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Premature ovarian failure (POF), also known as premature ovarian insufficiency (POI), is a condition in which a woman's ovaries stop functioning normally before the age of 40. It is estimated that POF affects approximately 1 in 100 women, making it a relatively common condition with significant implications for reproductive health and fertility.
The premature loss of ovarian function can result in hormonal imbalances and infertility. In this blog, we will explore the causes, symptoms, diagnosis, and available treatment options for premature ovarian failure.
Premature ovarian failure can have various causes, including genetic factors, autoimmune disorders, and certain medical treatments. Premature ovarian failure can occur at any age before 40, but it is diagnosed on average at the age of 27, and most commonly between 30 and 39.. In some cases, the exact cause remains unknown. Understanding the different causes can provide insights into the underlying mechanisms of POF.
Let's delve into each cause in more detail:
Genetic abnormalities are responsible for a significant portion of POF cases. Turner syndrome is a genetic condition in which women have only one X chromosome instead of two. It affects approximately 1 in 2,500 female births and is associated with a high risk of premature ovarian failure. Women with Turner syndrome have underdeveloped ovaries and experience ovarian dysfunction, leading to early loss of ovarian function.
Another genetic disorder linked to POF is Fragile X syndrome. Fragile X syndrome is the most common inherited cause of intellectual and developmental disabilities. It occurs due to a mutation in the FMR1 gene on the X chromosome, which can result in ovarian dysfunction and premature ovarian failure. Fragile X syndrome affects around 1 in 11,000 women.
X Chromosome Abnormalities: Besides Turner syndrome, other abnormalities affecting the X chromosome can lead to POF. For example, certain structural abnormalities or deletions in the X chromosome can disrupt ovarian function and result in premature ovarian failure.
Autoimmune disorders contribute to about 25% of POF cases. In these conditions, the immune system mistakenly attacks the ovarian tissue, leading to ovarian dysfunction and premature ovarian failure. Hashimoto's thyroiditis, an autoimmune disease that affects the thyroid gland, has been linked to an increased risk of POF. Addison's disease, an autoimmune disorder that affects the adrenal glands, is also associated with a higher incidence of premature ovarian failure.
Certain medical treatments can damage the ovaries and disrupt their normal function, leading to premature ovarian failure. Chemotherapy and radiation therapy, often used in cancer treatments, are known to cause ovarian damage. The severity of ovarian damage depends on factors such as the type and dosage of chemotherapy drugs, radiation intensity, and the patient's age. These treatments can lead to a reduction in the number of viable follicles and a decline in ovarian function, resulting in premature ovarian failure.
In some cases, the cause of premature ovarian failure remains unknown, and it is classified as idiopathic. This means that no specific cause can be identified despite extensive testing and evaluation. However, ongoing research is being conducted to uncover the underlying mechanisms and potential genetic factors associated with idiopathic POF.
Recognizing the symptoms of premature ovarian failure is crucial for early detection and appropriate management. Common symptoms include irregular or absent menstruation, hot flashes, night sweats, vaginal dryness, and mood changes.
These symptoms may vary from woman to woman, but it is important to seek medical attention if any of these signs are present. By identifying the symptoms and seeking timely medical care, women can receive a proper diagnosis and explore available treatment options.
To diagnose premature ovarian failure, healthcare providers employ various tests and assessments. Hormone-level testing plays a significant role in determining ovarian function. Blood tests that measure the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol can help identify hormonal imbalances associated with POF.
In women with POF, FSH levels are often elevated, while estradiol levels are reduced. Additionally, genetic testing may be recommended to identify any underlying chromosomal abnormalities associated with POF, such as Turner syndrome or Fragile X syndrome. Ovarian reserve testing, which involves an ultrasound examination to assess the number and quality of remaining ovarian follicles, can also contribute to the diagnosis of premature ovarian failure.
While premature ovarian failure is not reversible, there are treatment options available to manage its symptoms and associated fertility issues. Hormone replacement therapy (HRT) is a common approach that involves taking estrogen and progesterone to alleviate menopausal symptoms and maintain bone health.
It is interesting to note that HRT can also help preserve the uterus for future pregnancy. However, it is important to consider the potential risks and benefits of HRT in individual cases, and healthcare providers can guide patients in making informed decisions.
Fertility preservation is another crucial consideration for women diagnosed with premature ovarian failure who desire to have biological children. Egg freezing (oocyte cryopreservation) or embryo cryopreservation can be pursued before undergoing medical treatments that may affect fertility.
These techniques allow women to preserve their eggs or embryos for future use, increasing the chances of achieving pregnancy later on. The success rates of these procedures may vary based on factors such as the woman's age and the quality of the eggs or embryos.
In cases where fertility preservation was not pursued or if spontaneous conception is no longer possible, assisted reproductive technologies (ART) such as in vitro fertilization (IVF) may be considered. IVF involves the retrieval of eggs from a donor or the use of previously frozen eggs, which are then fertilized with sperm and implanted into the uterus. The success rates of IVF depend on various factors, including the age of the woman and the quality of the eggs or embryos used.
Premature ovarian failure is a condition that significantly impacts women's reproductive health and fertility. Genetic factors, autoimmune disorders, and certain medical treatments contribute to its development. By understanding the statistics related to POF, women can become more aware of their risks and seek appropriate medical care.
Early diagnosis through hormone level testing, genetic testing, and ovarian reserve testing is essential for effective management. Treatment options, including hormone replacement therapy, fertility preservation, and assisted reproductive technologies, can help manage symptoms and provide alternative paths to parenthood.
