You finally find the love of your life. A few months or years later, you get married. Shortly after your honeymoon, family and friends are pressuring you to start a family. I think everyone who has gone down this path has felt these pressures and maybe some of you have said “We’re quite not ready yet,” or “Can we just enjoy the honeymoon stage for a little while?” But I hate to say it: your friends and family might be on to something. As we get older ladies, so do our eggs.
Unfortunately, we were born with all the eggs we ever need: roughly 1 to 2 million eggs in our ovaries. We lose roughly 11,000 of them prior to puberty! Once we hit puberty and menstruation begins, we roughly have 400,000 eggs remaining. With every menstrual cycle, we lose 1,000 more eggs for that one lucky follicle that will become mature, float down the fallopian tube, and start ovulation. In the end, out of the 1 to 2 million, approximately 400 will become mature follicles throughout a woman’s fertile years.
Here at Carolina Conceptions, our embryology lab has over 40 years combined experience in the IVF field. With our combined experiences, we’ve seen a diverse quantity of women’s eggs/embryos. From a laboratory perspective, the quality of embryos does decrease after the age of 35, and continues to decrease as we mature. This is a fact ladies, and something that we wish wasn’t true, but is. By all means, you are still able to have a successful pregnancy after the age of 35. Many of our patients’ who are in their early 40s have great success, it just may take a bit longer than it would for a woman in her early 20s.
From a laboratory perspective, an embryo needs to possess two major components: the inner cellular mass (ICM) and trophectoderm cells (TE). The ICM creates the baby itself while the TE cells form the placenta. If these components are of good quality on a day 5/6 embryo, then the outcome for a healthy baby is promising! However, if these components are small in structure, or nonexistent, it is likely a woman will not become pregnant or will miscarry.
Women of all age groups will have good, fair, and poor quality embryos. However, the poor embryos are more prominent for our more mature patients then they are for our younger ones. With the process of In-Vitro Fertilization (IVF), combined with Preimplantation genetic screening (PGS), we’re able to pick the good from the bad, and the normal from the abnormal embryos. These processes are extremely beneficial for our more mature patients because they can reduce miscarriage rates and chromosomal abnormalities significantly. Typically a patient will undergo two IVF cycles to achieve a healthy pregnancy. However, as we mature, some women may need to undergo a few more cycles, or opt to do a donor egg cycle to get that good quality embryo to produce a healthy pregnancy.
As a woman ages, so does the quality and quantity of her eggs. Chromosomal abnormalities such as Down’s Syndrome, miscarriage rates, and health issues such as diabetes and high blood pressure all increase as we mature. Ovarian reserve decreases as well, making it harder for a patient to conceive without ART (Assisted Reproductive Technology). Despite these possible complications, a viable pregnancy is still an option, it just comes with a few precautions.
In the laboratory, we see a variety of women’s’ eggs and embryos from all age groups (18-44). Even though an egg/embryo may appear to be similar, age does affect how an egg/embryo will develop into a fetus.
Here is a picture of a 41 year old’s eggs. We retrieved four eggs on this patient. Two eggs were mature and injected with sperm via ICSI, two developed through day three (6 to 8 cell stage), but unfortunately stopped development on day five/six. This seems to be a frequent event with many of our more mature patients. Some patients try multiple cycles with similar results. Depending on a patient’s embryos, some may yield a viable pregnancy, while others may not.
In contrast, here are the eggs of a 32 year old. As you may notice, they appear to be similar in quality to the 41 year old’s eggs. However, the age of this patient may have played a part in the outcome. We retrieved 34 eggs. 18 were mature and injected by ICSI, 16 fertilized, 16 developed on day three (6 to 8 cell stage). On day five, three were blastocysts and one was frozen. Finally, on day six, seven were blastocyst stage and five were frozen. This patient ended up with six frozen embryos frozen for a future FET (frozen embryo transfer) cycle.
The eggs from both patients look similar, but yielded much different results for each of the patients. Every IVF cycle a patient goes through can produce different results due to various stimulation plans. But in the lab, it seems that repeated cycles are generating similar results for some of our mature patients. This is most likely related to one’s age.
Now you might be asking yourself, why does this happen? Well, there are many scientists working on this very question. They are still not sure exactly of the cause, but some say environmental factors and age related damage occur during the process of meiosis (the form of cell division that creates sex cells).
As a woman ages, the chances of chromosomal disorders increase, relating to a decrease of cohesion proteins. These proteins hold chromosomes together as they line up during meiosis. If these proteins have something wrong, an egg with the wrong number of chromosomes often results. Older eggs simply do not have enough of these proteins, which makes the chromosomes during division of meiosis go in different or similar directions, causing abnormalities. It is these proteins that scientists are starting to believe deteriorate as a woman ages.
It is important to remember that women of all ages may struggle at some point to achieve a healthy pregnancy. If you are struggling, or if you are 35 and older, seek medical help. The longer you wait, the harder and more frustrating it can be. Remember every patient is unique and different, so are their egg and embryos. No two embryos are the same. As long as an embryo has the right components, then the hope for a viable pregnancy is there, no matter what age you may be.