Other findings we associate with an age-related decline in fertility include a shorter or irregular menstrual cycle, symptoms of impending menopause, and low numbers of egg-carrying follicles in response to stimulation with hormones. If you have had previous surgery affecting your ovaries, such as the removal of an ovarian cyst or partial removal of ovarian tissue, that might also lead to an earlier loss of ovarian function.
In the last few years we have added another ovarian marker to help us assess the ovarian reserve. The hormone called anti-Müllerian hormone (AMH) is produced by an early stage of the developing egg-containing ovarian follicles. Very low levels of AMH denote poor ovarian reserve, whereas high levels suggest that the woman has many eggs remaining in her ovary.
Unfortunately, there are no treatments available that can turn back the clock on a woman's ovaries, but there are many treatment options that can greatly help you in your quest to have a child. We can prescribe fertility drugs to try to increase your chances of pregnancy. These powerful hormones can increase the number of eggs that develop in a given month and enhance the chance that at least one of them might be able to be fertilized and develop into a pregnancy.
The one consistently successful method to improve pregnancy rates in women with age-related infertility is through a donor egg. You may be a candidate to receive a donor egg if you are over age forty, have persistently high FSH levels at any age, respond poorly to fertility drugs at any age, or have poor-quality embryos after undergoing an IVF cycle.
Lots of Options
You never know where you will fall in the fertility lottery, so you may need to hedge your bets the best you can, particularly if you're in your late thirties or forties. You should probably talk with your doctor about donor-egg IVF, embryo development in the laboratory, and preimplantation genetic diagnosis (PGD).
For some women, the only hope is to use donor eggs. In this process, another woman's eggs are fertilized, either with her husband's or a donor's sperm, and the resulting embryo is transferred to the woman's uterus, which has been prepared to receive the embryo. While IVF success rates go down drastically after age thirty-seven, the success of donor eggs remains high.
With egg donation, success rates are dependent on the age of the donor rather than the recipient. We achieve live birth rates that exceed 50 percent per procedure with donors between twenty-one and thirty-four years of age. The use of donated eggs has made it possible for couples to achieve pregnancies where all other methods have been exhausted.
Embryo Development in the Laboratory
Another important approach to improve the success rate of IVF is to optimize the laboratory conditions for early embryos. We have developed a method to co-culture embryos with certain helper cells to enhance the development of fertilized eggs and improve embryo quality.