It is important for women diagnosed with premature ovarian failure to consult with healthcare professionals who can provide personalized guidance and support throughout their journey.
When planning for baby number two, women with a history of fertility issues may question how getting pregnant for a second time will be different than the first. The decision to expand the family is an exciting one. However, for couples who have experienced infertility in the past, preparing for a second baby can cause fear, anxiety and uncertainty.
Thankfully, second-time parents have experienced pregnancy before, which can help relieve the stress of the unknown. Taking the time to consider the factors that can affect a second pregnancy can give couples an idea of what to expect this time around.
It may be important to some couples that their children be close in age, motivating them to expand their families more quickly than others. While the decision is ultimately a personal one, not waiting long enough between pregnancies can be risky for both the mother and baby, especially if the previous pregnancy was strenuous.
Research suggests that ideally, women should wait 18 months between pregnancies. The interpregnancy period for women who have a history of infertility issues is not any longer or shorter than for women without.
Pregnancies less than 12 months apart can put infants at risk of congenital disorders such as preeclampsia and in some cases developmental disorders such as autism. Studies found that short interpregnancy intervals carry a 3% increased risk of preeclampsia and two to three-fold increased autism risk. Babies conceived within six months of a previous birth have an 8.5% risk of being born prematurely and the risk of miscarriage in these pregnancies increases by 230%.
Having a baby is no easy task and while it may be natural for new moms to shift focus from caring for themselves to caring for their new baby, it is important that women dedicate enough time after giving birth to recovering both physically and mentally.
Research shows that mothers need at least 12 months post-birth to fully recover in the following ways:
While not waiting enough time between pregnancies is ill-advised, waiting too long to get pregnant carries its own set of risks. One study found that women waiting 72 months or longer between pregnancies were at a higher risk of stillbirth than women who waited less than 6 months. This can be traced back to physiological changes affecting pregnancy in older women.
Couples on their second pregnancy have naturally aged since the birth of their first baby, which automatically decreases fertility in both partners. Parents who experienced fertility issues with their first baby should also take into consideration the role of aging in infertility.
Women who used ART, such as IVF, for their first baby may be worried about how this might affect their chances of having a second child. While there are no guarantees, a recent study published very positive results for IVF baby number two, reporting 43% of women had another baby after just one frozen embryo transfer. After six cycles of frozen embryo transfer between 61% and 88% of women had a baby.
It is important to note that these results differ when using fresh embryos, with successful birth rates standing at 31% after one IVF cycle. Frozen embryos are advantageous especially for women who are older at the time of the cycle than they were upon freezing the embryos.
IVF technology has advanced immensely, giving women with fertility issues a much greater chance at having children than ever before. That being said, science cannot prevent the aging process altogether and women who know they want to have a second baby should not wait too long before starting the process again. The study showed that success rates decreased with age, with women aged 40 at a 20% chance of getting pregnant with fresh embryos.
Women who experienced fertility issues with their first baby are likely familiar with the potential causes of primary infertility and how these factors might affect a second pregnancy. After giving birth, however, women can sometimes sustain damage to their reproductive organs caused by complications during pregnancy or surgery, posing a different set of infertility risks.
Some of the leading causes of reproductive organ damage are:
For parents that experienced difficulty with conception or pregnancy in the past, the thought of going through a similar process again may bring up more feelings of anxiety than excitement. Fertility problems can be traumatic and isolating, leading some to self-blame.
It may be hard to remember, but millions of couples face fertility issues each year. Some may find comfort in the fact that they are not alone in their struggles and can look to support groups or counselors. Building strong support networks either through therapy, friends, or family, can help cope with feelings of fear and loneliness surrounding the topic.
Some may prefer to keep their fertility treatments private. In this case, strong communication between partners is important to maintaining emotional health in the relationship. Setting realistic expectations before trying for a second child can help prepare for emotions that may arise, no matter the outcome.
Sometimes fertility can take center stage, making it easy to forget the importance of self-care. Mothers need to take care of themselves by exercising, eating right, and getting proper rest. Anxiety can negatively affect fertility, so while it may seem difficult, relaxing can actually make a difference.
Becoming as informed as possible can help empower couples by allowing them to make the right decisions depending on their situation. Consulting a fertility specialist is the best way to determine the best course of action.
Families that take time to do their research can regain a sense of control and calm. No matter the chosen path to becoming a second-time, we hope your experience is as smooth as possible.
For couples who conceived easily and naturally and had a healthy birth for their first, or even second and third, children, secondary infertility (SI) can be a huge shock. But the truth is that secondary infertility occurs approximately as often as primary infertility.
Secondary infertility means that a couple was unable to conceive after 12 months of unprotected sex, after having previously had one or more healthy pregnancies and births. Some couples with secondary infertility are able to conceive, but experience miscarriages and/or stillbirth that prevents them from reaching a live birth.
Some couples have secondary infertility after multiple previous healthy births.
Note that it’s only called secondary infertility if your first birth occurred naturally. If you used fertility treatment like IVF to get pregnant the first time round, then any struggles to get pregnant a second time are considered part of your primary infertility.
It’s generally thought that secondary infertility affects about as many couples as primary infertility. One study from 2006 reported that 3.3 million women suffered from secondary infertility, and that secondary infertility now accounts for 60% of all cases of infertility.
Another study revealed that among women aged 20-44, 10.5% experienced secondary infertility, while a report from the CDC calculated that 39% of women with fertility issues were suffering from secondary infertility.
It’s clear from these figures that a significant number of couples experience secondary infertility, but it goes under the radar of society far more than primary infertility.
Secondary infertility can originate in either the woman or the man.. It’s estimated that SI cases are divided roughly equally between male-caused infertility, female-caused infertility, and secondary infertility due to unknown causes.
