Saturday, November 12, 2016

The dreaded D word for the older infertile woman.

Most women know that their fertility declines as they get older because they run out of eggs. It's true that life is unfair - while men continue producing sperm all their life,  women are born with whatever eggs they're ever going to have, which means they never produce any new eggs after birth.

Sometimes women find this confusing, because don't they produce an egg every month? Isn't that called ovulation? The truth is that the egg which you ovulate every month was actually manufactured when you were a baby fetus in your mother's womb. This egg is  recruited after years of dormancy , and it matures and is released when you ovulate during your cycle. Think of this like Prince Charming waking up Sleeping Beauty every month . The hormones which do this are called FSH and LH. Thus, there really are no new eggs being produced, and this is why, as a woman gets older, her eggs get depleted and she finally becomes menopausal. This is also the reason why a 35 year old has lower fertility as compared to a 25 year old. Her eggs are much older, which is why both their quality and quantity have taken a beating.  The egg pool is finite, and we cannot reverse ovarian aging.

While women understand that the menopause represents a well-defined stop to their dreams of having a baby with their own DNA , they often don't realize the major impact this declining ovarian reserve has on their ability to have their own genetic baby after 35 . After all , even if your calendar age may be 40, you will always think of yourself as being 25 in your heart of hearts .This is true especially if your periods are regular - you naturally expect that your fertility will also be fine. However, just because your egg quality is enough to produce enough hormones to get regular cycle, this doesn't mean it is sufficient to make a baby. However, regular cycles lull you into a false sense of security.

General gynecologists and family doctors are also not aware of how quickly fertility drops after the age of 35, even in a woman who looks completely healthy.

Since most doctors do not check the woman's ovarian reserve, many older women keep on putting off having a baby . However, the tragedy is that by the time they're ready to start their family, their eggs may have become too old. Now they understand with their head that the best option for them to have a healthy baby is to use donor eggs. They know that older women have fewer eggs; that these eggs are of poor quality; and that their risk of having a miscarriage and a baby with a birth defect increase as they get older.
However, it's very hard for their heart to accept this. It's very difficult for them to come to terms with this, because everyone wants to have a baby who looks and talks and smiles like them - someone , who carries their own DNA.

It can be quite heart-wrenching to make a decision to use donor eggs. This is why a lot of older women who have failed many IVF cycles end up doing surrogacy, rather than using donor eggs , even though donor eggs would give them a much better chances of having a baby. While surrogacy is much more profitable for the doctor, the pregnancy rate for the older woman doing surrogacy with her own eggs is actually no better than transferring her own embryos into her uterus. After all, the bottle neck for the older woman is never her uterus - it's her eggs, which is why swapping a uterus makes no clinical sense. However, she is often pressurised by the IVF clinic to opt for surrogacy. She ends up wasting a lot of money , and loses confidence in all IVF doctors . She deprives herself of her best chance of having a baby because she has frittered  away
valuable time barking up the wrong tree, simply because she cannot come to terms with the fact that the major bottleneck is her egg quality .

Older women need to be open-minded , and be willing to consider using donor eggs. They should at least weigh the option carefully and thoughtfully before rejecting it out of hand.

I know this is easier said than done, and it requires a lot of soul-searching. You need to ask yourself - what do I want from having a baby? Do I want to be a mom , or do I want to transmit my DNA?  Normally, the propagation of your personal genetic heritage; pregnancy and birth; and parenting all come together as a single package. However, you now find that you have to choose between them, and decide what your priorities are. The answers to these hard questions will provide you with a lot of clarity as to your next steps.
Yes, it is a hard decision, but the good news is that other women have tackled this successfully.  The article at  is very insightful and provides a lot of food for thought.

Interestingly, I find that the women who worry the most about making this decision are usually the ones who end up making the best parents, because they have played out all the worst case scenarios in their head, and are well-prepared to love their baby.

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