Medical & Laboratory Director
Columbia University Medical Center
NYU School of Medicine
CCRM New York
At this point it might be beaten into your head that women’s fertility potential declines with age. That’s true, but here’s the problem: we have surprisingly little credible data on how quickly fertility dissipates for women in the general population.
This makes it incredibly difficult to use age to predict with any accuracy whether you’re likely to need IVF, especially during a woman’s thirties and early forties.
Women who are considering egg freezing are often shown charts like the one below depicting an age-related fertility decline:
The data in that chart, the standard used by ACOG and ASRM, does not meet our internal bar of what we’d show you on this site and we think you should view it (and others like it) with caution. Here’s why:
What we do have is a lot of data showing that for women who needed to use IVF to have babies, their success rates declined significantly with age. This data tells us why doing IVF with younger eggs is helpful, but there is no proof it reflects the patterns of the general population trying to conceive naturally.
In short, age, on its own, isn’t a perfect predictor of whether you’ll need to use medical assistance at a given point in time to build your family, but it does show us that if you become infertile, treatments become much less effective with age.
There are a few tests that are generally marketed to women as “fertility predictors” or “egg counters” that will reveal the secrets of their ovarian reserves. The most frequently mentioned is the AMH, followed by the FSH. These tests can be very helpful in predicting a woman’s response to fertility medications, if those medications are needed (which generally happens after a couple has tried to conceive naturally for a year). What they do not give us is a prediction of how fertile you are naturally, or how likely it is that you will struggle or get pregnant easily if you try at some point in the future.
Below is data from one study showing that women of varying AMH levels conceived naturally at a similar rate and after a similar number of attempts.
The same appears true of FSH and time to natural conception:
While this study suffers from two weaknesses (low sample size and an endpoint that is not “live birth”), the data is persuasive.
Women are often spurred into egg freezing based on learning they have a low, or a low-end-of-normal-range AMH. What AMH will give you is insight into how an egg freezing cycle will go if you choose to go that route -- if you have a low AMH, expect to collect relatively few eggs, and feel the need to do several cycles to collect an egg number you feel confident in.
If there are reasons you believe you’re likely to need IVF at some point, then freezing eggs is a compelling option -- eggs frozen now almost always have a better chance than eggs collected in later IVF cycles.
Here are some reasons, independent of age, that you may need to do IVF in the future (and where having younger eggs could help):
- You have blocked fallopian tubes (from a history of STD’s or any other reason)
- You have a partner with male factor infertility
- You have reason to believe you have endometriosis
- You have a family history of early menopause
- You have a genetic disorder that you want to screen for
- You’re considering having a child with a sperm donor later on
- You’re in a lesbian relationship and you and your partner want to do “reciprocal IVF” at some point