Your Biological Clock -- A Race Against Time?-- Amos Grunebaum, MD-- 02/23/04
By Amos Grunebaum
WebMD Live Events Transcript
You've seen the reports about fertility declining as you age, but what does it mean for you? What are the chances of success? What are the risks? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us to talk about trying to conceive at 30, 40, and beyond.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Member question: What is so magical about the age of 35 -- it seems that everything you read about concerns women 35 or older. I just turned 35; should I be worried that when we do get pregnant there will be lots of concerns?
Dr. Amos: There is really nothing completely magical about being 35, but at 35 your chances of becoming infertile rapidly increase. This increase becomes more pronounced as you become older. And many doctors feel that at and beyond 40, especially, your chances of delivering a healthy baby decrease even more rapidly.
Member question: When does fertility for men lower? My husband is 38 and I am 28. We've been trying for 8 cycles and so far there is nothing odd about my cycle that would prompt me to get tested (24-day cycle; 12-day luteal phase). Should the first step be my husband getting a semen analysis?
Dr. Amos: For men, fertility decreases significantly at a higher age, most likely beyond age 50.
Member question: I am 35 years old and apparently have not been ovulating every month. For two months now I have been using ovulation tests for at least 10 days (each month) and although I get a faint line the line never darkens to indicate ovulation within 12-24 hours. I had a miscarriage in October, so I know that I ovulate at least some of the time. What would be your suggestion?
Dr. Amos: The first step would be to make sure to find out exactly when and if you ovulate. This information can be achieved quickly by doing a fertility chart. Once you know that your ovulation is normal, then the next step in evaluating fertility is to do a sperm count and to check your fallopian tubes. This information can then be used to help identify where the problem is and how to treat it.
Member question: I am nervous that I won't get pregnant after reading about 35 and over! I know you can but it is a great fear! Should I be so concerned? We already have two children. We know we can get pregnant. Should I be concerned because I am trying at 35?
Dr. Amos: The decision when to have a baby is based on a lot of different information. It depends on your relationship with each other, your work, and your finances, among other things. So the information that as you get older you are less likely to have a healthy pregnancy is just one part of this information. So if you decide to not have a baby at this point and wait some more time, you can say that you were educated, and can't say, "I did not know that I could be infertile at a later age."
Member question: I have heard that women from different races mature at different paces -- for example I am Asian and I find that Asians on average are the slowest to mature compared with other racial groups. Does it also indicate that we also have more leeway to wait to conceive by an extra year or two?
Dr. Amos: The 35-year cutoff applies to all women, independent of the race, so I would assume that at 35 in every woman fertility decreases rapidly, no matter where she is from.
Member question: I am wondering if the risk is too high for me to attempt pregnancy again. I am 37 and had a horrible pregnancy two years ago, was on bed rest for a polyp (bleeding), had to have surgery to get pregnant (adhesions), got gestational diabetes, and at labor had an abruption. I am scared and thinking maybe it is not a good idea at my age and the state of my health.
Dr. Amos: You clearly will be a high-risk pregnancy. And before you become pregnant I suggest that you see a high-risk doctor; that's usually a doctor who is subspecialty board certified in maternal-fetal medicine. You should see the doctor, get examined, and review your history. You can then discuss what you can expect when you become pregnant.
You may want to get tested now for diabetes, because treating diabetes now will improve pregnancy outcome. And don't forget to take your daily dose of 400-600 mcg of folic acid a day to prevent fetal malformations. You must start taking it at least one to two months before conception.
Member question: Which prenatal vitamins are better: Ones from the grocery store or a prescription? I think as long as they have enough folic acid, I'm OK. What are your thoughts?
Dr. Amos: There are many different choices of prenatal vitamins. You should carefully read the label and make sure you know all of the ingredients. Once you know the exact ingredients you can decide which one to take. Just make sure it's a prenatal supplement, not a general vitamin. General vitamins can contain too much of certain vitamins for women who are TTC and during pregnancy.
Member question: If the clock is ticking, then why do some docs make you wait yet another six months to one year as the "usual amount of time" a couple needs to be trying -- wouldn't three months work before doing testing?
Dr. Amos: That is something you should discuss with your doctor. But you are correct; there is no absolute time to wait. Meanwhile, you can do a lot of things while waiting to see the doctor.
The first step is to make sure you ovulate regularly. If you don't ovulate regularly (do a fertility chart at the WebMD Fertility Center to find out) then you know already that there is a problem and should see your doctor immediately.
I also suggest that your partner has a sperm analysis as soon as you start TTC. Doing a sperm count test will save you valuable time that you otherwise may lose.
Once you know that you ovulate normally and that his sperm count is fine, then you should try and time sex regularly. Many couples I see in my office don't realize that making love regularly is essential when trying to conceive. Only after they see me do they realize that they haven't made love as often as they should have.