When secondary infertility originates in the woman, it can be caused by:
Secondary infertility that originates in men can be caused by:
The good news is that treatment for secondary infertility can have higher success rates than those for primary infertility. That’s because it’s usually possible to identify a specific cause for SI, and once the cause has been dealt with, fertility levels return.
In general, treatments for secondary infertility are similar to those for primary infertility.
When secondary infertility is caused by adhesions in the uterus or testicular varicocele, surgery to remove the scar tissue, fibroids, or other blockages, and to fix enlarged veins in men, can be very successful.
When secondary infertility originates in the woman, they are often given medications such as clomiphene and letrozole to increase and speed up ovulation and overcome ovulatory disorders.
When SI originates in men, they may be given antioxidants and anti-aging medication to improve sperm quality.
Depending on the cause of the SI, couples might be counselled about changing their diet to lose weight, reducing their caffeine and/or alcohol intake, and/or avoiding certain pollutants.
Timed intercourse together with ovulation monitoring can also help couples with secondary infertility to conceive.
Intrauterine insemination, or IUI, is when sperm is surgically placed within the fallopian tubes to increase the chances of fertilization. It’s been found to be very successful among couples with unexplained secondary infertility, with one study reporting IUI success rates of 47.4% among couples with SI, in contrast with 8.4% among those with primary infertility.
If other approaches don’t result in a healthy pregnancy, couples with secondary infertility are often advised to try IVF. IVF can be more successful among couples with SI than those with primary infertility.
Secondary infertility might be less talked about than primary infertility, but it can be just as upsetting for couples trying for another baby. If you’re struggling to conceive after one or more healthy births, take heart from knowing there are many successful treatment options which can help you build the family you dream of. Whatever path you take to adding to your family, we hope it’s as smooth as possible.
Maintaining good health is always a concern, but when you’re pregnant or trying to conceive, the world can feel like it’s full of germs and infections.
It’s an understandable feeling. There are some diseases and bacteria which can cause serious problems for you and/or your baby, but that healthy people would ordinarily shrug off.
But most of these health threats can be kept away by following good hygiene practices and getting vaccinations on time. Here are some of the diseases that can be harmful during pregnancy, and what you can do to protect yourself and your baby.
Chickenpox is usually harmless for children, but it can cause serious damage if you catch it while you’re pregnant. If you get infected with chickenpox before your 28th week of pregnancy, there’s a 2% chance that your baby could develop foetal varicella syndrome (FVS), which can harm their skin, eyes, legs, arms, brain, bladder and bowel.
If you catch it between 28 and 36 weeks, your baby will be infected too, but he/she won’t be born with any symptoms. However, it could become active while your child is still a baby or toddler, and cause painful shingles.
If you catch chickenpox after week 36, your baby will be infected and could be born with active chickenpox.
If you didn’t catch and recover from chickenpox yourself as a child, you should get vaccinated before you start trying to conceive.
Whooping cough (pertussis) has been rising in the last few years, with a serious epidemic in 2012 that saw 10 times as many cases as normal in the UK, and more annual cases than any year in the last 60 years in the US.
Whooping cough isn’t dangerous during pregnancy, but it can be fatal for your new baby. Babies under 6 months are too young to be vaccinated against the disease, but they are protected by your antibodies.
You were probably vaccinated against whooping cough when you were a child, but by the time you come to start a family, your antibody levels have dropped. They are usually high enough to protect you from the disease, but don’t provide enough protection for your newborn baby.
That’s why public health authorities in many countries recommend that women get a booster shot some time between 16 and 32 weeks of pregnancy.
It takes 2 weeks for antibody levels to peak and transfer to your baby. Then your baby has whooping cough antibodies in their own system to keep them safe until they can be vaccinated themselves.
CMV, or cytomegalovirus, is a common virus that’s part of the same family of diseases as cold sores and chickenpox. Once you’ve caught CMV, it remains dormant in your system but it can be reactivated if you get exposed to the virus again.
Most people catch CMV and have nothing more than a cold. But if you catch it or get reinfected when you’re pregnant, your baby could be born with congenital CMV, which can cause blindness or visual impairment, hearing loss, epilepsy, learning difficulties, or more serious birth defects. CMV can also cause stillbirth. It’s worst for babies whose mothers hadn’t been infected with CMV before, and catch it for the first time during pregnancy.
CMV is only harmful to your baby if it’s active while you're pregnant. The dormant virus isn’t dangerous.
Around 1 out of 150 babies is born with congenital CMV, and around 20% of those have birth defects or long-term health problems. Disabilities caused by CMV are more common than those caused by Down’s syndrome, spina bifida, or cystic fibrosis, which are all better known than CMV.
CMV is highly infectious, and it’s passed on through bodily fluids like urine, mucus, saliva, and tears. Small children often catch and pass on CMV, so you should be particularly careful if you come into contact with them.
Currently, there’s no effective way to treat CMV in babies or in pregnant women, although giving babies antiviral medication shortly after birth can reduce the severity of their symptoms. To prevent catching it, you should
Wash your hands regularly with soap and hot water, especially after changing diapers or wiping a child’s nose
Avoid sharing food, plates, or silverware with young children while you’re pregnant
Avoid kissing a child on the face
Flu is no fun at any time of life, but it’s particularly serious during pregnancy. Pregnant women are at a higher risk of developing complications from the flu, and it could cause your baby to be born prematurely, with birth defects or low birth weight.
