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Embryo Selection after IVF

Embryo Selection after IVF

Embryo Selection after IVF

Many of human embryos produced after in vitro fertilization carry abnormal chromosomes. Placing a chromosomally normal embryo (s) into a normal uterus has a very high chance of achieving a pregnancy. Your eggs have been retrieved and the mature eggs were fertilized. Now You and your reproductive endocrinologist are faced with the critical task of how many and which embryo to transfer to the uterus or which ones to freeze.

Why do we Need Embryo Selection?

Selection of the most appropriate embryo(s) for transfer aim at i. Maximizing the chance for pregnancy and ii. Minimizing the risk of twins and other multiple pregnancies. Casual inspection of the embryo does not yield accurate information about its chromosome makeup. One can follow an indiscriminate approach where all embryos are transferred. The problem is this approach yields high unacceptable multiple pregnancy rates. On the other hand one can transfer one embryo at a time. This is a much safer approach in terms of markedly minimizing twin rates but may lower the chance for getting pregnant. In addition it also require a robust freezing program so that frozen embryos can survive thawing. Right now in The US the survival of frozen embryos exceed 95% and the chance for pregnancy with a thawed embryo is approximately equal to a fresh embryo.

Measure of Success: time to conceive or cumulative chance for pregnancy?

One major issue related to fertility treatment especially IVF is how to measure success? specifically consider this question: if you have three embryos and decided to transfer them one at a time and got pregnant after the third transfer with a singleton, how does that compare to transferring all embryos in the fresh cycle and getting pregnant in twins? before answering it is important to know that twin gestation is associated with higher risk for pre-term delivery, ICU admissions and long term consequences for the babies.

In other words should you consider success as pregnancy taking place after one retrieval (cumulative chance from fresh and frozen embryos) or pregnancy taking place in the fresh cycle only (fresh embryos)? In other words would you like to shorten the time to conceive at the expense of higher risk for multiple pregnancy? Within reason, this is a question for you and your reproductive endocrinologist to answer based on your preferences and his practice

You have a Voice: How should you use your embryos after IVF?

You need to have a voice in the number of embryos transferred to your uterus. Although your fertility specialist can discuss numbers and chances and other technical details as well as long term risks for multiple pregnancy, there are questions that cannot be answered by anyone but you.

  • How do you feel about twins? triplets and quads?
  • Would you accept fetal reduction (removal of one or more sacs from the uterus and leaving only one or two)?
  • Do you have the social support system to take care of twins?

For these and many other reasons your input in the number of embryos to transfer is paramount.

Methods of Embryo Selection after IVF

Embryo Morphology and Female Age

Age is, by far, the strongest predictor of the health of the embryos. Younger women produce more chromosomally normal embryos than older women. An embryo from a woman at age 30 commonly implants 40% of the time as opposed to 5% or less in a woman age 40. For any given cohort, embryos are graded based on specific morphological criteria from the best looking to the worst. These criteria are technical and followed by all embryologists. Embryos are prioritized for transfer based on their shape. Morphology, however is may be 50 to 60% predictive of pregnancy, far from ideal. The combined use of morphology of embryos, stage of development (day 3 or blastocyst) and age is the standard selection method for which embryo is transferred first and how many. This method has the advantage of being sheep, quick and non-invasive. All other methods must prove superior to morphology + age before adoption.

Extended Culture to Blastocyst Stage (Day 5 Embryo)

Keeping day 3 embryos in culture may give these embryos may time to develop to blastocysts. Presumably, the better embryos progress to blastocysts or do so faster than less healthy embryos, thus they are preferentially selected for transfer.

Time Lapse Imaging of Embryos

time lapse embryo imaging-normal embryo division

time lapse embryo imaging-normal embryo division

Embryos are placed in a specific incubator in a specific plate and is observed at predetermined time

time lapse embryo imaging-abnormal embryo division

time lapse embryo imaging-abnormal embryo division

points using time lapse microscopy / photography. Photos are analyzed manually or through a computer and embryos are graded based on timely division of blastmeres (component cells). There is no evidence so far that pregnancy rate is improved above using morphology. There is extra cost associated with the use of the special plate and is also limited by the number of special incubators available.

