Infertility and the latest developments Fertility in women 30 and over

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Infertility and the latest developments Fertility
in women 30 and over

• Dr Femi Olarogun
• Reproductive medicine specialist

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Introduction

• Ability to conceive and reproduce successfully
  decreases with age
• With career and society pressures more and more
  women are delaying starting a family
• This scenario results in a higher need for
  fertility treatment in women aged over 30

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Physiology

• Women have the maximum amount of oocytes(eggs) at
  about 20 weeks gestation in-utero
• By birth that complement is diminished to about 2
  million
• From about age 35 the ability to conceive and
  maintain a pregnancy starts decreasing
• This further declines sharply from about the age
  of 40

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Physiology 2

• These situation know as diminished ovarian
  reserve is due to a decline in the quantity as
  well as the quality of the oocytes remaining
• The rate of chromosomal abnormalities as well as
  spontaneous miscarriages is also increased
• Other factors like genetics and previous
  gynecological conditions may also predispose to
  diminished ovarian reserve

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Testing for ovarian reserve

• Important as it enables us to counsel the
  individual regarding choice of treatment
• Hormonal assay of FSH and Estradiol on day 3 is
  easy to perform
• Antral follicle count on day 2 or 3 of cycle is
  also useful
• Others include clomiphene citrate challenge test
  and measurement of ovarian volume

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Antral follicle count
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Management
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General measures

• Stop smoking
• Healthy lifestyle
• Weight loss/control
• Adequate nutrition

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Medical

• IVF using varying protocols
• Oocyte donation
• Oocyte freezing
• Adoption

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In-vitro fertilization IVF

• Controlled ovarian stimulation
• Egg retrieval
• Embryo transfer

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Oocyte donation

• Expensive
• Difficulty in getting donors
• Good success rates as donor egg potential
  determines fertility
• Ethical issues not fully resolved

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Oocyte freezing

• Relatively new technique
• Problems with maintaining functionality of the
  egg through the process of freezing and thawing
• Only a few hundred babies conceived by this
  method so far.
• Not yet freely available

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Adoption

• Could be a cumbersome process
• Adoption agencies available to help through the
  process
• Co-ordination, counseling and follow-up essential

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Conclusions

• Fertility wish and potential in the older woman
  has become part of our lives
• Knowledge of ones ovarian reserve may affect
  choices
• Other general measures are just as important
• Treatment options do exist and are accessible