Flu can also cause stillbirth. The best protection is to get the flu vaccine. One study found that stillbirth rates fell by 51% among women who received the flu vaccine
Most women are vaccinated against rubella in childhood, in which case you’re immune for life. But if you haven’t been immunised and you didn’t catch it as a child, you should get vaccinated before trying to conceive. It’s not recommended to get vaccinated during pregnancy.
If you develop rubella during your first 4 months of pregnancy, you could experience a miscarriage or have a baby with serious birth defects like heart damage, brain damage, vision problems, or deafness.
Toxoplasmosis is a disease caused by parasites that are found in cat faeces, so it can be present in cat litter, in the soil, and in children’s sandpits that cats might use as their toilet. It’s usually a mild disease, unless you’re pregnant. Toxoplasmosis during pregnancy can cause blindness, intellectual disabilities, and other birth defects in your unborn baby.
To avoid coming into contact with anything that could transmit toxoplasmosis, you should:
Get someone else to clean the litter tray if you have a cat
Wear gloves if you’re gardening or handling newly-dug vegetables, and/or wash your hands well afterwards
Make sure that all vegetables are washed thoroughly before you eat them.
Group B streptococcus, or group B strep, is a common and usually harmless bacteria that’s present in the bodies of around 30% of people. You wouldn’t know that you have group B strep unless you get tested.
Group B strep doesn’t harm you or your baby during pregnancy, but if you have group B strep, it can infect your baby during birth. This happens in approximately 1 out of every 1,750 pregnancies.
Babies infected with group B strep can develop meningitis, blood infections, and/or pneumonia, causing long-term disabilities in around 1 out of every 14 babies who are infected. Approximately 5% of babies with group B strep die from the disease. But most babies make a full recovery if they are treated early with antibiotics.
Group B strep is effectively treated with IV antibiotics during labor, so it’s recommended that every woman get tested for the bacteria between her 35th and 37th week of pregnancy. The bacteria grow fast, so testing earlier could mean that infections go unnoticed. If you have group B strep when you give birth, there’s a 1 in 400 chance that your baby will be infected, but if you get IV antibiotics, the risk drops to 1 in 4,000.
Listeriosis is a type of food poisoning caused by listeria. Listeria can be found in:
Soft cheese
Raw, unpasteurised milk and dairy products made from raw milk
Pate and deli meats and other chilled ready-to-eat foods
Chilled smoked seafood
so it’s best to avoid these foods. It can also live on the surface of fruits and vegetables, so wash all fruit and vegetables before eating them or handling them without gloves.
Although listeria is rare, even a mild case can cause serious damage to your baby, resulting in miscarriage, stillbirth, and severe illness in your newborn.
A number of sexually transmitted diseases (STDs) can be harmful to your foetus or newborn baby. It’s best to always practice safe sex, including using a condom.
Chlamydia is particularly common, and you might not know that you have it. If you’re concerned that you might have been infected with chlamydia, ask for a test during pregnancy. It can cause premature birth, miscarriage, birth complications, and eye infections or pneumonia in a newborn baby. Chlamydia can be successfully treated with antibiotics before and during pregnancy to prevent you from passing it on to your baby.
Hepatitis B can be caught by contact with infected blood or sexual relations with someone who has the disease. If you have hepatitis B, you’re likely to pass it on to your baby. In that case, your baby will be given a vaccine at birth and at intervals during their first year, and it’s very effective at preventing them from developing long-term infection.
You might not know that hepatitis B is in your bloodstream, so it’s important to get tested for it during pregnancy. Women who are exposed to it during pregnancy can take antibodies that help reduce the risk of transmitting it to their baby. If you’re in a situation that increases your exposure to hepatitis B, you should get vaccinated before you try to start a family.
Hepatitis C is another blood-borne disease that’s transmitted through having sex, sharing needles, or getting a blood transfusion from someone who has the disease. The risk of passing it on to your baby is a lot lower than for hepatitis B, but if it happens there’s no effective cure.
Genital herpes are transmitted through having sex with someone who has genital herpes sores. If you catch genital herpes for the first time during your last 6 weeks of pregnancy, it could infect your baby with neonatal herpes. Neonatal herpes can be fatal if it goes untreated, but antiviral medication is very effective. The risk of transmitting it is a lot lower if you’ve had genital herpes before.
If you have genital herpes sores towards the end of your pregnancy, your doctor might recommend a caesarean section instead of vaginal delivery, to reduce the chances of infection.
The Zika virus is spread by infected mosquitoes, although you can also catch it through having sex with someone who’s infected. Zika disease is usually mild, but if you catch it while pregnant it can cause serious birth defects, like microcephaly, seizures, developmental disabilities, and blindness, as well as stillbirth.
ZIka outbreaks are common in some parts of South and Central America, parts of south and southeast Asia, the Caribbean, Africa, and some Pacific Islands. They’ve also occurred occasionally in some parts of North America, but the risks of catching it there or in the UK or Europe are very low.
It’s best to avoid traveling to areas where Zika is widespread during pregnancy, and to use mosquito repellent and to cover up if you are in an area with an outbreak.
Fifth disease, also called slapped cheek disease, is caused by the type B19 human parvovirus. It’s common among young children and it rarely provokes any serious effects, but it can cause miscarriage if you catch it when you’re pregnant.
Many women are already immune, because they caught it in childhood. There’s no vaccine against Fifth disease, so avoid being around anyone who might have it. You can also reduce the risk of catching it by washing your hands thoroughly.
Although there are a lot of dangers around you when you’re pregnant, the right precautions can help you keep yourself and your baby healthy and safe. Whether you’re hoping to conceive naturally or planning to undergo IVF treatment, we hope your pregnancy and birth go smoothly and without anxieties or health scares.
