The Issues Of Age And Infertility

It is fairly well known that the older a woman gets, the more likely she is to have problems with fertility. Women are born with all of the eggs that they will have in their lifetime; they do not make new eggs. As the female body ages, so do her oocytes, or eggs. Hormones and/or genetics could be the cause of trouble for a woman. Abnormalities involving the development or release of eggs (ovulation), problems with the female’s anatomy can affect the movement of an egg to the uterus, problems involving the attachment or implantation of the embryo or fetus, and even endometriosis (the discovery of tissue normally found inside the uterus outside the uterus) can all lead to trouble with reproduction.

Researchers are now learning that the same can be said for men when it comes to the issue of age. An article published in the August 2000 issue of Human Reproduction (a magazine published by Oxford University Press) indicated that a man’s age may also play a part in his fecundity, or the ability to impregnate within a year. In the article “Men Have Biological Clock, Too,” Terry Morris wrote that “women may not be the only ones who hear their biological clock ticking as they age.

“A large population study in Great Britain concluded that men’s fecundity varies with age and, in general, the older a man gets, the less fecund he appears to be,” the article continued. “The questionnaire-based study found that, in 8,515 planned pregnancies, the likelihood of conception within six or 12 months is lower in men older than 25.” This was the first study to suggest that male fertility may decline as a result of simple aging.

Age-related issues for men can include declining testosterone production; declining sperm mobility and overall production; an increased rate of prostate problems; an increased incidence of erectile dysfunction or ejaculation problems; years of environmental damage (including toxin exposure, alcohol or tobacco consumption) to the sperm production mechanism or sperm cells themselves; and/or less frequent sexual activity in general.

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. Infertility can occur when just one part of the reproductive system is not working well.

RESOLVE, a national infertility association, recommends seeing the medical advice of an infertility specialist when the care of an Ob/Gyn is no longer appropriate. Of course, some couples will not know when that time arrives, so Diane N. Clapp, BSn, RN, and the medical information director of National RESOLVE, says in an article called “Selecting an Infertility Physician” that the expertise of an infertility specialist can make the difference between years of infertility and that much desired outcome –– successful pregnancy.”

Ask questions. That is the best thing a couple can do if they are not getting success with their own Ob/Gyn. Ask for a referral, or visit a website such as www.MedSeek.com, which lists all Ob/Gyns and their training, and physicians and their credentials. The American Board of Specialties can also help; its website is www.ama-assn.org and its telephone is 847-491-9091.

Once a couple begins to consider a specialist, some subjects to cover, again according to Ms Clapp, include information about fee structure, payment plans, and insurance coverage; whether the doctor or any of his or her nurses have call-in times so that you can ask questions about your case; whether the lab and ultrasound office is open on weekends and holidays; whether procedures can be done on weekends if needed.

Additional questions include: Is this a group practice, and will you be seeing only one doctor or several doctors in the practice? Which hospital does the doctor have admitting privileges to? Does the doctor have a particular urologist for evaluation of the male? Does the doctor do assisted reproductive techniques? If so, where do these take place? Is the doctor a member of the American Society of Reproductive Medicine?

In terms of what a clinic should include, clinics should also have either on-site or access to a reproductive endocrinologist (who may also be a reproductive surgeon), a reproductive immunologist, a reproductive urologist (who may also be a reproductive surgeon), an andrologist, access to a geneticist for patients who have genetic abnormalities.

It is also imperative that a clinic have accredited facilities for freezing and storing embryos, cycle monitoring and staff availability, and laboratory certification. The Clinical Laboratory Improvement Amendment (CLIA), which is federal legislation passed in 1988, requires accreditation of all laboratories. Additional accreditation by a national organization is also recommended.

Psychological counseling and screening should also be available.