PGS (Embryo Chromosome testing)

New forms of PGS (performing biopsy at the blastocyst stage) and more accurate platforms for analyzing the biopsied cells are available. However, the concept that better selection will lead to improved IVF results is far from certain.

It success of an IVF cycle is measured after transfer of fresh then frozen embryos till pregnancy ensues (cumulative success) ad patients are will to be patient for 1-2 more months, then any form of embryo selection, PGS or otherwise, will not improve the live birth rates. Moreover, PGS can be harmeful as it may misdiagnose the health of the embryos (see this article on PGS for details). PGS increases the expense of treatment $4000 to 6000

Embryo selection is maybe be able to improve the time to pregnancy, if embryos with the highest implantation potential are transferred first.

Based on the available evidence, judicious selection of embryos based on patient age, morphology and the use of extended culture to blastocysts are the standard of care in embryo selection after IVF. Two additional factors to consider is how robust is the freezing program of that specific lab (generally excellent all over the US) and the acceptability of fetal reduction by the couple. Liberal use of single embryo transfer when appropriate should be strongly considered. ‘New’ ideas should be subjected to rigorous scientific evaluations ‘fertility clinical trials’ before they are ready for routine use. Thus far, based on published evidence, embryo time lapse imaging and PGS should remain investigational.

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Fertility Treatment: Do not be Distracted

Fertility Treatment: Do not be Distracted

Fertility Treatment: do not be distracted by worthless recommendation

Fertility Treatment: do not be distracted by worthless recommendation

Fertility Treatment: Do not be Distracted

When contemplating options for fertility treatment with your own eggs, it always boils down to continue frequent intercourse, ovarian stimulation / ovulation induction + IUI or some form of IVF. During consultation or when weighing your options do not lose perspective of the big picture. Many suggestions may present themselves and serve to distract you. Men and Women load up on these distractions from the web, friends, primary care physicians or the couple themselves. Some of these recommendations are harmful because they shift the focus to non-proven interventions and most notably cause delay consultations with a reproductive endocrinologist and completing the infertility workup or starting treatment if needed.

Do not be distracted by these arguments

I am Healthy

Many women in America consider being healthy as being fertile. The media also bombard us with photos of beautiful women in their forties with babies. Truly many women, are in great shape with ideal body weight, exercise regularly, have no medical problems and feel great about themselves.

Fertility though speaks to a specific set of factors related to the ovaries, fallopian tubes and quality of sperm. Healthy women can have low egg reserve or blocked fallopian tubes or their partners have low sperm counts. Hence their fertility could be impaired. On the other hand, women not leading a healthy lifestyle or having a medical disorder can be very fertile if all fertility factors (tube, ovary, sperm) are functional.

I did not try enough

If you do not use birth control pills or condoms and you have having regular intercourse, then you are trying, irrespective of your conscious intentions. If you are you had regular intercourse for one year and are younger than 35 years or six months and 35 or older, then you have tried. Regular intercourse means two to three times a week. If you had intercourse with reasonable frequency for 6months to a year and you are not pregnant consult with a fertility specialist. There is a strong relationship between the length of trying and pregnancy rate. The longer that you have been trying, the lower the chance for spontaneous conception.

I did not time my ovulation

Timing your ovulation is not required at all if you are trying to conceive. Actually timing your ovulation maybe harmful to your chance to conceive. Because the methods you would use to time ovulation (cervical mucus, ovulation prediction kits, basal body temperature or intelligent thermometers and apps) are not accurate, you may miss valuable time and have intercourse at the wrong time if ovulation takes place unexpectedly early. Moreover, you cannot get higher odds for getting pregnant above and beyond  having intercourse three times a week because sperm will be available all the time when you ovulate. Several studies failed to show any increase in pregnancy rates using many of these timing methods.