Most couples discuss when might be the ideal time to start a family. Although everyone would love to be told exactly when is the best time to have a child, the truth is that there’s no single perfect moment when you should try to conceive.
There are always a lot of variables to consider, including:
It’s important to explore these issues. Although there’s no perfect time, there are indeed periods in your life which would be more suitable to raising a child, and times when it would be better to wait. Here are some of the issues to consider before you plan to start a family.
Ideally, it would be best to wait to start a family until your lifestyle is established and there are no major changes expected in the next year or two.
This isn’t just because you want to raise your child in a stable environment, but also because big changes to your life always increase stress and anxiety. That’s true even for positive changes, like moving to the region where you always wished to live or switching careers to pursue your dream job.
It’s still unclear whether stress has a significant effect on your fertility, but scientists do think that increased levels of the stress hormones alpha-amylase and cortisol could interfere with the production of GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. A US-based study found that women who have the highest levels of alpha-amylase took 29% longer to get pregnant than those with the lowest levels, and different research concluded that for men, stress affects sperm shape and speed.
You should also never decide to try for a child as a way of fixing a problematic relationship. Again, not just because you might not have resolved your issues by the time your baby is born, but also because the added stress can affect fertility.
Many people struggle with mental health disorders like anxiety and depression, and worry that these could stop them from starting a family. The good news is that there is no reason why you can’t have a healthy baby and a happy family even while struggling with anxiety or depression.
However, both anxiety and depression can make it take longer for you to conceive naturally.
Anxiety could raise your stress hormone levels, and may be caused by an imbalance in the sex hormones estrogen and testosterone. Depression can disrupt the hypothalamic-pituitary-adrenal axis, which controls the menstrual cycle, or disrupt the luteinizing hormone which regulates ovulation.
If you’re suffering from depression or anxiety, and it’s not yet under control with medication or lifestyle changes, it is better to wait until you have received medical help and balanced your mental health.
In general, if you or your partner are scared about having a baby, wrestle with anger management problems or psychosis, or a mental or emotional health disorder that affects your daily life, it’s not a good time to start a family. Simply trying for a baby can be stressful on its own and could adversely affect your state of mind, while caring for a new baby, and then a toddler, can be the last straw if you’re already depressed, anxious, or experiencing mood swings.
It’s best to consult with your healthcare provider to improve and stabilize your mental and emotional health, before you begin or expand your family.
Most temporary illnesses don’t affect female fertility, so a cold, cough, or flu isn’t a reason to wait to start a family, although you might not feel much like having sex when you’re feeling ill. However, male fertility can be affected by a high fever (38.8°C and up) that continues for three days or more. The high body temperature can depress sperm production for up to six months, but it does recover with time.
Some chronic illnesses can reduce male and/or female fertility, including:
Other conditions don’t affect your fertility but can increase your risk of miscarriage or stillbirth. Women who have heart or kidney conditions, rheumatoid arthritis, high blood pressure and other auto-immune disorders, are generally considered to be high-risk, and are therefore kept under careful observation during their pregnancy. If you fall into any of these categories, it’s wise to consult with your doctor before you start trying to conceive.
If you have lupus, you should plan your pregnancy carefully. The CDC advises that you make sure that your disease is under control or in remission for at least six months before you conceive. Getting pregnant while you have active lupus can cause serious health problems for you and/or your baby or lead to miscarriage or stillbirth.
If you’re taking certain medications, they could make it harder for you to conceive. These include:
Most of these effects are reversed once you stop taking the medication. If you’re on any of these medications, you may prefer to wait to try for a baby until after you finish taking them.
Your age is definitely going to affect your timing. Although you can still get pregnant when you are aged 40+, your fertility declines faster once you reach the age of 32, and drops faster still from age 37.
Additionally, when you’re over 35 your risk of having a miscarriage or stillbirth increases significantly. One study found that for women in their early 20s, 10% of pregnancies end in miscarriage, but that rises to 18% when you’re over 35 and 34% if you’re in your early 40s.
That means that if you’re approaching 35, you might want to consider your options including both trying for a baby soon, or potentially freezing eggs for a later date. The American Society of Reproductive Medicine (ASRM) recommends that if you are aged over 35 and you haven’t become pregnant within six months of unprotected sex, you should begin evaluation for infertility treatment, rather than waiting the standard 12 months.
If you received radiation therapy for cancer or other illness, you have PCOS, fibroids, or endometriosis, or you’ve had an STI in the past, the American College of Gynaecologists suggests seeing a fertility advisor straight away. They can help you plan the best times to get pregnant and give you advice about IVF and egg freezing.
Many doctors advise freezing your eggs before undergoing any kind of treatment which could affect your ability to get pregnant in the future. Egg freezing means that your eggs are collected, frozen and stored securely until you are ready to start a family, when fertility doctors will help you through the IVF process. If you freeze your eggs when you are young and healthy, it greatly increases your chances of success later on when you’re ready to undergo treatment, even if you have conditions like those mentioned above which make it difficult to get pregnant naturally.
Although there’s no perfect time to start a family, there are many good options. What matters most is that you both feel that the time is right. Whenever that may be, we hope that your path to parenthood goes smoothly.
If you’re trying to start a family, you are probably vaguely aware of the onset of menopause as you consider your timing. It’s like a huge “end” sign in the race to have children. For most women, menopause occurs between 45 and 55 (on average at 51), but some women find that it appears much earlier than expected, which could potentially throw a wrench into your family planning preferences.
Doctors distinguish between early menopause, which happens between the ages of 40 and 45, and premature menopause, also called premature ovarian failure (POF) or premature ovarian insufficiency (POI), which occurs before the age of forty.
