YOUR BIOLOGICAL WATCHES: MYTH OR REALITY?

24 September 20224′ read3 sections

CONTENTS

Ovarian Reserve
Treatment
Conclusion

Many women have heard of the notorious reproductive "biological clock", but may not realise how real it is. Ageing is a natural, inevitable process. As you get older, your fertility declines because of age-related changes in the ovaries. A woman is born with all the eggs she will ever have, unlike men, who continue to produce sperm throughout their lives. Of the eggs remaining at puberty, only about 200 will be ovulated over all the reproductive years, and the rest will undergo atresia. Atresia is a degenerative process that occurs regardless of whether you are pregnant, have regular menstrual cycles, use contraception or are undergoing fertility treatment. Smoking appears to accelerate atresia and is associated with early menopause.

Unfortunately, there are few or no outward signs of a woman's reproductive potential. The chance of conceiving generally begins to decline at around the age of 30, although it may start earlier in some women. At 30, a healthy, fertile woman has a 20% chance of success in any one month of trying. By the age of 40, this chance has fallen to just 5%. In rare cases a woman may have premature ovarian insufficiency, and her ovaries may stop producing eggs much earlier, perhaps in her late 20s. Not only does a woman's reproductive potential decline with age, but the likelihood of miscarriage also increases. This increase is probably due to the quality of the eggs (a higher number of abnormal eggs) that she produces as she gets older.

Ovarian Reserve

Ovarian reserve refers to the quality and quantity of the eggs in the ovaries and how well they respond to the hormonal signals they receive from the brain. Ovarian reserve can be assessed with a simple blood test and an ultrasound scan. The blood test measures the hormones FSH (follicle-stimulating hormone), LH (luteinising hormone) and oestradiol on day 2, 3 or 4 of the cycle (day 1 is the first day of full menstrual flow). High FSH levels indicate that your ovarian reserve is low and that your chances of conceiving are therefore low. Your doctor may also perform an ultrasound count of the small or "antral" follicles in your ovaries. A low follicle count predicts a higher likelihood of a poor response to treatment and a lower chance of a live birth.

Treatment

There are many different treatments for infertility. Deciding to undergo fertility treatment is an important decision and should be discussed with your partner and your doctor. As a woman gets older, not only does her fertility potential decline, but the options for effective treatment also become more limited. Traditional hormonal ovarian stimulation combined with intrauterine insemination may be the preferred treatment for some patients under 40, but it is much less effective in women over 40. IVF is the most effective treatment for women of any reproductive age, but the live birth rate for women using their own eggs for IVF falls significantly in women over 40. IVF success rates in women over 40 increase significantly with the use of eggs from a young donor. While age can have a dramatic effect on the ovaries and the eggs they produce, the uterus of a woman in her 40s is usually as good as that of a younger woman. However, many women would prefer to use their own eggs rather than a donor's, and should therefore start trying to conceive well before the age of 40.

Conclusion

Ageing has a profound effect on all of us. The signs of ageing in a woman's reproductive capacity may be subtle or completely hidden. As they plan their future, women need to understand that the decline of the ovaries is a natural and continuous process. Unfortunately, there is no treatment that can restore eggs or improve their quality. It is therefore important for women to be aware of the possible effects of ageing on their fertility, including the general decline in fertility, the higher risk of miscarriage and the higher risk of chromosomal abnormalities in newborns.

If you are concerned about your reproductive potential or are having difficulty getting pregnant, contact the "Dr. Alexandros Traianos" Centre for Reproductive Medicine and Fetal Medicine to schedule an appointment.

ABOUT THE DOCTOR

Dr. Alexandros Traianos

Gynecologist · Specialist in Reproductive Medicine and Fetal Medicine

He supports scientific excellence in clinical practice and recognizes the possibilities offered by modern reproductive methods to couples who wish to have a child of their own.

His profile

The content of this article is for information only and does not replace a medical examination and advice.

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Frequently Asked Questions most frequently.

Infertility is defined as the failure to achieve conception after one year (or 6 months in the case of a woman over the age of 35) of normal, regular sexual intercourse. In other words, when a year has passed without the woman becoming pregnant, the couple should consult their treating physician, so that the cause preventing pregnancy can be identified and subsequently addressed. However, we should all be aware and not forget that age is the most critical factor for female fertility, and that an individualized approach to each couple is the "golden key" that solves the problem.

Of course not. In approximately one third of cases, infertility is due to the woman (female factor), while in another third of cases it is due to the man (male factor). In the remaining third, it is due to both partners (both the man and the woman) or even to unknown factors.

• alcohol • narcotic substances • environmental toxins, including pesticides and lead • smoking • health problems • medications • radiotherapy and chemotherapy • age

In general, specialists agree that the fact that a couple has already had a child may be considered evidence that, at least initially, there is no infertility problem. It is like a small test that has been carried out and shows that they “succeeded” at least once. On the other hand, however, we should be aware that circumstances may have changed in the meantime and that a problem may have developed (e.g., the man may have had an inflammation affecting the quality of his sperm, or something may have occurred that affects female fertility: an inflammation, gynecological surgery, an abortion, etc.). In any case, therefore, if a reasonable period of time (one year) passes and a couple is unable to achieve a pregnancy, then, with the help of their doctor, they should investigate whether a problem causing infertility has arisen.

Success rates vary at each IVF center. Very important factors also include the woman’s age, her hormone levels, and, of course, her husband’s sperm. In general, rates are around 45% or slightly higher for women up to 35 years of age.

The number of treatment cycles a woman may undergo is not fixed. It is certain that in our country there are highly qualified obstetrician-gynecologists and well-organized infertility treatment centers that provide excellent medical services in this field. Provided that the appropriate indications are present (e.g., ovaries that respond to stimulation treatment, a good-quality endometrium, etc.), the success rate—particularly with the use of newer techniques and biotechnological medicines, which demonstrate increased bioactivity compared with conventional urine-derived medicines—reaches a cumulative rate of approximately 65%–70% after 4 treatment cycles.

Egg retrieval takes 10–15 minutes, is not painful, is performed under sedation, and after the procedure is completed you can return to your activities.

The association between IVF medications and the risk of developing cancer is the greatest concern for women participating in these programs. However, numerous literature references gathered from reliable scientific studies and published in reputable medical journals worldwide are reassuring and do not confirm this concern.

At Dr. Traianos' Reproductive Medicine Center, we offer egg and sperm cryopreservation services for individuals who have a personal or medical reason and require this service. We use the most advanced vitrification technique for the freezing of sperm and eggs.

Ovarian Reserve

Treatment

Conclusion

The first step is a discussion.

Frequently Asked Questions most frequently.

When is a couple considered infertile?

Is infertility only a female problem?

What increases the risk of male infertility?

I already have one child, but I am now having difficulty becoming pregnant again. Could a problem have arisen with me or with my partner?

What is the success rate of in vitro fertilization?

How many times can a woman undergo in vitro fertilization (IVF)?

Is egg retrieval painful?

Can IVF medications cause cancer?

Can I freeze my eggs or my sperm?