A woman's age is always a sensitive topic - and this is true, no matter how old she is. If she's infertile, she is likely to become even touchier about this, because she's aware of the fact that she has a biological clock which she cannot rewind. As she ages, she no longer has all the time in the world in order to have a baby.

Reproductive choices have become far more complicated than in the past, when women got married and no options about getting pregnant. They had sex and had baby after baby, and really had very little say in the matter. Biology used to be destiny, but the introduction of birth control changed this helplessness dramatically. Women can now decide to space their families - and lots of women do choose to do just that.

However, we pay a price to pay for everything - and one of the prices young women pay for delaying childbearing is that sometimes their ovarian reserve will decline, which means their eggs are no longer good enough for them to be able to have babies in their bedroom on their own. They then need to seek assisted reproductive technology - and many women today believe that IVF offers a panacea for infertility, which means that they can have their cake and eat it too !

Unfortunately, the reality is that IVF is not a magic solution to all fertility issues - and that especially for older women, the success rates for IVF are low. This is because older eggs are often of poor quality, which means these women usually end up with poor quality embryos , so that their implantation rates are low.

So what is the 35-year-old woman supposed to do? Should she freeze her eggs, " just in case" ? Or should she put her career on hold and have a baby stat ? or can she afford to wait ? Or should she do IVF straight away ? There are many options, and part of the problem is there's too much information online ! Patients get confused - and because so much of the information is contradictory, this just adds to the lack of clarity ! Should you trust a success story you've read on a bulletin board ? Do supplements work? Will acupuncture help ? Or is your doctor pushing you into doing IVF because he wants to make a quick buck ?

Older women need to understand that it's not that doctors are worried about just their calendar age - they're worried about their ovarian age - and while it is true that ovarian reserve declines as a woman gets older, this does not mean that older women can't have babies in the bedroom. The problem is that when there is so much data, it becomes very difficult to sort the wheat from the chaff or make sense of the statistics. This is especially true for the individual patient ! Thus, IVF doctors are biased because they see only women who think they need IVF. They naturally start believing that all older women have fertility issues ! This is not true, of course, because the older woman who gets pregnant in her bedroom never needs to see an IVF doctor !

Similarly, while research is a very good at providing data as to how ovarian reserve declines in a population of women, most women don't care about the other 999 38-year-old women in this world - they only care about themselves, and what their own personal fertility potential is. The problem today is that we don't have a very good of predicting the individual woman's fertility potential - we can only generalize.

We are forced to lump apples and oranges together, and this creates problems for the individual patient, who's not sure what her next action steps should be. Ironically, if an IVF doctor does IVF for a 36 year old women ( even if she does not need it ), she will happily refer lots of her friends for IVF, because she naively starts believing that all older women need IVF !

Let's look at this from the perspective of an individual 37 year old women. She knows she's getting older and her biological clock is ticking, but how does she translate this generic information into a concrete action ? Should she take the promotion she's getting and move to the US for 2 years, even though this will mean that she will have to put off having a child for another 2 years, as her husband will not be able to accompany her. Or should she freeze her eggs as an insurance policy ? Or should she allow nature to take its own course. because her grandmom continued to have babies until she was 44 ? Or should she do IVF, even though she's scared that the cycle may fail, because she's heard so many horror stories from her friends.

It's very hard for the individual older woman to know what to do, and this is why two things are critically important.

  1. Do your homework, so you can make sense of the contradictory information out there - and understand why it's sometimes so contradictory. If you know why people have certain biases, you can use this information intelligently
  2. Listen to your heart, so that you can make the right decisions for yourself, and make the best use of your own biological potential to have a baby.
Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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