Infertility Causes and Treatments

A significant shift in priorities and social attitude of the masses has given birth to the mushrooming culture of delayed childbearing, which has in turn lead to mounting occurrence of age related infertility. In an environment of intense competition and struggle, couples prefer to be “settled”, both financially and career-wise before taking on the responsibility of parenthood. Widespread availability of contraceptives has also played a role in the growth of this trend. Studies conducted by the American Society for Reproductive Medicine show that nearly 20% females in USA wait until 35 years to have their first offspring. But most of these women remain oblivious to the possible biological complications that may arise, because of their age.

It’s a medically accepted fact that infertility increases exponentially with age, more prominently in women than in men. The Food and Drug Administration (FDA) defines infertility as the failure to conceive after having normal unprotected sexual intercourse for a year. A woman’s fertility begins decreasing in her early thirties and experiences a sharp decline after the age of 35. Studies conducted by the American Society For Reproductive Medicine (ASRM) show that a healthy 30 year old woman has a 20% chance of conceiving while this figure drops to as low as 5% for a woman in her forties. Both the statistics and the graph (Source: Management of the Infertile Woman by Helen Carcio) only validate the bitter truth.

 
The Menstrual Cycle
Every woman is born with approximately 1,000,000 eggs. By the time a woman reaches puberty a major portion of these eggs degenerate leaving behind just about 300,000 functional eggs, which are resting in the ovary under the sheath of a follicle. 35-40 follicles each day and about a 1000 follicles each month leave their resting pool. These follicles go through the following stages of development- early primordial, primordial, primary, pre-antral and finally the antral follicle. The complete transformation from the resting follicle to the ovulating follicle takes close to eighty-five days. One of the antral follicles is released in the middle of the twenty-eight day long menstrual cycle, a process termed as ovulation, while the others are destroyed by a degenerative process termed as Atresia.

Until the antral follicle is formed, the whole process is not influenced hormonally. Once the antral follicle is formed, it develops in response to FSH and secretes Inhibin B and estrogen, which in turn decrease the levels of FSH through a negative feedback loop. The FSH levels continue to decline towards the middle of the menstrual cycle. The antral follicle, which shows maximum sensitivity in its reception towards FSH eventually, becomes the ovulating follicle. Owing to this particular characteristic, it responds to FSH even when it’s present in low quantities while the others perish.

Consequences of Aging on Infertility

Infertility among women

As was mentioned earlier, effects of aging on infertility are more pronounced in women than in men. As a woman ages, the number of eggs available for fertilization decrease, thus; reducing the probability of conception. With growing age, the number of follicles leaving the ovaries experiences a steep decline. Nearly 30-35 follicles are released every day in a woman when she is twenty years of age, while this figure drops to just two when a woman is over forty. Therefore, the number of follicles which will later form the antral follicle decreases with increasing age, thus reducing the fertility.

Aging also has damaging implications on the quality of the eggs. Eggs belonging to a 35-year-old female are less likely to undergo fertilization successfully than eggs belonging to a 25 year old. Chromosomal and cellular abnormalities are also prevalent in older eggs. These anomalies may lead to repeated miscarriages and abortions. They are also known to cause several critical genetic chromosomal ailments like Turner’s Syndrome and Down’s Syndrome. Thus women who conceive in their late thirties are more prone to give birth to genetically deformed offspring.

It isn’t only the eggs, which undergo the depreciative process with progressing age; it’s the entire reproductive system. Under normal physiological conditions, certain hormones like the follicle stimulating hormone (FSH) and the Luteinizing Hormone (LH) are released by the Pituitary Gland. This stimulates the growth of the follicles in the ovary, which later will develop into the egg. With increasing age, the hormones’ efficacy decreases, and thus a higher quantity is needed to stimulate the development process.

It’s also believed that the endometrium, one of the layers surrounding the uterus, deteriorates with age, thus making the uterus less hospitable to the embryo.   Page 1  2