Understanding the Menstrual Cycle
Polycystic Ovary Syndrome (PCOS)
Asian Patients Have Lower Rates Of Pregnancy And Live Birth Than Caucasian Patients
Fertility and Age
Age is the most important predictor of fertility. As a woman ages, her eggs age also, and become less likely to fertilize and result in a pregnancy. Women are born with a certain number of eggs. Over time, the number of eggs carried by the female decreases, as does their quality - so when you are younger it is much easier to become pregnant compared to when you are older. This is solely due to the quality of the egg. Some tests can help predict “Ovarian Reserve.” These tests are an indirect measurement of how your eggs are doing in your ovaries. Many studies have found that a drop in pregnancy rates occurs at approximately 35 years of age and drops dramatically after 37 years of age. The quality of the oocytes drops dramatically as age increases, and the number of genetically abnormal eggs also increases with age.
The increase in abnormal oocytes leads to an increase in embryos with an abnormal number of chromosomes. Chromosomes are where our genetic material is stored. We each are composed of cells possessing 23 pairs of chromosomes. One set comes from the sperm and one set comes from the egg. The architecture inside the egg at fertilization must bring these chromosomes together just right. As we get older, the architecture inside the cell becomes older and sometimes does not align the chromosomes as accurately as it did when the eggs were younger, resulting in an increase in the number of embryos that have what is called “Aneuploidy” or an irregular number of chromosomes. The most famous form of aneuploidy is Down’s Syndrome, which is a normal complement of 23 pairs of chromosomes, plus an additional number 21 chromosome, called Trisomy 21, or 3 copies of the number 21 chromosome. Aneuploidy also decreases the rate of implantation of embryos, reducing fertility rates as well as increasing miscarriage rates.