Studies have found that around 5% of women experience early menopause, and another 1% experience premature menopause.
For many women, early or premature menopause is idiopathic, which means that there’s no known medical cause. That said, there are a number of issues that can lead to early menopause or POI:
Chemotherapy and radiotherapy often bring on menopause because the treatment can damage your ovaries and stop them from ovulating. In these situations, it’s possible for your body to recover and begin ovulating again, although you might still struggle to get pregnant because of other ways that the treatment impacted your reproductive organs.
Genetic and chromosomal disorders, like Turner’s syndrome, can affect the ovaries from birth and bring on early or premature menopause.
Autoimmune diseases like diabetes, rheumatoid arthritis, and thyroid diseases are signs that your immune system has malfunctioned in some way and is attacking your body instead of the disease. In these cases, your immune system could also attack your ovaries and prevent them from working properly.
Infections, like mumps, malaria, and tuberculosis, can damage the ovaries, but this is very rare. HIV and AIDS that are not controlled properly with medication can also bring on menopause.
Surgery to remove the ovaries inevitably causes menopause.
Smoking can speed up the degeneration of follicles (premature eggs). A woman is born with one million follicles on average, and these slowly dwindle over time. Follicles aren’t just used up through ovulation and menstruation; they go through a process called atresia, which means that the egg follicles simply degenerate and die. If you smoke, you speed up this process.
A Danish study found that there’s a link between your mother’s age at menopause, and your own ovarian reserve, which means the number of eggs that remain in your body. If you have a family history of early menopause, you’re likely to have a lower ovarian reserve than average, have trouble conceiving at a younger age than average, and experience menopause yourself at an earlier age than average.
It’s rare for menopause to occur completely overnight (in fact, that would only happen if your ovaries were surgically removed). Women go through a period called perimenopause, which is when you’re still ovulating, but far less frequently. During this time, your periods become irregular and spaced further apart.
Perimenopause can last as long as six years or more, and during this time it is still possible to get pregnant, but it’s far more difficult.. One study found that between 2.2% and 14.2% of the women involved conceived naturally and gave birth to a healthy baby.
If your periods become noticeably longer or shorter than usual, or stop entirely for three cycles, you could be entering perimenopause. You might also see some of the symptoms of menopause, such as hot flashes, vaginal dryness, insomnia, headaches, anxiety, and joint pains.
Once you’ve gone through menopause, you won’t be able to conceive naturally, but you can still successfully start a family by using IVF with either donor eggs, or your own eggs that you froze at an earlier point in life.
You might have heard about hormone replacement therapy, or HRT, which is often recommended for women who experience early menopause. However, HRT is only prescribed to address various other health issues associated with menopause, like osteoporosis and an increased risk of cancer, in addition to managing its symptoms. It doesn’t improve your fertility.
If you:
it’s wise to consider freezing your eggs as soon as possible.
When you freeze your eggs in your 20s or 30s, egg quality is higher, which improves your chances of success when you use them later to get pregnant via IVF. Egg quality can drop well before menopause, which means that even if you do get pregnant during perimenopause, you’ll have a higher risk of miscarriage and of the egg failing to divide properly, resulting in the wrong number of chromosomes in each cell in the embryo.
The chances of going through early or premature menopause is something that you should bear in mind when you think about your path to growing a family. We hope that whatever you choose, your journey to parenthood is smooth and successful.
We all know that younger women, as a whole, have an easier time getting pregnant and giving birth to healthy babies. But understanding why that’s the case is more complicated.
There are at least two different factors that make successful pregnancy trickier for older women:
Let’s take a look at the impact of each on successful pregnancy. Then we’ll ask the question: which matters more - the uterus or the egg?
A baby girl is born with 1 to 2 million egg cells. That egg supply steadily decreases, giving the average adolescent 400,000 eggs and the average 37-year old 25,000 eggs.
Eggs don’t just decrease in quantity; they also decrease in quality, for several reasons. First, your body tends to pick the best quality eggs for use first - when you’re in your teens, 20s and early 30s. By the time you get to your later 30s and 40s, the remaining eggs are less likely to be as high quality.
Additionally, when the egg cell matures in the ovaries during the part of your cycle prior to ovulation, it needs to divide several times. Older egg cells are more likely to divide abnormally, leaving the cell with the wrong number of chromosomes. The result is an egg that will not fertilize, or - even if it does fertilize - will not develop correctly and will not lead to a successful pregnancy or a healthy birth.
Who hasn’t felt that her body at 40+ just isn’t the same as it was at 20+? (There’s a reason why women who don’t want to share their age often respond to “How old are you?” with the facetious answer, “21.”)
Women who get pregnant after 35 are more likely to experience pregnancy complications such as:
Gestational diabetes
High blood pressure
Pre-eclampsia
Complications during childbirth, including prolonged labour, need for a Caesarian section, or stillbirth
Any of those complications can decrease the chances of a healthy pregnancy and birth.
Before we ask that question, maybe we should ask: Why does it matter which matters more? If you’re over 35, both your eggs and the rest of your body is over 35 - so who cares?
While you can’t change the age of your body (unless you’ve invented a time machine), when you’re using IVF you can potentially change the age of your eggs. This can be done either by using donor eggs from a younger woman, or by using your own eggs, if they were frozen when you were younger.
So, it makes sense to care about and to find out which matters more. Let’s take a look.
The UK’s HFEA (Human Fertilisation and Embryology Authority) presents some very telling numbers in their most recent report, using data from 2017.
