Tick tock – fertility clock

by Dr Gillian Lockwood



Time’s running out if you’re thirty-something and want to have a baby. Dr Gillian Lockwood , Medical Director of the Midland Fertility Services, tells you how to preserve your fertility
We have to face it - human beings, as a species, aren’t very fertile. To be blunt, once you reach your mid-thirties, your chance of getting pregnant is 10-15% each month and by your early forties it’s less than 5% a month. Plus you’re facing a 40% chance of miscarriage if you get a positive pregnancy test.

As you get older your ovulation pattern can become less predictable and your monthly cycles shorter. This means you have a shorter pre-ovulation phase and so your ‘fertile window’ occurs earlier in your cycle.

More depressing statistics to come

Your chances of success will be lower if you or your partner have problems with irregular ovulation or poor sperm quality. And the risk of chromosome abnormalities, such as Down’s syndrome, increases rapidly for couples in their late thirties. Find out more about your age and fertility.

It’s not all gloom and doom

Fertility is to a large extent genetically inherited, so you can get a good idea of your reproductive prospects by finding out about your mother – a chance to pry! If your mother had difficulty getting pregnant after her late twenties, and had a relatively early menopause (younger than 45-50years), there’s a chance that you may experience similar problems. If your mother or grandmother had a baby effortlessly in their late thirties or early forties, you’ll probably be able to do the same.

A blood test can also help to assess your fertility

Many fertility specialists now advise women to have a blood test to assess their inhibin B levels. Inhibin B is a hormone produced by the ovaries and it’s a useful predictor of the way the ovaries will respond to stimulation during fertility treatment. It can also gauge your spontaneous fertility and provide vital information about whether you can ‘safely’ postpone trying for a baby for a few years, or whether your ‘ovarian reserve’ is already low and you need to get a move on. It’s a simple blood test taken during days four to six of the menstrual cycle.

Fertility treatments can help some women
Women in their forties are acutely aware that their biological clocks are running down fast, and they can’t risk waiting (or wasting!) six months to ‘give Mother Nature another chance’. It’s wise to get help sooner rather than later and, given the limited amount of fertility treatment available on the NHS and the long waiting lists, you may have to consider going private if you can afford it. See – fertility treatment - the postcode lottery.

Intra-uterine Insemination (IUI) in conjunction with ovarian stimulation can help some women who want to conceive later in life. Intra-uterine insemination with ovarian stimulation boosts the chances of getting pregnant by increasing the number of eggs released each month and ensuring that high quality sperm are in exactly the right place at the right time. The woman has daily hormone injections to stimulate her ovaries which are monitored by ultrasound. When two or three good follicles have developed, ovulation is triggered with an injection of HCG (human chorionic gonadotrophin) - a hormone used to stimulate ovulation which helps the egg mature within the follicle and promotes its release). Two days later her partner produces a sperm sample from which the most active sperm are selected. They are then passed into the cavity of the womb through a fine plastic tube and deposited high up near the opening of the fallopian tubes. Success rates with stimulated IUI are typically 10-15% per cycle. The relatively aged egg seems to prefer the gentle stimulation and the in vivo rather than in vitro environment of IUI.

Many women in their late thirties or early forties choose to have IVF treatment even if there’s no explanation for why they haven’t conceived. The success rates for IVF (approximately 25% per cycle for women under 40 and 10-15% per cycle for 40+ plus) depend on a woman having good ‘ovarian reserve’, - that is, being able to produce a good number of follicles containing eggs in response to the stimulating drugs used in IVF. If several eggs can be collected (ideally up to six) then there is an increased chance of a pregnancy occurring. We can predict a success rate for IVF – taking into account age, past medical history, FSH (follicle stimulating hormone) levels and ovarian scan results.

Human eggs can now be frozen and thawed later to generate embryos for transfer in an IVF cycle
At the moment this technology is mainly used to help young women who are facing a diagnosis of cancer. Lifesaving chemotherapy or radiotherapy will probably render women sterile, and the technique of egg freezing allows them to ‘bank’ their oocytes (eggs) for later use, so they have a chance of giving birth to their own genetic children.

Oocyte cryopreservation

A woman goes through an IVF cycle up to the point where the eggs are harvested. They are assessed for maturity, and then frozen in a special solution that ensures that ice-crystals don’t form. These could damage the eggs.

