Over 40 and Infertile- A Growing Concern in Our Society

Article contributed by Juergen Eisermann, MD FACOG IVFMD South Florida Institute for Reproductive Medicine, a participating provider in the WINFertility Network Here we are- affluent, educated and career oriented. All that college- and post graduate training is finally paying off. Our daughters are into exploring the options and career choices offered to them, and they are doing a fabulous job! Over half of all physicians are women, lawyers the same, and if you look around the sales and promotional industry, women dominate those fields- because they are good at it. The same goes for architecture, design broadcasting, education and of course, the entire health care provider sector. All this is sort of new for the generation following the baby boomers. In the past, only actresses would delay childbirth for the purpose of staying in the lineup, so to speak. Now, the hungry and the ambitious are mapping out their careers at a time in their lives, when their mothers were already married and taking care of their kids. Naturally, this has to have consequences. Aging does not stop at the egg cell. To the current day, nobody has found a way to stop the perpetual loss of eggs over time. There is no pill, no supplement, no magic formula, to slow down the deterioration of egg quantity and quality. To make things worse, with age we tend to gain extra pounds, develop certain dining preferences and tend to stay out of the gym, ‘cause there is this meeting to prepare for or the dinner to go to or the on call schedule that prevents a structured private life. Needless to say, the metabolism associated with overweight, perpetual stress and lack of good sleep creates a type of oxidative stress, that makes normal cell function a thing of the past. Add to that the growth of the new uterine fibroids, the emergence of endometriosis (the disease of the type A personality) and the difficulty to properly time undisturbed, enjoyable relations- all this qualifies for acceptance into the ever growing sorority of what we call the reproductively challenged, yet fully educated and informed, determined, mostly 40 and older group, that is also defined by the conviction, that this “little fertility issue” can be managed just like all the other obstacles they have been able to clear out of the way so easily in the past. Not so fast! Sure- modern reproductive medicine can offer comprehensive genetic screening. This procedure is able to check for normal embryos, but does not assure them by any means. Absolutely, one can transfer genetically healthy embryos with in-vitro fertilization- but there is no more than a 60% chance they will attach and grow. It has been truly frustrating to experience the high percentage of poor quality embryos and the low probability of finding healthy embryos in this over 40 population. And then I hear: Doc, I am going to prove your statistic wrong! I just need one more trial, please! It is truly amazing how fast rational decision making goes overboard the moment a desperate woman is attempting to beat the odds. It sure is tempting to use fertility medications as psychotherapy- but at some point it just keeps prolonging the agony. Practicing ethical medicine in a highly charged scenario with nothing but confidence and determination sitting across from you is not always easy. You feel for the person, you wish to provide the outcome desired, but you quickly recognize the limits of what you can accomplish reliably. I love to counsel those over 40 ones, and I throw myself into the battle 100 percent, but I can’t stop thinking about the beach boys and their song: I wish they all could be California (=under 40 year old) girls…