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Fertility and the Aging Woman


By Dr. Minoos Hosseinzadeh

Fertility and the Aging Woman: “The ‘Hollywood Phenomenon’”

It is a fact that women are born with all of the eggs they will ever have and this number decreases with age, along with fertility potential. The impact of this, however, is usually underestimated. Peak fertility potential is reached when a woman reaches her late 20’s. it decreases by approximately three to five percent each year past age 30, becomes more of an issue at age 35 and decreases dramatically in women over age 40. In the unfortunate event a woman has waited too long, the only feasible treatment modality available to help her start a family is the use of donor eggs.

It is this use of donor eggs that explains the so-called “Hollywood phenomenon,” in which increasingly more and more women are bearing children well into their late 40’s and beyond. When all the facts are not made public, this has the potential of lulling the average woman into thinking that she, too, can delay childbirth without any harmful effect on conceiving her own biological child. Women should know that a decrease in quantity and quality of eggs can translate not only to difficulty conceiving, but also to an increased chance of miscarriage and genetic problems such as Down’s syndrome.

Although, at the present we may be unable to “turn back the biological clock,” modern day advances of egg freezing will hopefully allow us to “stop our biological clock.” Tests like a hormonal evaluation, or day 3 FSH, anti-Müllerian hormone (AMH) and the estradiol levels can help determine a woman’s ovarian reserve. An ultrasound evaluation can measure the basal antral follicle count (BAFC), the follicles that house the egg. A small number of BAFs and the small follicle present in the ovary can spell a poor prognosis. For those with decreased ovarian reserve, the question arises as to whether or not the woman should use her own egg. To do so would require high doses of injectable medications (gonadotropins) to stimulate the growth of follicle in the ovaries, which may or may not be successful. This is usually used in conjunction with intrauterine insemination (IUI) or with in vitro fertilization (IVF). When IVF is performed, genetic testing on the embryos- as with Preimplantation Genetic Diagnosis (PGD) – is also an option.

Donor eggs are the option of choice for women with decreased ovarian reserve. In most cases, anonymous donors from an agency provide the eggs, but they can also be from a known donor. The donor will use hormones (gonadotropins) to stimulate the follicles to grow before undergoing a minor surgical procedure to harvest the eggs. These eggs are then combined with sperm from the patient’s partner. Once the eggs are fertilized, the resulting embryos will be grown in the lab for a few days, and then only those of the highest quality will be chosen to be transferred back into the patient’s uterus. If there are excess, good quality embryos, these will be frozen for use at a later time. Because the patient’s age is no longer an issue, this creates the so-called “Hollywood phenomenon,” whereby women well into their late 40’s and beyond are having kids.

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