Monday, April 24, 2006

I wish someone had told me about how I lose eggs as I grow older

I just completed doing an IVF cycle for a very nice 32 year old woman. She is happily married, confident, articulate; and has a very successful career. She now wants to start a family, and has found to her dismay that she can't conceive on her own. During her workup, she found to her shock that her egg quality was poor. She could not understand why her egg quality was an issue when she was only 32 years old.
I explained the biology of fertility to her. All women are born with a certain number of eggs - and they don't produce any new eggs during their lifetime ( unlike men, who produce millions of sperm daily). As women grow older, their eggs start getting depleted, until they run out of eggs and their periods stop for ever. This stage is called the menopause. However, for a period of about 10 years before they reach the menopause, their egg quality declines silently, so that it's enough for them to get regular periods, but not enough for them to conceive. This phase is called the oopause, and is "silent" - there are no signs or symptoms, as the biologial clock ticks on with a vengeance.
This is why when a young woman with regular cycles finds out she is infertile because of poor quality eggs, the news comes as a rude shock.
This is the first time these young people are having to confront their own biological limitations - their own mortality. Most other things in life have fallen into place for them. They work hard, do well in their exams and jobs, earn more money, get a promotion, buy a new car, a new house - and this is the first time they are being forced to deal with a situation which is out of their control - no matter how hard they work at it, or how much money they spend on it. This can be a very uncomfortable feeling, and they find their life spins out of control.
The commonest complaint I hear is - I wish my doctor had told me that my fertility would drop so dramatically. I wouldn't have wasted so many years taking birth control pills ! Why didn't my doctor warn me ?
This is why most women find themselves between a rock and a hard place when they try to balance childbearing and their career.
In all women, fertility declines after the age of 20 , but from 20- 30 the decline is so gradual , that it really does not matter much. After 30, it does become an issue, and after 35, the decline is precipitate.
However, the rate of decline varies from woman to woman, and while some 40 year old women can happily make babies in their own bedroom, many 35 year olds have a hard time conceiving, and need IVF treatment.
The easiest way to monitor your ovarian reserve ( your fertility) is by doing a simple inexpensive blood test which measures your FSH ( follicle stimulating hormone) level. This is best done on Day 3 of your cycle. As a woman grows older, the FSH level rises, and high FSH levels correlate well with poor egg quantity and poor egg quality.
Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !
While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderling high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.
I feel women already bear a disproportionate burden of responsibilities in our world.
Educating them about how they can check their fertility reserves can help them deal better with the career versus baby conflict so many of them have to deal with in their lives.


  1. Anonymous8:45 PM

    This is really fascinating, but I know my primary care physician would balk if I asked for such a test -- should I tell her I'm willing to pay for the FSH test out-of-pocket? Or is this something I should request from my ob/gyn?

    Also, I'm a journalist, so do you think this issue would make a good news story? "A Simple Way To Test for Fertility?"

    Joy Victory
    Health Producer
    New York, NY
    joy.n.victory @

  2. Anonymous12:52 AM

    I am a 35 year old women who recently had a FSH test which came back with excellent results, but i couldn't get pregnant. I must add I have a 2 year old daughter and since the birth my fertility has dropped. I found FSH did not pick up my eggs are as old as a 44 year old womens until I had my anti mullerian hormone checked and discovered my results where terrible, I then had a vaginal ultrasound done and found out then my eggs were in bad shape, I am still trying to conceive but I doubt my chances are very good as i have been trying to conceive for a long time.


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