Time and the infertile couple

Age is a critical factor in fertility. Your biological clock is ticking away. The earlier you take action, the better your chances for successful conception.

There are many variables which influence the success of infertility treatment and many infertile couples are aware of the importance of healthy eggs , sperm, uterus and tubes in making a baby. They factor these into their calculations, but one of the most important variables in baby making is one which many infertile couples ( and their doctors) often overlook - and this variable is time . Infertility specialists , on the other hand, are acutely aware of a woman's biological clock, and the impact of reproductive aging on reproductive efficiency is a key concept of infertility treatment today.

However this is often something many patients and doctors overlook This is why they often end up treating a 40 year old woman exactly the way they would treat 25 year old woman . However this is not good medical practice .

Younger women have the luxury of time they can afford to experiment and try and this treatment options even those with lower pregnancy rates or experimental treatment protocols because they can afford the luxury of doing so

However for the older woman , time is at a premium , and they cannot afford to fritter away their precious time on treatments with low pregnancy rates or untried treatments. They need to focus their energies on treatments which will maximize the chances of getting pregnant.

This is what I am always upset when I see 40 year old women being treated with options such as intrauterine insemination, which were designed for much younger women Remember that whether you're dealing with fertility or fitness, age does play a role. Whether you feel like you're 15 or 50, whether you look your age or not, your body knows how old you are, and your ovaries do too. As regards your fertility, it's not your calendar age which is important, it's the age of your eggs, or your "ovarian age "!

Another important concept is that of "trying time" , or how long you have been trying to have a baby. If you have been trying to conceive for over 3 years and have failed to do so , the chances of your succeeding on your own without medical treatment are very slim.

For women, optimum fertility occurs at the age of 18. It stays pretty constant in the early part of the 20s and then begins a gradual downward turn from 30 onwards. By the time you turn 35, the process has accelerated and when you approach 40, the slide becomes even more dramatic. One third of women over 35 have difficulty conceiving, and this increases to two thirds when they are over 40. The live birth rate in women more than 44, is less than 1%. As usual, Mother Nature is very unfair, and men have it much easier . Their fertility generally remains constant throughout their 40s. It does begin to decline after the age of 60, but at a much slower pace than for females.

Unfortunately many infertile couples waste a lot of time. They get paralysed into inactivity ("paralysis by analysis" ) because they are confused by their treatment options, and they don't know how to proceed . This often means they end up doing nothing , which is the worst possible treatment option of all. Many will hang on to the unrealistic hope of having a "natural "pregnancy ; while others will change doctors at the drop of a hat . Neither of these are constructive strategies - you need to retain focus on your end-goal, which is having a baby.

Unfortunately many doctors also waste their patient's time . This is true specially for gynecologists rather than infertility specialists , who contribute to this inefficient use of their patients' precious time. Common examples of time wasting treatment include using danazol to treat patients with mild endometriosis; or using antibiotics to treat pus cells in the semen . Others will insist on repeating a laparoscopy -  "to see for themselves"; or repeat the same treatment which the previous doctor has given This often means that patients get fed up and frustrated and lose confidence in themselves and in their doctors.

Studies presented by Dr Leridon at ESHRE in July 2004 have shown that under natural conditions, 75% of women starting to try to conceive at the age of 30 will start a successful pregnancy within one year. This falls to 66% for those who start at 35 and drops to 44% for women starting at age 40. Unfortunately, assisted reproductive techniques will make up for only half of the births lost by postponing a first attempt at pregnancy from age 30 to 35 and fewer than 30% after postponing from 35 to 40 years. Referring to women 35 or older, Dr Leridon has found that even ART "will not fully compensate you for the years, and the chances of conceiving, that you have lost."

When trying to make sense of these figures, remember that human reproduction is a very inefficient process at any age. Ultimately, you are the only statistic that counts when you're trying to conceive. Again, the statistics provide probable outcomes, not facts - they apply to populations, not individuals, and you are unique !

Everything in life comes back , except for time. " For all sad words of tongue and pen, the saddest are those 'It might have been.'" But kicking yourself later doesn't help . You need to factor in time as an important variable when formulating your treatment plan, so you have peace of mind you did your best. You need to know when it's time to move on - on to the next stage of treatment, or the next stage of resolution.

Infertile couples need to take a proactive approach in their treatment, and have a treatment plan in their mind , so that they can maximize their return on investment. This is why IVF is such a useful option- it maximizes your chances of conceiving in a short span of time, and by magnifying your fertility, it telescopes time, allowing us to accomplish in one month what Nature would ordinarily take 3-6 months to do !

Time management for infertile couples is important, not only to maximize your chances of conceiving, but also to maximise the pleasure you get from parenting ! After all, the time and energy you can devote to your child when you are 35, is far more than when you are 45 !