The numbers tell about the live birth rate per embryo transferred (PET). For women using their own eggs, the birth rate steadily decreases, from 27-30% (depending on whether the eggs were fresh or frozen) for women under 35, to 2-4% for women over 44.
For women using donor eggs, however, the decrease is much less significant (where there even is a decrease). Birth rate per embryo transferred is 28-33% for women under 35 - not too different from the numbers for that age group who use their own eggs. But birth rate for women over 44 is 22-26%. What a significant difference from the 2-4% for women who use their own eggs!
Why is this the case?
Donor eggs are almost exclusively from women under the age of 35. When they use these younger eggs, even women in their mid-40s have a significant chance of having a successful pregnancy and birth. True, it’s still not as high as the success rate of those in their mid-30s, showing that the older body and uterus do have an impact, but it’s far higher than women who are using their own mid-40-year-old eggs, showing the much greater impact of the egg’s age.
Another support for the egg’s age having a greater influence than the body’s age is seen by difference in success rate between women using their own frozen vs. fresh eggs. For those under 35, the IVF success rate is comparable when using their own fresh eggs. All older age groups, however, have a higher success rate for frozen eggs. The eggs, frozen at a younger age, boost their chances of success.
The same boost is seen when performing IVF using embryos frozen at an earlier age.
No, we don’t know of any miraculous source that will make you 21 again (if that’s even what you want). Your body is stuck at the age that it’s at. Period.
But the numbers given by the HFEA point the way to a potential fountain of fertility. Using younger eggs - whether your own frozen eggs or a donor’s eggs - can give you a higher IVF success rate. Additionally, the earlier you freeze your eggs (especially if you freeze them before 35), the greater your chances of a successful IVF pregnancy and birth.
We wish you much success in your fertility choices and in having the family you want, when you want.
While right now we have no way of freezing the biological clock, modern technology has given us a type of “snooze button.”
Freezing of eggs and embryos, otherwise known as cryopreservation, preserves these fertility keys at the biological age they were when frozen. Since the major factor in viable pregnancy and birth is the age of the egg and not the age of woman carrying the baby, this is great news for those women whose biological clocks are sounding alerts.
If you’re thinking about going this route, the next big question to ask is: are you going to freeze your eggs or your embryos?
This is not a simple decision, with many questions to ask and factors to consider before you begin. Below follows an extensive list of factors to help you decide which path is right for you.
The initial stages of egg freezing and embryo freezing are the same. You’re given medications which increase your ovulation and get more eggs ready than usual. The eggs are then harvested from your ovaries (an intravaginal procedure done under sedation).
This is the last stop if you’re freezing your eggs. If you’re planning on freezing embryos, on the other hand, now is time to go ahead and make those eggs into embryos. To do so, of course, you’ll need sperm - from your partner or from a donor - to fertilize the egg. If the egg fertilizes, it will be frozen once it has multiplied and reached approximately 50-100 cells.
This brings us to the first major factor in deciding between freezing eggs and freezing embryos:
Yes, it may be obvious, but we’ll point it out anyway: you need sperm to create an embryo. If you have a partner that you’re sure you want to have children with at a later time, or if you’re planning on using donor sperm anyway, then there are no obstacles to creating and freezing embryos.
If you’re single and still hoping to find the right partner to raise a family with, freezing eggs may make more sense. All you need for that is one party - YOU.
Eggs are more fragile than embryos, as they are only one cell (not 100), and that one cell is mostly water. But while earlier methods of egg freezing often created issues when the egg was frozen or thawed, the vitrification (flash-freezing) process that has become common in the past few years has brought success rates of frozen eggs up to par with those of fresh eggs.
When you freeze embryos, you know exactly how many fertilized embryos - how many chances at a viable pregnancy - you’re preserving. When you freeze eggs, on the other hand, you don’t know how many of them will fertilize when thawed.
That said, creating each IVF embryo usually requires multiple eggs anyway. This sample chart shows 2 viable embryos developing from a group of 12 eggs that were retrieved (obviously an individual’s results may vary). Assuming you matched this chart, as long as you froze all 12 eggs, it would basically be equivalent (probability-wise) to freezing 2 embryos.
As we all know, a viable egg - and even a fertilized embryo - do not (unfortunately) guarantee a successful pregnancy and birth. But do you have a better chance at a live birth when you start with a frozen embryo - or with a frozen egg?
The UK’s HFEA (Human Fertilisation and Embryology Authority) reports the following birth rates for frozen embryos using a woman’s own eggs and partner’s sperm, based on age of woman at transfer:
Under 35 - 27%
35 - 37 - 26%
38 - 39 - 21%
40 - 42 - 15%
43 - 44 - 8%
45 and up - 4%
Since reliable methods of freezing eggs are a more recent development, we have less data on frozen eggs (and especially on women using their own frozen eggs) than on frozen embryos.
What we do have, according to the HFEA, is a birth rate for frozen donor eggs in 2016 that was around 30%. This is comparable (and maybe even a little better) than the above rates for frozen embryos, but it doesn’t divide the data by the age of the woman at transfer.
The average birth rate for women using their own frozen eggs was 18%, which is similar to the birth rate for frozen embryos for women who at transfer were approaching or after the age of 40.
The HFEA points out that a reason why the donor eggs led to more successful births was that they were in general frozen earlier - and we know that the age of the egg is one of the most critical components. Additionally, in order to donate eggs, women need to meet specific health criteria, which is not the case for women who freeze their own eggs - which results in the pool of donor eggs being overall “healthier.”
According to that, if you use your own young, healthy eggs, you would likely have better results than the average, potentially bringing it close to the rate for frozen donor eggs and frozen embryos.
