Seattle Press on Line - When Fertility Drugs Don't Work

Body and Soul

When Fertility Drugs Don't Work

By Amy Poffenbarger

Apr 04, 2001 -- Women entering their late 30s may find themselves facing a challenge that has vexed their predecessors in the Baby Boom generation: how to have a child at this stage in their lives.

Many women, for many reasons, put off trying to have a baby. They are often surprised and disappointed to discover that their odds of conceiving and successfully delivering a child dramatically decrease in the decade before menopause, says Dr. Nancy Klein, an assistant professor of obstetrics and gynecology at the University of Washington School of Medicine. She practices at UW Medical Center Fertility and Endocrine Center in Seattle.

Fertility drugs are often ineffective in treating age-related infertility, Klein says. The drugs are aimed at getting a woman to produce more eggs, to increase the odds of successful conception. Older women's ovaries are often resistant to these drugs, so that they fail to produce multiple eggs. More importantly, for reasons that are still unclear, most of the eggs produced by older women are defective.

"There's a slight decline in fertility at age 30. It becomes a little more steep as you pass through the 30s and then drops more dramatically somewhere around age 38," Klein says.

The problem lies within the chromosomes, which are a vital part of every living cell. Because of chromosomal disorganization within the egg, the odds of a 45-year-old conceiving a pregnancy that results in a successful delivery are only about two percent per month. That's partly because even if there is conception, many of the defective eggs won't implant on the uterus. And if they do implant, the odds of miscarriage are as high as 50 percent.

Unfortunately, there is no sure way to predict when you're younger whether you will be one of those who could have successful pregnancies in later years. A test of FSH, or follicle-stimulating hormone, may provide a clue. The level of FSH normally rises as women approach the later reproductive years. A woman who is 30 and who has an abnormally high FSH should know that she is already becoming less fertile and may be destined for earlier menopause, Klein says. But it is not a sure-fire clue; scientists are still investigating how a high FSH level affects fertility in otherwise normal, younger women.

By the time a woman is 42, taking fertility drugs will only marginally increase her odds of successful delivery, Klein says. The alternative for many people is egg donation.

Egg donation uses the male partner's sperm to fertilize eggs donated by another woman. The donor is usually a woman under 35 who does not have a history of infertility. The fertilized egg is then transferred into the female partner's uterus. Fortunately, the aging mechanisms that cause deterioration of the egg usually do not seem to affect the uterus. So an older woman, if given appropriate hormones, can successfully bear the child.

It can be emotionally difficult for women to accept the need for this method, Klein says. Some feel disappointment and depression. Others may disagree with what the doctor is telling them. They may know someone in her 40s who had a child, and figure they too can be an exception. They may say their periods are regular, and that their hormone levels are normal. But the bottom line, Klein says, is that their eggs are often defective.

This means that older women should think about these issues as they plan a family. In general, fertility experts recommend that couples seek professional assistance if they've been trying to conceive without results for a year or more. For women 35 and older, the recommendation is to wait no longer than six months.

"Even though it is frequently normal to take that long to conceive, if there is a problem, you want to recognize it early to initiate treatment at a time when it is most likely to be effective," Klein says.

For more information, contact the Fertility and Endocrine Center at the University of Washington, (206) 598-4225 or (206) 598-4493.

Reader Comments

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HJ LUI	Apr 04, 2003	SEATTLE	SCIENTIST
I AM 28 YEARS, ASIAN WOMAN, HEALTH. I WOULD LIKE TO DONATE AGGS TO HELP OTHERS.


Lena	May 18, 2004	Kennewick,WA	cpa
I am interested in contacting the reader (HJ LUI) who posted the comment on April 4,2003 related to the article titled "When Fertility Drugs Don't Work" Can you help me with an e-mail address?