On Fertility Apps and other monitors

Many (>4 million) websites discuss times intercourse utilizing other methods (fertility monitor, cervical mucus, calendar methods, urine LH kits..). More recently technology entrepreneurs are delved into the “trying to conceive” area and volunteered advice. There is no evidence to support that any calculation method improves the odds of getting pregnant over frequent intercourse. These non-scientific advice is a major distraction. Even if these apps collected data on how many women got pregnant, without a comparison group, is not a prove that they actually work. One study indicated that timed intercourse is associated with higher incidence of erectile dysfunction (43%) and extramarital sex (11%).

My progesterone level is not optimal

For almost all women, low progesterone level is not a cause for infertility. In natural cycles, progesterone starts to rise after ovulation. Levels of 3 nanogram/mL or more indicates ovulation, Optimal levels to maintain the lining of the uterus are 8 to 10ng/mL. Levels less than 8 (luteal phase defect) may lead to miscarriage because progesterone is not adequate to maintain the lining of the uterus but it is not a cause for not getting pregnant (infertility). Progesterone is monitored, and supplemented if low, during fertility treatment but in itself low progesterone is not a cause for infertility.

On Clomid & Letrozole

Clomiphene is widely used as initial fertility treatment. This use is commonly not appropriate because

a. clomid is used without infertility workup (checking ovarian reserve, sperm analysis and fallopian tubes)

b. clomid  is used without performing basic tests related to the safety of getting pregnant (infectious disease and genetic screening)

c. clomid is used by women that are not likely to benefit from it e.g regularly ovulating women with low ovarian reserve and unexplained infertility. Women that are most likely to benefit from clomid are women with chronic anovulation e.g women with polycystic ovary syndrome (PCOS).

d. clomid is commonly used with no monitoring using ultrasound. If you do not get pregnant, one would not know if you did ovulate or not. 10-20% of women do not respond to clomid. If you are destined to get pregnant, there is a possibility that you have many eggs developing in the ovary because you are unduly sensitive to the medicine. Strong response to clomid makes you at risk for multiple pregnancy

e. clomid is commonly use for extended periods of time while the majority of pregnancies take place in the first 3 months.

f. IUI is preferred to intercourse only, in clomid cycles because it can cause the cervical mucus to be thick. IUI bypasses the cervical mucus and deposit the sperm into the cavity of the uterus

g. Letrozole is similar to clomid regarding the use and indication but there is evidence that pregnancy is higher after letrozole compared to clomid.

Use clomid or better ltrozole for the right indication, with monitoring and for 3 (max 6) months only.

On Setting Time Limits

For each fertility treatment step: intercourse, ovarian stimulation + IUI or IVF define the number of cycles you will try before proceeding to the next step. Statistically, these treatments are more likely to succeed in the first three treatment attempts. Subsequently, the chance for getting pregnant diminishes and you and your physician should consider moving to another treatment.

Do not loose track of your age and ovarian reserve

You have normal fallopian tubes and partner sperm and you ovulate every month. Younger women are encouraged to try (have regular intercourse). The duration of trying on your own should be guided by ovarian reserve tests and age. Younger women with good reserve can try a bit longer than older women or women with low reserve. This recommendation should be based on scientific information not general perception. Do not accept the advice ‘ keep trying’ from any one without considering you age and without performing the tests for ovarian reserve (vaginal ultrasound, AMH and FSH on day 3). Female age is the most important factor in occurrence of a healthy pregnancy and should be the prime consideration even if ovarian reserve tests and other factors are normal.

There is a plethora of low quality information, recommendation and advice out there. Women accumulate them from multiple sources or just using there simple logic. They can lead to delay in fertility testing and fertility treatment that could be detrimental to future fertility.

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Fertility Treatment Options

Fertility Treatment Options

Fertility Treatment Options: What Are Infertility Treatments?

 

 

Following detailed fertility investigation of the male tubal and ovarian factors, patient and her reproductive endocrinologist decide together on the optimal fertility treatment options.

