 5% and at 24 months/two years it’s 1%.
If you have been trying for a year and have not conceived, no matter your age it’s not normal and you need help. Sometimes the help you need can be relatively simple. Sometimes, it’s complicated and might take you on an IVF journey.
If you are over 35 and a woman and have tried to conceive for 6 months, both you and your partner should see a CREI fertility specialist immediately.
While the problem equally often lies with your male partner, finding out what your problems are and trying to fix them or get around them effectively takes time.
Seeking help as early as possible once you suspect there is a problem gives you and your doctor more time to consider all possible treatment alternatives including non-IVF modalities.
While this point is important for both men and women, when it is a couple seeking fertility, a woman’s fertility is much more time dependent.
AMH or Anti-Mullerian Hormone levels can be seen marketed as a Fertility Test which is not really true. AMH tells us about egg number not egg quality. You can have great numbers of eggs that are all of poor quality. You can have low numbers of eggs that are of great quality. The most important factor in fertility is age.
If you are getting older and thinking about egg freezing (best done around 30 or after that, as young as possible), don’t be reassured by a high or normal AMH. Normal level’s mean your ovaries and eggs are ok now (we should hope that they are). It doesn’t mean your fertility won’t decline naturally with age both in terms of egg numbers and more critically egg quality. Freezing eggs of high quality is how egg freezing helps women to “work the system” in terms of their biological clock and age related limits on human reproduction. Having a normal AMH at an older age is no protection against infertility.
Even in couples with no underlying fertility problems, who have conceived children naturally and easily, around 35 female age starts to play a major role. All females ultimately become totally infertile around 10 years before they experience menopause. The average age of menopause is 51 years, so the average age of losing your natural fertility is 41 years.
Between 35 and 40 years, fertility loss begins quickly. The reason for most women is not the fact that she is running out of eggs as many believe. The main reasons for fertility decline with female aging is egg quality and competence. In short, eggs start to make major mistakes meaning they can no longer make a normal embryo. Chromosome errors, known as aneuploidy become very common. These DNA problems are not inherited but happen spontaneously and sporadically during the normal early egg cell divisions important for the creation of genetic diversity among our children. In short, this is a normal process going wrong in the creation of an embryos instruction manual.
In older women, even in IVF, when egg and sperm unite, a significant proportion, then the majority, and eventually all of the embryos created are abnormal. No matter how fertile a woman was when she was younger. No matter how fit and healthy she may be in her 40’s.
This is an age where only the luckiest among women conceive with ease and most other struggle. At 40, 50 % of naturally conceived pregnancies will result in miscarriage (for the same reason of embryonic aneuploidy or DNA mistakes). Many women suffer multiple miscarriages when trying to conceive at this age or beyond.
Unfortunately even advanced fertility science has no direct tools to overcome this problem. We use IVF as a tol to create multiple embryos, which we can genetically profile via PGT (Preimplantation genetic testing). This technology can help us find DNA normal embryos with 23 chromosome pairs, otherwise known as euploid or NAD (No Abnormality Detected).
When starting a family late in life, choosing to go through a few IVF treatments to locate NAD embryos and freeze them will enhance your ability to have more than one baby over time.
The good news? We are lucky to live in this time where donor egg conception is possible via IVF. Using an egg from a young fertile women who gives the ultimate selfless gift of egg donation can overcome age related egg quality concerns in IVF. Egg donation helps many women over 40 conceive healthy children at an age when that is no longer possible using our own eggs.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.