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Worried about conceiving over 35?

Worried to death about conceiving because you've now reached your mid-30's?

I just wanted to have a quick rant about this issue after consulting with a lovely couple this evening who are dealing with secondary infertility.

They had conceived their son naturally, a couple of years ago, but in spite of numerous investigations, fertility medications and 1 IVF cycle, still no joy.

When queried on how they were both feeling about it all, the woman told me she was feeling like she was 'near the end'. I said, 'you mean, of trying naturally?', to which she responded, 'No, of trying at all, as I'm 35 this year, so maybe that's it for me'.

This is something I hear all too often and the media have a lot to answer for on this issue.

Here is what I have learnt about the impact of age on fertility, in my 12 years of clinical practice;

- Your chronological age (i.e. what age you actually are) is not the same as your biological age (i.e. you could be 40, but have the internal health of a 32 year old).

- Egg quality is dictated largely by the follicular fluid that nourishes the eggs in the 4 month lead up to ovulation, not solely, how long the eggs have been there.

- I have noticed a definite drop off in ability to conceive naturally, once a woman is past 42/43, yet I have still seen cases of natural conception in my practice up to the age of 45. After that, success with the help of IVF, still with the woman's own eggs, up to 47 years old. Beyond that age, nearly every woman is having IVF treatment with donor eggs.

- Equally, I have seen women of 29/30 who I was quite concerned about because they had so many secondary health issues that I knew would make it harder for them to get pregnant.

- What about the man!! A woman's 'ageing' eggs are often not the problem, as we know that ageing affects men too and in up to 80% of unexplained infertility cases, the problem was the sperm quality, not the quality of the eggs.

- The AMH test is only an approximate measure of how many eggs you have left, it tells you nothing about their quality, which is what really matters.

- On that note, the AMH is a hugely UNRELIABLE test and you can read my detailed discussion of this topic here. I have seen AMH results make a woman feel utterly depressed about her ability to conceive, even when her other hormones (I.e. FSH, LH, Prolactin, Testosterone, Progesterone, Melatonin, DHEA, Cortisol, Thyroxine...see, it's a long list) were actually in good nick and there were no signs that she was peri-menopausal.

- That's not to say I would advise women to wait around Of course not. If you're 35 and have yet to have your first child and would ideally like the option of having a second child in the future, then you should get cracking. If it hasn't happened naturally after 3-4 months of trying, then get tested, so you know what's going on and have the chance to address it before deciding what your next steps should be.

- IVF is not a 'cure all'. Nor should it be your first step, just because you've been trying to conceive for a few months. There are less invasive measures you can try first that may work for you. Plus, the better prepared you are for IVF treatment, the more likely you are to succeed.

Take home message- your egg quality does not fall off a 'cliff' on the day of your 35th birthday, that's just insane. Ask yourself honestly, 'what is my overall state of health?' and 'what areas do I need to improve upon?'. If you do that, then you are already one step closer to conceiving your baby.

There. Rant over.

I hope these thoughts and tips help to calm the frazzled nerves of those of you out there who fall into the '35 and over' camp. It really doesn't have to mean 'the end' of the road, in fact, it might just be your beginning ;)

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