Menopause Mondays: Women’s Fertility and the Biological Clock
New Girl has got me thinking: Where have all the good eggs gone? During a recent episode, Sadie, the show’s “friendly neighborhood gynecologist,” broke the news that a woman can lose up to 90 percent of her eggs by age 30. Jess (and I!) had a little more than a minor freak-out. Very funny, FOX. Isn’t this supposed to be a sitcom? While I’m past my baby-making days (and probably so are many of you), our lives are full of young women—our sisters, daughters, and friends—who we want to experience the same joy in raising children that we did in raising them. It’s up to us to make sure they have the know-how to make that happen.
Well, there is good news and there is bad news. First, the bad news: About 95 percent of 30-year-old women have only 12 percent of their original number of ovarian follicular cells, which can develop into eggs. And at 40, only 3 percent of the cells remain, according to research from the University of Edinburgh. Now, the good news: The research says that before birth, females have roughly 600,000 cells. That means that even if you lose 88 percent of them by the time you blow out 30 candles, you can still celebrate having 72,000 cells left. While it’s easiest for women to become pregnant before age 35, all egg-laying ovaries are not created equal, says David B. Smotrich, MD, a Diplomate of the American Board of Obstetrics and Gynecology specializing in Reproductive Endocrinology and Fertility. During your early 30s, your eggs can decline in quality and you might begin ovulating less frequently, even if you are having regular periods, Smotrich says. A 30-year-old woman has a 20 percent chance of getting pregnant per cycle, but by the time she’s 40, her odds drop to 5 percent per cycle, according to the American Society for Reproductive Medicine. That’s where some newfangled fertility tests come in. Yep, Jess and Cece aren’t the only women getting their test on.
If you plan to have a baby in the great “someday,” Smotrich recommends treating yourself to a baseline exam or two for your 30th birthday. Follow up with yearly tests until age 35, semi-annual tests (I suggest you time them with the Victoria’s Secret semi-annual sales!) until 39, and quarterly tests thereafter to monitor your fertility, he says.
Here are some of your fertility-testing options:
Follicle-Stimulating Hormone (FSH) Test A blood test that measures your body’s levels of follicle-stimulating hormones, which control your menstrual cycle and your production of eggs, he says.
25-Hydroxy Vitamin D Test A blood test that determines if your body is deficient in calcidiol, your body’s main form of stored vitamin D. Calcidiol levels generally decline with age, and deficiencies can predispose your baby to health complications, according to Smotrich.
Estradiol Test A blood test that measures the amount of a hormone called estradiol in your blood. Estradiol is a form of estrogen that is largely made in and released from the ovaries, adrenal cortex, and the placenta, which forms during pregnancy to feed a developing baby, he says.
Anti-Mullerian Hormone (AMH) Test A blood test that estimates the number of the eggs in the ovaries, according to Smotrich.
Running out of eggs—and time? Medical interventions can help women older than 35 conceive. During in vitro fertilization, for instance, eggs are harvested from your ovaries, frozen unfertilized, and stored for later use. Your eggs can then be thawed, combined with sperm in a lab, and implanted in your uterus. In women ages 35 and younger who undergo up to six cycles of in vitro fertilization therapy, the live-birth rate ranges from 65 to 86 percent. Women ages 40 and older have half the chance of giving birth from in vitro therapy, with their rate ranging from 23 to 42 percent, according to an analysis of more than 6,000 patients published in The New England Journal of Medicine. The procedure typically costs about $10,000 per cycle, according to Smotrich.
During perimenopause, it is possible to conceive a healthy baby, while at the same transitioning to menopause, he says. However, since the risk of chromosomal complications increases with the mother’s age, Smotrich recommends women older than age 35 talk to their doctor about having their developing baby monitored for chromosomal conditions including Down syndrome. Tests include anuchal scan, a type of ultrasound, and amniocentesis, also referred to as amniotic fluid test or AFT, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled, he says.
While men experience a drop in fertility after age 50, mom’s age is the most important one in terms of conceiving, according to Smotrich. Still, older men have increased levels of sperm DNA instability, which is linked with a higher risk of autism and schizophrenia in children, according to Eric J. Topol, MD, Professor of Genomics at The Scripps Research Institute and author of The Creative Destruction of Medicine.
Our baby makers don’t work forever. Thank goodness. Can you imagine if they did? But if we keep an eye on our fertility clock, we can help make sure that when our lives are ready for pregnancy, childproofing, and dirty little handprints all over our walls (and our hearts), so are our bodies. If you are more in the grandma stage of life than the mom stage, share this information with the young women in your life who are in their childbearing years. It is up to us to help educate the younger generation so they can someday have the families of their dreams.
Suffering in silence is OUT! Reaching out is IN!