Our expert is David L. Keefe, MD, Stanley H. Kaplan Professor and Chairman of Obstetrics and Gynecology, and Professor of Cell Biology at NYU Langone School of Medicine.
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AGE AND INFERTILITY ARE LINKED
Infertility affects roughly 12% of women. However, this figure goes up with age; by the time a woman is in her early 40s, her chance of infertility rises to 20%. For the older woman, it’s a particularly difficult problem because the quality of her eggs has been deteriorating as she aged. A woman in her 20s would typically have genetic abnormalities that would cause an egg to be unviable in 60% of her eggs. In her 40s, that same woman is likely to have 95% of her eggs be unviable. Realistically, the older a woman gets, the more problematic conception becomes.
IN VITRO FERTILIZATION (IVF) IS NOT A PANACEA
Your patients may have read stories about movie stars in their mid-50s giving birth to twins and unfortunately the popular press perpetuates the myth that you can be fertile forever. However, it’s not so. IVF is not quick, easy, or reliable. Further, it will typically cost in the $14,000 to $19,000 range for each attempt and insurance may or may not cover that, depending on the policy. The success rates range from 5% to 60%, depending on the age and health status of the woman.
FREEZING EGGS CAN BE A VALUABLE OPTION
In the case of a woman who knows she will be delaying childbearing, there is a way of sidestepping the problem of her eggs becoming less viable as she ages. Normally her eggs will age much faster than her reproductive organs, but if she chooses to freeze her eggs, she can stop the aging process for her eggs. Her reproductive organs will continue to change, but importantly, their rate of aging is slow enough that she’s highly likely to be able to carry a fetus to term in her 40s. The downside of this is, freezing her eggs will be expensive, typically in the $15,000 range, and she can’t be sure she’ll get a baby at the end. Her success is likely to be around 65%, but keep in mind that this means that 35% will not get a baby.
NEW ADVANCES IN IVF INCREASE THE ODDS OF HAVING A HEALTHY BABY
Women generally will have many good eggs and many infertile eggs. Recently we have made enormous strides in identifying which eggs have the chromosomal abnormalities that would result in miscarriages. By the time an embryo is five days old, we’ve found that it’s safe and reliable to take one of the 40 to 80 cells that are present and test that cell for chromosomal abnormalities. The way we can do this is, we take the individual cell that we harvested and cause it to produce enough copies of itself so that we can test for all the known chromosomal abnormalities. With this process, we can find the embryos that are destined to make a healthy baby, as opposed to ones that would result in failure to implant or an early miscarriage.
MISCARRIAGES ARE REMARKABLY COMMON
About 15% of women miscarry, but the good news for a woman who has miscarried once or even twice, is that she’s no more likely than someone in the general population to miscarry again. It’s nature’s way of making up for its errors, which, by the way, are frequently chromosomal errors. The odds of a serious underlying problem don’t really increase until there’s a third miscarriage. However, when a woman goes through a miscarriage, even for an unplanned pregnancy, it is a devastating experience, and both the woman and her loved ones need to recognize that asking her to be “strong” is probably not the best approach. Expressing her grief and disappointment can speed the process of getting over it.