Age and infertility unfortunately go together
As a woman ages, her fertility decreases. This decrease usually occurs slowly up until about 35 years of age, when fertility falls even faster. This drop in fertility is seen even in women who have perfectly normal, regular menstrual cycles. In fact, for some women fertility may no longer be possible 5 to 10 years before menopause. Decreased ovarian reserve is thought to reflect both a decreased number of eggs and a decrease in egg quality.
Women are born with a finite number of eggs and that number decreases every month. A woman’s ovarian reserve depends not only on the quantity but also the quality of the eggs in her ovaries, as well as the quality of the response of ovarian follicles to hormone signals from the brain. As women age, a natural loss of eggs occurs as well as a decrease in the quality of those eggs.
In the few years preceding menopause, the body produces more FSH (follicle stimulating hormone) and LH (luteinizing hormone) due to a decrease in response of the ovaries to these hormones. Menstrual cycles become shorter and eventually stop altogether. The average age of menopause is 50 and by then, ovaries stop functioning and there are few or no eggs left.
Other factors can also cause a decrease in the lifespan of the ovaries, making pregnancy after 40 difficult. Such factors include smoking cigarettes, chemotherapy or radiation from cancer treatment and diseases of the ovaries.
Ovarian reserve testing can provide you with an estimate of egg quality and quantity.
Ovarian reserve testing includes several blood and imaging tests to determine the quantity and quality of a woman’s eggs. These tests are performed on specific days of the menstrual cycle and include blood tests to determine levels of FSH, E2, Inhibin B, or AMH. An ultrasound can also be performed to measure the ovary size and number of follicles.