By Dr. Peter Ahlering
Dr. Peter Ahlering
There are few individuals—females and males—who don’t at some point in their lives think about having children and raising a family. It is in the human genetic code to think about these things. However, it is increasingly more common to get ‘distracted’ in life from thoughts of procreation and family, pushing them out of our minds while we occupy ourselves with other activities such as career, etc. Almost invariably, however, the idea of childbearing comes back. The problem is that nature does not get distracted from its incessant negative effects on reproductive potential. The ‘Biological Clock’ does not stop ticking for anyone - and for some, it ticks faster than they would hope and or expect.
This sounds horribly ominous! Nevertheless, it is true. However, there are ways to work around this inevitable process and effectively preserve one’s fertility—through cryopreservation (freezing) of eggs or sperm for future use.
The first crucial step for anyone, male or female, in understanding the effect of the biological clock on you at any given point in time, is through a fertility assessment. For females, this ‘snapshot’ assessment is simple and easy to perform with bloodwork and ultrasound. It is almost always covered by insurance, and if not, can all be done for a few hundred dollars.
Table 1
Here is the background for women: Even before birth, the egg supply in your ovaries begins to diminish (see table 1) At birth, there are about 2 million eggs. By the time the first menses occurs around age 11, there are about 400,000. In the mid thirties, the rate at which you lose eggs increases such that by age 50, on average, your egg supply is depleted. This time is called menopause.
Table 2
In addition to the issue of declining egg quantity, there is a corresponding decline in egg quality as women get older. The chance that any one egg will make a baby decreases as ‘The Clock’ ticks and time passes. I think that everyone instinctively knows that fertility declines with age. But what is not commonly known is that the decline starts a lot younger than most people think (see table 2).
So eventually there is the double whammy—fewer eggs left and poorer quality ones at that. In Reproductive Medicine, the first thing that I do in evaluating a patient/couple that is having problems achieving pregnancy is assess the impact of the ‘Biological Clock’ in that individual woman, since every patient is different. This means assessing ovarian reserve—finding out “how many eggs are there.” This enables a woman to see how ‘The Clock’ is ticking for her at any given time. Once the reserve of that patient is known, decisions on fertility can be made.
Ovarian reserve and egg quality are undeniably the most important aspects related to initiating a pregnancy. If the reserve is low, time is not that patient’s friend. She may decide to pursue pregnancy sooner rather than later, before the reserve diminishes even more or perhaps is completely depleted. If reserve is high, she can plan accordingly as well. Getting this information is a matter of undergoing these simple screening tests and discussing the results with your doctor. The information gained from a fertility screening can be key to making educated and informed decisions about your life and future such as:
- Do I want family?
- How soon do I want/need to start?
- Does the knowledge gained from fertility screening alter how I look at that?
- What do I want to do with my career?
Some misconceptions about fertility that I hear frequently are:
- “I am young, so I should have no problems getting pregnant when I’m ready.”
- “I know someone (perhaps family member) that had a baby at age 42. I’ll be OK”.
- “I’m healthy, eat right, and exercise, so I should have great fertility.”
- “My Mom was 55 before she went through menopause, so I’ll be fertile for a long time.”
These thoughts often give people a false sense of security. Don’t make assumptions. The only way to know where you stand is to do these simple blood tests and ultrasounds. Then talk to your doctor or reproductive specialist about what it means to you; put it in context of your particular situation. This is easy to do and it can change your thinking and your life.
For those who do decide to take action to preserve their fertility for the future, there are techniques and technologies for egg preservation that have evolved and improved dramatically over the past few years. Whereas methods for freezing embryos or sperm have been successfully practiced for many years, pregnancy rates using frozen/thawed eggs have been dismally low. New technologies are now making egg freezing a viable prospect for women seeking to preserve their fertility. We can now cryopreserve eggs for patients who are undergoing potentially damaging ovarian surgery, cancer chemotherapy (both of which can alter ovarian reserve and thus fertility future) as well as for those that wish to preserve fertility for other personal reasons. Some may choose, in response to fertility testing and discussion, to consider egg cryopreservation as well.
I strongly recommend that women take these issues into consideration and at least get information. It’s too easy not to do.
Peter Ahlering, M.D. is Medical Director of the Sher Institute for Reproductive Medicine (SIRM) in St. Louis. His focus is on treatment of the full spectrum of reproductive issues, with special expertise in Recurrent Miscarriage, In Vitro Fertilization, Evaluation and Management of Male Factor Infertility, and Laparoscopy. A native of St. Louis, Dr. Ahlering comes from a family of physicians; his father and brothers also practice in the specialty of Obstetrics and Gynecology. He has a reputation for outstanding care and a warm bedside manner. Dr. Ahlering has published several articles in the realm of Reproductive Medicine and has also presented papers at national and international medical conferences. More information about Dr. Ahlering and SIRM can be found at www.haveababy.com. You can also directly reach Dr. Ahlering by phone at (800) 630-4895 or via email at: stlouis@haveababy.com