Factors to consider in selecting the best fertility treatment options include:

Sperm source

  1. Is there a male partner: if so what is the ejaculate volume, sperm concentration, motility and shape? if >10 million moving sperm then pregnancy through intercourse or IUI is possible. Lower numbers indicates IVF or ICSI. If azospermia (no sperm in the ejaculate) then surgical sperm retrieval may be needed (TESE) or donor sperm can be used.
  2. If there is no male partner: anonymous or known donor sperm is used

Tubal Factor

  1. Open fallopian tubes allow for natural conception or IUI.
  2. Blocked fallopian tubes require IVF. Sometimes tubes can be fixed using tubal surgery.
  3. Blocked and dilated fallopian tubes (Hydrosalpinx) require surgical removal of the dilated tubes followed by IVF. Dilated tubes are very difficult to fix and can leak fluid into the uterine cavity and prevent implantation of the embryo.

Ovarian Factor

  1. Women who do not ovulate due to polycystic ovary syndrome  (PCOS): ovulation can be induced using oral medications (clomid or letrozole) or injection medications  (gonadotropins). This is usually combined with IUI.
  2. Women who do not ovulate due to defect in the master gland in the brain (Hypothalamic amenorrhea): ovulation can be induced using injection medications  (gonadotropins). This is usually combined with IUI.
  3. Women diminished ovarian reserve and unexplained (idiopathic) infertility commonly have lower quality eggs and may benefit from inducing multiple ovulation followed by IUI or IVF, to increase the chance that one of the eggs is healthy (chromosomally normal).

Donor Eggs

  1. Donor eggs are needed in women with low egg reserve that fail multiple IVF cycles after menopause or those who carry some genetic abnormalities.
  2. Donor eggs can enable same sex male couples parent a child (together with a gestational carrier).

Gestational carriers

  1. Gestational carriers enable women to parent a child if the uterus is absent or was removed due to a disease e.g endometrial cancer or if the lining of the uterus is damaged e.g intrauterine scarring due to prior scrapping.
  2. Gestational carrier enable women who cannot get pregnant to parent a child e.g history of breast cancer
  3. Gestational carriers enable same sex male couples to parent a child.

Genetic analysis of the eggs or embryos (PGD)

  1. Women and men with risk of conceiving a child with a specific genetic disorder e.g cystic fibrosis, sickle cell anemia should consider testing their embryos before transfer into the uterus (PGD)
  2. PGD can also be used for selecting the sex of the baby for family balancing.
  3. PGD can be used to test the chromosomes of the embryo to increase the chance for pregnancy in women select women but its efficacy for that purpose is still being investigated.

Fertility Preservation

  1. Women at risk for diminished fertility due to a medical problem or treatment e.g breast cancer can freeze their eggs or embryos to use later
  2. Men at risk for azospermia due to genetic factors, cancer and cancer treatment can freeze sperm for use later
  3. Many other techniques for fertility preservation can also be applied to adults and children to preserve reproductive organs and tissue.

 

Many fertility treatment choices exist to help women and men conceive a child. One or more of these methods can be tailored to each

i. individual circumstances:

singles women or men,

heterosexual couples or

same sex couples.

ii. reproductive aim:

wants to get pregnant now versus later,

wants one child only or accepts twins,

wants to conceive a child of certain sex,

will use own uterus or a gestational carrier,

will use own gametes- sperm or egg or donor gametes.

 

To learn more about  fertility treatment options please visit nycivf.org

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Thin Endometrial Lining During Fertility Treatment

Thin Endometrial Lining During Fertility Treatment

Some women encounter thin endometrial lining and abnormal pattern during natural cycles or during fertility treatment. The implantation of embryos is impaired in women with thin lining and abnormal pattern. Abnormal lining can lead to recurrent implantation failure in young women undergoing IVF after repeated transfer of good quality embryos.

The thickness of the lining appropriate for implantation is commonly defined at 7 to 13mm measured on vaginal ultrasound. The most receptive pattern of the lining of the uterus is a tri-laminar pattern (three line pattern) without little homogenous pattern when visualized shortly before ovulation (pattern 1 and 2 of the photo, Fanchin et al 2000).

Causes for Abnormal Endometrial lining during Fertility Treatment

The two most common abnormalities encountered are

a. Fluid inside the Cavity: fluid may accumulate inside the cavity due to stenosis (narrowing) of the cervix probably because of prior surgery or leak of fluid from a blocked dilted fallopian tube (hydrosalpinx).

b. Thin lining and /or abnormal pattern of endometrium. Possible causes

1. Acquired (Asherman Syndrome): prior D&C (termination of pregnancy), uterin surgery (e.g fibroid surgery) or tuberculosis in women from certain geographical locales. All work through the formation of scar tissue inside the uterus.

