Check before you wait

Many women seek fertility treatment in their late 30s or early 40s. How they wish they had done so earlier.

It’s unfortunate, as most of these women are actually medically normal, but are unable to conceive because they have lost out on precious time; they have depleted their ovarian reserve [number of eggs in the ovaries].

Infertility affects over nine per cent and nearly 70 million women worldwide. The causes of infertility in women include PCOS [Polycystic ovarian syndrome], tubal block, endometriosis [a problem affecting uterus] and hormonal disturbance.

The most common cause, however, is late pregnancy. It is totally avoidable; sadly, most couples are oblivious to the fact until it’s too late. Till a few years back, this was a problem that was common in the West, but India it is catching up in India, soon.

Her age matters

The woman’s age is important for a couple’s success in fertility. Hence, it should be considered before postponing pregnancy for other priorities.

Studies show that the conception rate for older women [those above 35 years of age] is half that of younger women [those up to 25 years of age]. That is because women are born with a fixed number of eggs in the ovaries. Of the 1 – 2 million eggs that are present at birth, by puberty just 400,000 remain.

After that, a 1000 more perish every 30 days. Along with the decline in the number of eggs, their quality goes down too. This is the main reason for decreasing fertility in women as they age. Though such women have the option of using eggs from a younger donor and undergoing In Vitro Fertilization or IVF [test-tube babies] to conceive, this is a compromise you can avoid.

The key is to start trying for a baby when the woman has a sufficient egg reserve and allow enough time for natural conception.

Knowledge is power

Sometimes, there is no choice but to postpone pregnancy. Even then the decision should be taken only after the ovarian reserve has been tested.

This helps the couple determine how long their ‘golden period’ viable for pregnancy will last. It also helps the woman make a well-informed choice about delaying her pregnancy, so that neither her personal nor her professional goals are hampered.

To check your ovarian reserve, you need to carry out some simple tests:

• Serum FSH [Follicle Stimulating Hormone], LH [Luteinising Hormone]; estradiol on day 2 or 3 of menstruation and tests for AMH [Anti-mullerian hormone]—all these are blood tests. If your FSH level is below 8 and AMH level is higher than 2, it means you have a good ovarian reserve.
• Antral follicle count and ovarian volume give you a precise idea of the number of eggs in your ovaries. These are ultrasound tests.

The tests are simple and inexpensive but their worth to you is invaluable.

You can freeze

You have an option to freeze the eggs when you are young for later use. It involves stimulating the ovaries to produce more eggs and harvesting these eggs with transvaginal ultrasound.

So if you wish to have a baby but it might have to wait longer than you would want it to, check your ovarian reserve, and if required, consider egg freezing so that time doesn’t run out on you.

However, IVF with frozen eggs has a success rate of only about 30 per cent—consider this when you make the decision.