A helpful tool in your decision may be the Brigham Women’s Hospital Egg Freezing Counseling Tool. It’s a research-backed calculator that predicts the likelihood of a live birth for women who choose to freeze their eggs and use them later. (Note: as per the disclaimer on the tool itself, while it is based on research, “This calculator is not externally validated, and as such, should be used with caution.”)
When you freeze embryos that were fertilized with a specific partner, in certain senses you’re locking yourself in. While you might be head over heels with your current partner, and convinced you’re going to build a family with him someday, life bears witness that relationships don’t always work out the way we plan.
Most consent forms for undergoing IVF and freezing embryos contain legal clauses that stipulate how ownership of the embryos will be divided if the relationship ends. That said, if the breakup is nasty, you might face legal hassles… if you even still want to use those embryos.
Egg freezing avoids all these issues. Your eggs are yours alone, to use if, when and how you want.
In practice, many women don’t end up using their frozen eggs and embryos, either because they conceived naturally, they decided not to have children, or they reached their ideal family size before using all the eggs/embryos. What happens to your genetic material once you decide you don’t need or want it anymore?
Many faiths consider an embryo a human life and have restrictions on how one can treat it, even if it is no longer needed. Aside from faith, it is not uncommon to feel uncomfortable about casually disposing of an embryo. Unfertilized eggs, on the other hand, are much simpler to dispose of, both emotionally and ethically.
An unexpected insight comes from Briallen Hopper, who found that having embryos (from donor sperm) safely frozen actually diminished her possibilities for romantic love.
In her early 40s, Briallen wants to have children - but men who want to have children are starting to rule her out as a potential partner. Her chances of conceiving naturally are getting significantly lower - and odds are slim that those family-oriented men would be interested in having a baby using an embryo that doesn’t include their genetic material!
Briallen’s frozen embryos from donor sperm may enable her to become a mother but, oddly enough, at the expense of becoming a romantic partner.
Egg freezing, by leaving open the possibility of who the father will be, doesn’t have the same impact on the way you feel about love - or on your romantic prospects.
Neither freezing eggs nor freezing embryos is cheap. If your financial resources are limited, your choice between freezing eggs and embryos may depend on what procedures - if any - your insurance covers.
For Briallen Hopper, mentioned above, the financial aspect was critical in her decision. Egg freezing was prohibitive, but IVF was covered by her insurance, putting the embryo freezing process within reach.
Freeze eggs? Freeze embryos? It’s not a simple choice. You need to make a decision that includes your present and your future, your hopes and wishes, and your reality.
We hope that the different factors here leave you more informed about what the pros and cons of each process are. And we wish you clarity and satisfaction with your decision.
You’ve probably heard the phrase “The clock is ticking…” so often that it’s nauseating - or at best ultra-cliché. But for women who have bearing children on their radar, the ‘ticking’ feeling can’t be just brushed off as a nothing. The complexities of fitting in career advancement, the search for an ideal partner and other life complications all before having a child means that that “ticking clock” isn’t just an annoying joke; it’s a legitimate concern. While fertility doesn’t suddenly disappear in a poof of smoke, neither does it last forever - and the process of fertility decline starts in one’s 30s. Here’s why - and here’s what you can (and can’t) do about it.
A woman’s supply of fertile eggs is not constant over her lifetime. While an adolescent girl has approximately 400,000 eggs available, these numbers taper quickly. Dr. Sherman Schreiber, author of “Beating Your Biological Clock,” explains that once a teen starts her menstrual cycle, she loses 1,000 immature eggs every month, and that this loss is simply a biological process, not something that can be changed by factors over which we have control. The average woman has around 25,000 eggs available at age 37 and only 1,000 at age 51. One might still think - hey! In order to conceive a child, only ONE healthy egg is necessary. So those numbers still sound pretty high. But successful conception is not only a numbers game.
Not all eggs are created equal. In order for an egg cell to be ready to be fertilized, it must undergo several cell divisions first. In the complex, amazing process that is cell division, the chromosomes must replicate themselves, then be split perfectly as the cell divides into two. As egg cells get older, they have more difficulty with the division process. One issue can occur with the chromosomes themselves. They separate too early in the process of cell division, giving the resulting egg the wrong number of chromosomes - called aneuploidy. Another issue can occur with the parts of the cell that surround the chromosomes and make them line up correctly during cell division. In aging egg cells, these parts - called the microtubules - often have less control over the process, and end up - again - giving the resulting egg the wrong number of chromosomes.
What happens to an egg cell with the wrong number of chromosomes? It may either:
Bottom line? While plenty of older women do bear healthy children naturally, the older an egg cell gets, its chances of abnormal development increase, and its chances of resulting in a healthy birth decrease.
Professor Greg Fitzharris suggests that in the future, we might be able to take the chromosomes from an older woman’s cell and put them into the cell of a younger woman. That way, the genetic material would remain entirely yours (NOT like getting a “donor egg cell” today), but the younger cell microtubules would make the chromosome division more successful. Exciting as that sounds, it’s still far off. But women who are thinking in advance about fertility can effectively preserve their egg cells’ youth - even today. Women who freeze some of their eggs when they’re in their early 30s, for example, can use them in their 40s when they decide it’s the right time for parenthood. This freezing process is called mature oocyte cryopreservation and it is done in fertility clinics around the world. Freezing eggs effectively stops the clock, retaining the quality in both the chromosomes and the surrounding cell matter. It’s one of the best solutions we have today for preserving fertility. While there are never any guarantees, being aware of the options, anticipating and planning ahead are the best steps you can take to make your motherhood dreams can come true.