2. Idiopathic: no prior cause is identified.

Evaluation of The Uterine Cavity

Proper evaluation of the uterine cavity and lining is an integral component of fertility evaluation and monitoring is also essential during treatment. Methods of evaluation include

i. Vaginal ultrasound for the thickness and pattern during the follicular and luteal phases of the menstrual cycle

ii. Evaluation of the cavity of the uterus using HSG (hysterosalpingogram), saline sonography (water sonogram) or hysteroscopy. Saline sonography is the most invasive and is a very accurate method for evaluation of the cavity and identify if a lesion arising from the wall of the uterus projects into the cavity.

iii. MRI: magnetic resonance imaging can accurately identify abnormalities in the wall of the uterus; fibroids, adenomyosis, congenital anomalies (septum, bicornuate, T shape uterus)

iii. Endometrial biopsy: rarely indicated. The lining of the uterus is sampled and with special stain to detect chronic infection. The value of this testis questionable.

Treatment of Abnormal Endometrial Lining

Many treatments are available to normalize the cavity of the uterus and improve the lining

1. Excision of hydrosalpinx: a dilated blocked fallopian tube especially those seen on ultrasound should be excised to avoid leak of fluid into the uterus. This has the potential of doubling the implantation rate of embryos. Laparoscopy can be used to remove dilated tubes in a minimal access day surery

2. Asherman syndrome: operative hysteroscope can be used to accurately cut the scar tissue and allow the surrounding healthy lining to cove the row area. The lining is treated with estrogen after surgery to promote healing

3. Uterine fibroids and polyps and spetum can be removed using operative hysteroscope.

4. Antibioitics to treat chronic inflammation of the lining of the uterus are seldom effective.

5. During IVF if the lining is not favorable all embryos can be frozen. In subsequent cycle, the lining is prepared with estrogen as long as needed till adequate thickness and pattern is achieved. Progesterone is then started and embryos are thawed in the appropriate time and transferred into the uterus.

6. Sildenafil (viagra) can be given as vaginal tablets but its value is questionable.

7. Gestational carriers can be used if all other methods fail.

 

Meticulous attention to the condition of the lining and cavity of the uterus is important during fertility treatment of the uterus. Endoscopic surgery and hormone preparation can improve the majority of the linings and increase the chance for embryo implantation

 

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What Can you Accomplish through IVF ?

What Can you Accomplish through IVF ?

Defining your reproductive goals early on before starting  is essential in guiding the choice of treatment. IVF is the most versatile and robust fertility treatment available. In addition, it accomplish many reproductive goals that are no achievable with IUI.

What Can you Accomplish through IVF ?

Getting pregnant now

IVF can be performed in almost all causes of infertility:

Ovarian factor, male factor, tubal factor, emndometriosis, polycystic ovary syndrome (PCOS) and uterine factor. Success does not appear to be affected by the cause of infertility with the exception of diminished ovarian reserve. Hence, it is important that you seek evaluation as early as you can.

The ovary is stimulated using fertility medication. Various protocols of treatment are tweaked to your special situation and to maximize egg production. Sometimes mild or minimal stimulation IVF is a more suitable approach. Eggs are retrieved and fertilized in the lab using husband or donor sperm.

Embryos are graded based on morphology (shape) and an appropriate number is transferred into the uterine cavity. In the majority of men, sperm is obtained from the ejaculated sperm. In some surgical sperm retrieval (TESE) is required.

Getting pregnant with a single baby

Conceiving with a single baby should be the aim of every woman. The risk of twins and high order multiple pregnancy is high risk of preterm delivery. Premature delivery can lead to long term health problems in the babies. Unlike IUI where the number of embryos reaching the uterine cavity cannot be controlled, IVF allows for a strict control on the number of embryos reaching the uterus. Women with reasonable quality embryos up to age 38 or so can consider the transfer of a single embryo and freezing the other embryos.

