Advanced Maternal Age

As you age, there are more challenges to your fertility. If you’re over 38, your chances increase of having a fibroid in your uterus, an STD or infection, or complications from a pelvic surgery. However, either treatment or IVF can address those issues. The biggest concern for women over 38 is their eggs. Because you may have gone through many eggs already (by menstruating), the key question is: how many high-quality eggs do you have? Read on…

How it’s tested

There are two factors we’re interested in: egg quantity and egg quality.

Egg quality (how good they are)

There are no specific tests for egg quality, although we know that quality drops quite a bit in women over 35 – especially if you have endometriosis or other scarring in your pelvis. So being over 38 has a less optimistic outlook, no matter what your medical history is.

Sometimes “peak estrogen” is associated with egg quality. Peak estrogen is how much estrogen you have at the time of ovulation. We like to see levels of about 1000 units. Numbers as low as 500 are still considered normal, but if your peak estrogen is less than 400, we can anticipate lower egg quality.

Egg quantity (how many there are)

There are three tests for egg quantity: Serum Day-3 FSH levels, antral follicle counts and serum AMH. Don’t be scared by those medical words; it’s less complicated than it sounds.

Day-3 FSH

Day-3 FSH used to be the primary test for measuring egg quality. It measured the baseline levels of Follicle Stimulating Hormones. Doctors assumed that if levels were high, your body was working extra hard to get your ovarian follicles moving (which is a bad sign). However, some women with nice low levels still had low egg quality. Because of this inconsistency and other issues, this method is now very outdated and no longer common.

Antral follicle counts

IVF requires a woman to produce 10-15 healthy eggs, which is sometimes difficult if you’re older and have fewer eggs. To nudge your body along, fertility medications are used. But for those medications to be effective, it helps to have a good number of “antral follicles” – ovarian follicles that can produce mature eggs.

Every woman may have a different number of these egg-raising follicles. Your antral follicle count helps us assess how well you’ll respond to the medications, and therefore how well IVF might work. It’s an effective and informative test for us!

The more follicles you have the better: one study (Jayaprakasan et al, Fertility and Sterility, September 2012) measured the antral follicle counts of 1000 women, and found that the live birth rate with 4-10 follicles was 23%, 11-15 follicles was 34%, and 16-22 follicles was 39%.

Serum AMH

The third test, serum AMH, also helps us determine if you can produce the eggs necessary for trying IVF. It’s an even better test than the antral follicle count (which itself is quite good!)

AMH is a hormone released by immature ovarian follicles. Higher levels tell us that you have lots of immature eggs, and a better chance of being able to produce the 10-15 healthy eggs we need for IVF. It’s pretty neat: we can measure the amount of AMH in your body, and multiply it by four to estimate the number of eggs you have.

How it’s treated

There are no proven treatments for egg quality. However, many doctors suggest exploring lifestyle changes and dietary supplements to maximize egg quality.

Our recommended supplements often change, as none have been proven to work in any scientifically definitive studies (called “randomized control trials”). If you’re worried about your age, we strongly recommend contacting your physician. She or he can advise you on supplements and other factors that could maximize your egg quality. Here are just a few examples you could discuss with your doctor:

  • Coenzyme Q10 is a supplement that may give your eggs more energy. This is based on the theory that your eggs will develop better if their mitochondria (the “powerhouse” of each egg) are very active before and after being fertilized by sperm.
  • If you have polycystic ovaries, diabetes or metabolic syndrome, Myo-Inositol may be beneficial.
  • If you have endometriosis, high-dose antioxidants like vitamins C, E and Pignogenol may be helpful.
  • If you have pelvic scarring or your doctor believes there could be blood flow issues, acupuncture may be worth exploring.

This list is just for starters. In our practice, we consider DHEA, AndroGel, Saizen, pre-treatment estrogen, thyroid micromanagement and other tools to try to maximize the likelihood of good-quality eggs. But every woman is different, so speak to your doctor for information tailored to you.

As a general rule of thumb, we recommend sticking with your treatment course for at least two months. Any benefit should be seen within six months, so you don’t need to take supplements longer than this if they aren’t showing benefits.

That said, please don’t experiment wildly with various supplements or put up with bad side effects – take it easy on your body!


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