Trying to get pregnant over 40 is generally not easy. I know because I tried for years to have a baby without success. While there are many factors which impact conception, one of the first concerns for women over 40 is if they have enough healthy eggs to get pregnant. Research has shown that women carry a reserve of eggs throughout their lives and that reserve diminishes over time. There are several tests to assist in pregnancy over 40 which help to determine ovarian reserve including antral follicle testing, the clomid challenge and the AMH test which is relatively new.
The antral follicle test uses vaginal ultrasound to count and measure the small follicles, antral follicles, on the ovary. The higher the number of antral follicles, the better ovarian reserve and better odds for conception.
The AMH Test , anti-mullerian hormone test, measures the levels of AMH in a woman’s blood. Since this hormone remains relatively constant over the menstrual cycle, it can be tested at any point in the month. Women with higher AMH levels tend to have a better ovarian reserve and a better chance at conception.
When I decided to try to conceive one last time at age 44, my reproductive endocrinologist began by ordering the clomid challenge test. For the test, I took clomid, a fertility drug used to induce ovulation, for 5 days. Generally speaking, the procedure works like this:
• On Day 3 of your menstrual cycle, a blood test is given to measure your FSH, LH, and estradiol levels.
• On Day 5 of your cycle, you begin to take a 5-day supply of clomiphene citrate, 100 mg of clomiphene each day for five days.
• On Day 10, you will have another blood draw to check FSH, LH, and estradiol levels again.
Normal results include low FSH values on both Day 3 and Day 10, and low estradiol values on Day 3. Results are abnormal if your FSH values are elevated. Your doctor may decide to re-test if your results are abnormal.
My results were normal but that is a fraction of the total conception story and half of the ovarian reserve story. Ovarian reserve consists not only of the quantity of eggs but also the quality of eggs. Research tells us that while tests like the clomid challenge check for the quantity of eggs, the quality of eggs is generally determined better by age. This is an unfortunate fact for those of us over 35.
According to Dr. James Toner in his paper “Ovarian Reserve, Female Age and the Chance for Successful Pregnancy”, once women reach their mid thirties, specifically 37, their egg quantity begins to diminish at a faster rate. Tonor also reports that even if egg quantity is good, chances of a viable pregnancy drop due to the diminishing quality of eggs as women age.
Based on the research, it is clear that the averages do not look promising for women over age 35 trying to have a baby. There is, however, other information to consider. Let’s take a look at the bell curve. Basically, about 2/3 of the cases for a given situation fall in the fat part of the curve meaning that averages generally apply to most people. However, there are still one third of the people who fall outside of the fat part of the bell curve and averages do not generally apply to them. As you look at your individual situation, it is your lab work, anatomy and physiology that matter. I am a classic example of defying the odds. My ovarian reserve quantity was good but that wasn’t what was preventing me from conceiving a child. It took many more tests to determine that a badly placed uterine tumor was most likely preventing implantation. At age 44, the research showed that an average woman in my situation had only a 3% chance of having a healthy baby. Yet, I was able to conceive in two of 4 IUI treatments and gave birth to a healthy little girl 9 months ago at the age of 45.
There are many components to pregnancy over 40 including ovarian reserve. There are also many medical interventions to boost the odds of conception. Medical research provides us with excellent information about infertility and age including work on ovarian reserve. While the research tells us that the odds of getting pregnant in late 30’s and 40’s diminishes, one needs to remember that each woman is unique and she needs to work with her doctor to explore all options in her quest for pregnancy.