In that regards IVF is the more conservative approach when compared to IUI, besides being several folds more successful in achieving a pregnancy.

Getting pregnant in the future with a current partner

Embryos created now after IVF, can be frozen for several years. When desired, frozen embryos are thawed and transferred into the uterus in a natural or hormone treated uterus. This allow you to extend your fertility for years to come. The survival of frozen embryos is excellent, especially using moder freezing methods (vitrification).

The pregnancy rate after transfer of frozen embryos is comparable to fresh embryos. There is also some evidence that pregnancies ensuing after transfer of thawed embryos are at lower risk for obstetrical problems.

Getting pregnant in the future with a future partner

If you do not have a male partner and do not want to use donor sperm, you can consider freezing your eggs. Because your ovarian reserve; the number and quality of eggs; will diminish as the time goes by, freezing eggs at an earlier age, enables you to freeze healthier eggs and use them years later when you are ready. Egg freezing is a fertility solution for fertile women.

Selecting the Sex of the Baby (Family Balancing)

Eggs are retrieved, fertilized. The resulting embryos are tested; one cell is obtained from each embryo and tested for the X and Y chromosomes to identify the genetic sex. The desired embryos are transferred into the uterus . Women consider sex selection for family balancing (had a baby of one sex and desire another baby of the other sex). Women consider sex selection when they want to reach their reproductive goals e.g one boy and one girl, while limiting the number of children conceived.

Getting Pregnant with Donor Eggs

For women with markedly diminished egg reserve or some genetic abnormalities, using an egg donor is an option. Egg donor may be known or anonymous. The donor is stimulated and fertilized with partner or donor sperm then the embryos are transferred to the uterus of the mother or a gestational carrier.

Becoming a Biological Parent without Getting Pregnant

Some women are not able to get pregnant in their own uteri because of a condition affecting the uterus: scarring, multiple fibroids, adenomyosis, recurrent preterm delivery..Others prefer not to get pregnant because of a general health problem: successful treatment of breast cancer, severe hypertension or heart disease. Embryos are created through IVF and transferred to the uterus of a gestational carrier (surrogate mother).

Genetically Test the embryos before getting pregnant

Embryos created after IVF can be tested genetically for i. A specific gene or ii all the chromosmes. This is accomplished through two steps. Biopsy of the embryos (one cell in day 3 embryos or few cells from the trophoectoderm of day 5 embryos – blastocysts). The cells are tested for the desired genetic target and the healthy embryos are transferred to the uterus.

Becoming a Biological Father if you are in a Same Sex Relationship

Men in a same sex relationship can father children using an egg donor and a gestational carrier. The donor ovaries are stimulated. Eggs are retrieved and fertilized  with one partner sperm or split between partners. Embryos are then transferred into the uterus of a gestational carrier.

Preserve your Fertility in the face of a medical Problem

Sometimes a a medical problem or its treatment reduces the chance for future reproduction. Breast cancer treatment in young women commonly involve treatment with chemotherapy. Medical problems other than cancer also may require treatment with chemotherapy e.g systemic lupus. Chemotherapy leads to loss of ovarian follicles and diminish egg reserve.

The ovaries are stimulated prior to exposure to chemotherapy. Oocytes are retrieved and frozen unfertilized or after fertilization. After treatment, eggs or embryos can be thawed and used for reproduction.

How Successful is IVF ?

Irrespective of the situation, the most important factor in IVF success is the number and quality of eggs remaining in the ovary (Ovarian reserve). Maternal age is the most important determinant of egg reserve. Younger women have more chromosomally normal eggs and are more likely to have a baby after IVF.

In women younger than 35, the transfer of two embryos yields a pregnancy rate of 48 to 50% and one embryo 35 to 40%. In women 40 or older the pregnancy rate per cycle is approximately 5 to 20%  depending on age. Many cycles in older women are not completed due to low response to fertility medications.

Modern IVF enables many women and men to achieve there reproductive goals and conform to their social and personal preferences and aspirations.

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What do Millennial women think about infertility?

What do Millennial women think about infertility?

What do Millennial women think about infertility?

