Infertility

It is not uncommon to have trouble becoming pregnant or to experience infertility.  Infertility is defined as not being able to become pregnant, despite trying for one year, in women under age 35, or after six months in women 35 and over. Pregnancy is the result of a chain of events:   A woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg (embryo) must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

Reasons for Infertility

Age

There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30s and 40s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s.  And while many women in their 30s have no problems getting pregnant,  50% of women in their late 30’s and beyond will seek fertility treatment.  As a general rule,  fertility especially declines after age 35.

As a woman ages, there are normal changes that occur in her ovaries and eggs. All women are born with over a million eggs in their ovaries (all the eggs that they will ever have), but only have about 400,000 left by puberty.  Then of these, only about 400 eggs will be ovulated during the reproductive years.  Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality.

 Ovarian reserve is the number and quality of eggs in your ovaries and how well the ovarian follicles respond to hormones in your body. As you approach menopause, your ovaries don't respond as well to your hormones, and in time they may not release an egg each month. A reduced ovarian reserve is natural as a woman ages, but young women might have reduced ovarian reserves due to smoking, a prior surgery on their ovaries, or a family history of early menopause.  Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down Syndrome.  Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage (early pregnancy loss).