Age

Undoubtedly, age is the most important factor in determining your chance of achieving a successful pregnancy through IVF. As the oocyte (egg) ages, it undergoes changes that render it less and less fertile as a woman advances through her 30s and 40s. As a woman ages, her chance of conceiving through IVF decreases. Her risk of early pregnancy loss increases, too, mainly related to the increasing frequency of chromosomal abnormalities within the oocyte and, thus, the developing embryo. Pre-implantation genetic diagnosis (PGD) is a test designed to help identify genetically problematic embryos before being transferred back to the uterus. PGD may help to reduce the risk of early pregnancy loss related to the chromosomal abnormalities (aneuploidy) frequently found in embryos produced from aging oocytes.

FSH Levels

Day 3 follicle-stimulating hormone (FSH) levels are also critically important in evaluating your potential for a successful conception in an assisted reproductive technology program. This blood test is usually drawn on the third day of a woman’s menstrual cycle. Day 3 FSH levels have shown an incredibly accurate predictor of IVF success, independent of age. An elevated Day 3 FSH value indicates a poor prognosis for conception through IVF and a high risk of pregnancy loss should a rare conception occur. Unfortunately, if you ever exhibit a high FSH value, having a normal value at a later time does not favorably change this prognosis. Every IVF program establishes a “threshold” FSH value unique to their laboratory, above which pregnancies are rarely conceived despite great effort and repeated IVF attempts. At RMA, we have determined that an FSH value of 15 or higher predicts that IVF will be of no value in helping to achieve pregnancy. FSH values over 14.5 have produced only rare pregnancies in our program. Before initiation of any IVF cycle, Day 3 FSH values are evaluated. Many factors can artificially depress FSH values but only diminished ovarian fertility reserve can cause an elevated FSH level. Egg donation is generally recommended as the most potentially successful treatment option in the setting of high FSH levels, especially when associated with age beyond 35.

Ovarian Fertility Reserve

The clomiphene citrate challenge test can also determine the extent of your ovarian fertility reserve. This test was designed to “unmask” undiagnosed cases of diminished ovarian reserve when Day 3 FSH values are normal – the equivalent of a “stress test” for the ovaries. During the CCCT, a Day 3 FSH value is assessed. If normal, 100 mg/day of clomiphene citrate (Clomid, Serophene) is administered from days 5-9 of your menstrual cycle. An FSH level is then assessed on Day 10. Suppose either the Day 3 or Day 10 FSH value is elevated. In that case, the test is considered abnormal and predicts a poor prognosis for IVF outcomes.

The Effects of Age on Fertility

Aging is a normal, inescapable process. As we age, various components of our bodies develop limited function or cease to function altogether. Changes in our reproductive processes are some of the more subtle changes that take place. The scientific community has recognized for quite some time that a woman’s reproductive potential declines with age. However, as societal changes have resulted in many women delaying childbearing, these nearly silent changes can significantly impact a woman’s life. 

Unfortunately, there are few, if any, outward signs of decline in the reproductive potential of most women. A woman may continue to have regular cycles until she nearly reaches menopause. However, her chance of conception starts to decline at a much younger age (Figure 1), generally around 30 years old. This results in a situation where nearly 1/3 of the couples with a woman 35 or older will have problems with fertility. It has been estimated that only 10-30% of women over 40 can become pregnant on their own. In addition, a woman’s chance of miscarriage also increases with age.