Millennial generation were borne between 1982 and 2000. They have commonalities not shared by other generations. Generation Y is the highest-educated generation in American history.

On the Incidence of infertility in the US

The 2006–2010 National Survey of Family Growth (NSFG), indicates that the incidence of infertility among married women aged 15–44 is 6.0% (1.5 million) in 2006–2010, down from 8.5% in 1982 (2.4 Million women).
Impaired Fecundity (ability to have a live birth) among married women aged 15–44 Increased from 11% In 1982 To 15% In 2002, But decreased to 12% In 2006–2010. Both Infertility and impaired fecundity remain closely associated with age. The decline is probably reflects greater delay in childbearing (less women attempt to conceive thus less fit the definition of infertility).

Infertility prevalence can be estimated using two approaches: [1] a constructed measure derived from questions on sexual activity, contraception, relationship status, and pregnancy, and [2] a measure based on estimated time to pregnancy derived from the respondents’ current duration of pregnancy attempt (i.e., current duration approach). Prevalence was approximately twofold higher using the current duration approach (15.5%) vs. the constructed measure (7.0%). Both methods identified similar patterns of effect of increasing age (American Society for Reproductive Medicine 2013).

On Delaying Marriage in Generation Y

According to Pew Research Center analysis of U.S. Census data, 51% of US adults are currently married. Only 22% of Millennial women are married. The median age of first marriage for Gen Y women is 26.5 years and for men 28.7. Currently, there are more unmarried women in their early 30s than at any time in the last 60 years in the US.

What do Millennial women think about infertility? Generation Y : late marriage and late first birth

Millennial Women : late marriage and late first birth

Millenials give birth to their first child  many years later than predecessors. The mean age at first child’s birth for women was 23 and the mean age at first child’s birth for men was 25 and even much later in more recent research (The Guttmacher Institute). One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview.

Delay in bearing a child remains true even after cohabitation and other adult living arrangements are considered. The gap between first sex and first birth is 9+ years for Gen Y and 3+ years for Gen X.

 

Millennial Women Overestimate their Fertility Potential

Many Generation Y women, age 25 to 35, think a 30 year old woman has a 70-per cent chance of conceiving per month and in a 40 year old is close to 60% (Fertility IQ 2011 Survey, 1,000 women). Women were wrong most often about how long it takes to get pregnant and about how much fertility declines at various ages.
It is not clear why do millennials overestimate their fertility potenials possible explanations could be [1] Ignoring the disconnect between general health and ovarian aging; women can be very healthy and have very few eggs remaining in the ovary.
[2] Media celebrated older high profile and celebrity births in mid 40s.
[3] Some success of fertility treatment in older mothers.

Generation Y women are anxious about their fertility

Perceived infertility is the individual’s belief that she or he is unable to conceive or impregnate, regardless of whether this belief is medically accurate. Overall, 19% of women believed that they were very likely to be infertile, according to a Gutmacher institute 2012 survey of 1,800 unmarried men and women aged 18–29. A survey from Europe indicates that 31% of women and 52% of men believe that dramatic decline of fertility occurs after age 44.

 On The Utilization of Fertility Services by Millennial Women

Millennial women appear to utilize Fertility Service different than generation X. Twelve percent of women aged 15-44 in 2006-2010 (7.3 million women), or their husbands or partners, had ever used infertility services. Among women aged 25-44, 17% (6.9 million) had ever used any infertility service, a significant decrease from 20% in 1995. Thirty-eight percent of nulliparous women with current fertility problems in 2006-2010 had ever used infertility services, significantly less than 56% of such women in 1982. In all survey years, ever-use of medical help to get pregnant was highest among older and nulliparous women (NSFG). Gen Y also overestimate the success rate of IVF.

Consideration of fertility by generation Y without changing reproductive plans include

  1. No harm in evaluation of ovarian reserve. Some women, though very young, do have a diminished ovarian reserve to the extent that delay of seeking fertility treatment is detrimental to there ability to conceiving a biological child
  2. Delaying childbearing does not mean ignoring fertility for an undefined period. Many options can be exercised to preserve fertility, including lifestyle modifications, egg freezing and embryo freezing.
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