In this insightful discussion, OBGYN and fertility specialist Albert L. Hsu, an associate professor at the University of Cincinnati, addresses the critical issue of ovarian aging and its impact on fertility. He explores the decline in fertility rates among women over 35 and the biological factors at play, including mitochondrial defects. Hsu emphasizes the importance of educating women about their reproductive health and discusses proactive strategies like egg freezing to enhance future pregnancy chances.
Ovarian aging significantly impacts fertility in women over 35, with declining function leading to reduced success rates in treatments.
Egg freezing offers a viable strategy for women to preserve fertility, enhancing chances of future successful pregnancies when done at a younger age.
Deep dives
Declining Fertility Rates and Age of First Birth
Fertility rates in the United States have seen a significant decline, dropping from approximately 71 births per 1,000 women in 1990 to 56 in 2022. The age at which women have their first child has also increased, with the average age rising from 27 in 1990 to 30 in 2019. Contributing factors to this trend include economic concerns, work commitments, and insufficient support systems for pregnancy and child-rearing. As women opt to postpone childbearing, understanding the implications of ovarian aging on fertility becomes vital to address these societal shifts.
Ovarian Aging and Infertility
Infertility rates among couples have risen, with the World Health Organization reporting an increase from one in eight couples experiencing infertility to one in six. In particular, female physicians face even higher rates, with one in four experiencing challenges in conceiving. Ovarian aging contributes to this issue, as women are born with a finite number of non-growing follicles, which deplete significantly over time. By age 35, women may have approximately 16,000 eggs left, highlighting the importance of understanding how age affects fertility, especially as those wishing to conceive delay parenthood.
Cryopreservation as a Strategy for Delayed Childbearing
Oocyte and embryo cryopreservation, commonly known as egg freezing, provides women the opportunity to preserve their fertility for the future. The process involves stimulating the ovaries to produce multiple follicles, from which oocytes are retrieved and frozen for future use. Evidence suggests that egg freezing at a younger age results in significantly higher success rates for achieving pregnancy compared to waiting until later and undergoing IVF. This technique not only increases the likelihood of a successful live birth but can also reduce the associated financial burden, making it a compelling option for women considering delayed childbearing.
Ovarian aging is an important cause of infertility in women older than 35 years. Success rates of fertility treatment decline with age, most commonly due to declining ovarian function. Author Albert L. Hsu, MD, MS, of University of Cincinnati, Ohio, discusses this and more with JAMA Deputy Editor Kristin L. Walter, MD, MS. Related Content: