Many women do not fully appreciate the consequences of delaying motherhood, and expect that assisted reproductive technologies can reverse their aged ovarian function, Yale researchers reported in a study published in a recent issue of Fertility and Sterility.
"There is an alarming misconception about fertility among women," said Pasquale Patrizio, M.D., professor in the Department of Obstetrics & Gynecology at Yale School of Medicine and director of the Yale Fertility Center. "We also found a lack of knowledge about steps women can take early in their reproductive years to preserve the possibility of conception later in life."
The report stemmed from the observations Patrizio and colleagues made that more women are coming to the fertility clinic at age 43 or older expecting that pregnancy can be instantly achieved, and they're disappointed to learn that it can't be done easily. "We are really seeing more and more patients 'upset' after failing in having their own biological child after age 43 so we had to report on this," said Patrizio. "Their typical reaction is, 'what do you mean you cannot help me? I am healthy, I exercise, and I cannot have my own baby?'"
These women delay pregnancies in their most fertile years for a variety of reasons, such as focusing on careers, lack of financial stability, or not having a partner. They are vaguely aware that fertility decreases with age, but it is only when they experience age-related infertility firsthand that they begin to understand the reality of their situation, note the researchers.
The growing popularity of assisted reproductive technologies (ART) has given women the impression that female fertility may be manipulated at any stage in life, notes Patrizio, who says the problem is exacerbated due to images of celebrities who seem to effortlessly give birth at advanced ages.
According to the Society for Assisted Reproductive Technologies, the number of in-vitro fertilization (IVF) cycles performed for women under age 35 increased by about 9% between 2003 and 2009. During this same time period, the number of IVF cycles performed for women aged 41 and older increased by 41%. But this procedure doesn't always result in success.
"Even though the number of women turning to ART has increased, the number of IVF cycles resulting in pregnancy in women above age 42 mostly remained static at 9% in 2009," said Patrizio. "If pregnancy is achieved at an older age, women then face higher risk of pregnancy loss, birth defects, and other complications."
Patrizio hopes to prevent age-related infertility by combating these misconceptions with education.
"As clinicians, we should begin educating women more aggressively," Patrizio said. "Women should be given the appropriate information about postponing fertility, obstetric risks, and the limited success of ART in advanced age to allow them to make informed decisions about when, if at all, they hope to become pregnant."
Patrizio said that one of the techniques women should take advantage of is oocyte (egg) freezing, which appears to be the best strategy for women who want to postpone motherhood but really care about having a child with their own genetic material. Alternative options such as egg donation, which leads to the highest pregnancy rates reported for any ART method, are also available.
"There is an urgent need to educate women that reproductive aging is irreversible and, more importantly that there are options to safeguard against he risk of future infertility," said Patrizio. "These techniques are valid options for women and should not be viewed as experimental," he added. "Doctors and health professionals must begin the discussion about fertility preservation in their patients and make certain that young women truly understand all their options."
Other authors on the study include Nichole Wyndham, and Paula Gabriela Marin Figueira, M.D.
Citation: Fertility and Sterility doi:10.1016/j.fertnstert.2012.02.015
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