With stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment. When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40’s. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual. A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of 45 year olds’ embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.
The advent of ICSI (intracytoplasmic sperm injection) two decades ago has enabled men with very low sperm counts to father children through IVF. Prior to this, as fertility specialists, we could offer these couples only donor sperm. Despite this “miracle” of modern medicine, one of the lingering concerns was as to whether using sperm from men with very low counts might lead to a more birth defects. Adding to this concern, were some studies suggesting that ICSI or even regular IVF might result in a higher than normal rate of abnormalities. Some good news, however. A recent study from the NIH suggests that this is not a concern. The researchers found that couples who conceived with very low sperm counts did not have children with more birth defects.
Apparently according to the NFL, it is. One of the players on the Indianapolis Colts was suspended after taking clomiphene, a fertility pill commonly used by Fertility Specialists, OBGYNs and Urologists to help women (and sometime men) coping with infertility. Even though he was using it to help his wife get pregnant, successfully I might add, the NFL considers Clomid a “performance enhancing drug.” Most patients who have taken clomiphene, and put up with some its side effects would likely take issue with that assessment.
A recent study from the NIH suggests that couples who have high cholesterol levels may not just be at higher risk for heart disease, they may also have a harder time getting pregnant. Couples (who were not yet considered infertile) in which both partners or even just the female partner had high cholesterol levels on average took a longer time to conceive. These findings are not so surprising since ovulation disorders such as polycystic ovarian syndrome (PCOS) are among the most common causes for infertility, and many of these patients have underlying metabolic problems that place them at risk for heart disease and diabetes. So what does this mean? It does not mean couples trying to get pregnant should rush out and go on statins to lower their cholesterol. Cholesterol is the chemical from which sex hormones such as estrogen and testosterone are made from, so these drugs could potentially be harmful to your fertility. However, healthy lifestyle changes such as moderate excercise and avoiding processed high carbohydrate foods may help both cholesterol and fertility.