Member question: I am 35 and have been TTC for over two years. The only diagnosis my RE can give is "unexplained" infertility. Would you recommend fertility meds to women my age, even though I ovulate regularly and my hormone levels are fine?
Dr. Amos: Unexplained infertility is a diagnosis made when all tests are normal and you still can't get pregnant. There are several approaches to this diagnosis. One is to wait some more time and continue trying. Many couples with this diagnosis will eventually be able to get pregnant on their own.
In general, the success rate of IVF in couples with unexplained infertility is excellent, often exceeding 50% in the first month.
Moderator: OK, folks, we'll open things up to all of the TTC topics you've been asking about.
Member question: I'm 25 years old and have had two early miscarriages in the past. We weren't TTC then but we are now. Is there a better chance for me to have a healthy pregnancy because I am aware of us TTC (eating healthy, quit smoking, lost weight) or does that even factor into TTC?
Dr. Amos: You may want to discuss your prior miscarriages with your doctor. In general, most women will be able to have a healthy pregnancy after two miscarriages, but to make sure, some doctors will do some tests and see if there is anything that needs treatment.
Member: I have discussed the miscarriages with my doctor; she wasn't too concerned yet
Dr. Amos: That is not unusual. Good luck!
Member question: How long after having the Miretta (IUD) can I be fertile again? I finally had regular cycles in December and January of 28 days. Then on Feb. 7th I only had a one-day period with two other days a little spot of blood on both other days. I am not taking any kind of contraceptives. I am 30 years old. This would be my second child. What are the chances of me conceiving soon?
Dr. Amos: It's all about the BIG O (OVULATION). Miretta contains hormones that can sometimes affect ovulation. But once the IUD is removed, the medication is out of your body and you should be able to ovulate regularly again. So in the next cycles you may want to monitor your ovulation and see when and if it happens. This information will help you find the answer to your question.
Member question: Dr. G, is there ever a point during a long TTC journey when you speak to your patients about alternatives such as adoption?
Dr. Amos: Adoption is always an option for every couple, and it's a very personal decision to make, which many times is at the end of TTC evaluations or infertility treatments. I am glad that you are bringing up this issue, because every single couple trying to have a baby, even those without major infertility problems, should always consider adopting a child. It should rarely, if ever, be the last resort, but should be an option for everyone who wants a child.
Member question: Dr. Amos I am 21 and everyone keeps saying that my body hasn't matured enough yet to have kids, and that I should wait until I am at least in my 30s. What age do you suggest women start having children?
Dr. Amos: From a statistical point of view 21 is an optimal age to have a child, but I am just speaking from a medical point of view, and there are many other considerations for having a baby besides medical aspects. There are emotional and financial aspects too.
Member question: I am 30 years old and have tried five IUIs and one ICSI but have not been able to conceive. The eggs fertilize and my husband's sperm count is good, but the embryo does not implant and the uterine lining does not reach a good level. What would you suggest I do to improve uterine lining?
Dr. Amos: The issue of ICSI and IVF and endometrial lining is very complicated, and many infertility specialists have come up with different solutions to this issue. Unfortunately we can't mention them all here in this small space. Each treatment needs to be individualized and the very best approach is to find a competent and experienced infertility specialist who can evaluate the problem and design an individual approach for each woman.
Member question: What are your feelings on natural supplements like Vitex, Evening Primrose oil, flax seed, aspirins, etc.?
Dr. Amos: Before you consider these supplements you should look at yourself and see what's going on. If his sperm count is not OK, then no matter what supplement you take, you won't get pregnant. And if your fallopian tubes are closed then no matter what you take, you won't get pregnant. But if these issues are resolved and you want to take the extra steps in trying to conceive, then sometimes chaste tree berries may improve fertility. I am aware of some studies showing that Vitex agnus-castus may improve hormonal balance, but I am not aware of the same for the others.
Member question: I just bought an ovulation predictor kit (Clearblue Easy) and it has 99% accuracy. Should I use first morning urine or midday? Does that matter?
Dr. Amos: Your optimal timing is twice a day, 12 hours apart. That way you can be sure you will not miss the initial peak. But if you test only once, then it's suggested to test the early afternoon around 2 p.m. to 3 p.m.
Member question: I have a question about charting. When you refer to charting, what exactly are you talking about? I assume you are talking about something beyond BBT.
Dr. Amos: The WebMD Fertility Center explains all different aspects of charting. It is not just the temperature, but includes other things such as CM and timing of sex. They have a great introduction to charting and I strongly urge everybody interested in getting pregnant faster to sign up on the Fertility Center.
Moderator: Thanks again to Amos Grunebaum, MD, for talking TTC with us.
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