When the woman wants to have a baby, some of the eggs are thawed out and the ICSI (intra-cytoplasmic sperm injection) technique is used to achieve fertilisation. ICSI involves the micro-injection of a single sperm into each egg using a glass needle about a tenth the thickness of a human hair. The embryo is transferred 2-3 days later and the pregnancy test can be taken after 14 days.

Oocyte cryopreservation is still at a relatively early stage of development and the success rates are not yet as high as they are with conventional IVF. If you’re considering storing your eggs, don’t delay beyond your mid-thirties as every passing year means both the number and quality of the eggs available for storage is reduced. If you go private, Oocyte cryopreservation is available for women who are concerned that they may not be in a position to become a mother until they’re older, when their chances of success are low. However, it’s an expensive technique and success can’t be guaranteed.

Men are different – lucky things

A man doesn’t usually need to store his sperm unless he’s going to have medication which will affect his fertility (treatment for an enlarged prostate gland for instance or chemotherapy) or some kind of serious surgery. Despite some decline in quality and quantity, healthy men go on producing viable sperm into their seventies.

Too old to conceive?
by Dr Howard Lee


I am 37 and trying to conceive. I have taken oral contraception for years and am considering checking into a fertility clinic. After seeing my GP twice, she tells me to give it time and insists I take my temperature every morning for six months. I feel as though my time’s running out. Should I wait six months or ask for tests and treatment now?



It would be a good idea to start some preliminary investigations at this stage. As you say, age is an important factor in pregnancy. The older you get, the less likely you are to conceive. For more information, see our article Fertile at forty?
One of the most important questions couples are asked when they’re trying for a baby is if either partner has had children from a previous relationship. This helps to narrow down possible causes of fertility problems.
Remember that fertility problems are common: 15% of all couples are affected. 50% of couples will conceive in the first 2–3 months, but for 10% it will take a year or more to get pregnancy going.

As you know, some people, male or female, are more fertile than others and for about 1 in 5 cases the problem is caused by poor quality sperm or a low sperm count. Find out if your husband is willing to do a sperm test.

Depending on where you live, you may get treatment on the NHS. But if you feel time is running out consider going privately. Ask your GP for advice and information about clinics in your area. I do wish you both every success.

If you don’t get pregnant, what treatment is available? Guidance from The Family Planning Association
If you’ve been trying for over a year to get pregnant, or you are over 35 and have been trying for six months, then it is worth seeing your doctor. Your GP may refer you to a consultant at your local hospital or a specialist fertility clinic for further investigations. Treatment for infertility within the NHS is limited and waiting lists vary. When you see your GP ask him what is available locally on the NHS and if there is a limit to the help you’ll receive.

Check too
about the cost of any prescribed drugs. Will the practice pay or will the bill come to you? If you want treatment privately, your doctor will tell you about clinics in the area. Phone them to get information about the tests and treatments they offer, waiting times and the costs involved. Then ask your GP to refer you to the clinic you’ve chosen.

When you see the specialist you’ll have limited time for the consultation. Take a list of questions you want to ask. You may have waited a long time for this appointment and you may wait a long time for the next.

Tests for a woman may involve:

Blood, urine and cervical mucus tests – to check hormone levels or ovulation.
Ultrasound scans – to check if a follicle, which should contain an egg, is being produced. Treatment for ovulation problems usually involves drugs and has a high success rate.
Sperm mucus crossover – this checks if the woman’s cervical mucus allows her partner’s sperm through.
Endometrial biopsy – a sample of womb lining (endometrium) is removed to check that it is free from infection and that ovulation has occurred.
Hysterosalpingogram – where dye is passed through the fallopian tubes to check they are not blocked.
Laparoscopy (usually under general anaesthetic) – uses a thin telescopic instrument to view the reproductive organs through a small cut below the navel. It checks for scar tissue, endometriosis, fibroids or any abnormality in the shape or position of the womb, ovaries or fallopian tubes.

Tests for a man may involve:
Semen analysis to look at the number, shape and size of sperm, as well as the way they move.
Blood or urine tests to check hormone levels.
Testing the sperm in special solutions.
Special X-rays/scans to find blockages or check the blood supply to the testes.
You’ll probably go through a range of tests because a couple can have a combination of problems that cause infertility. Once you have a diagnosis you may just need straightforward treatment or surgery to help you conceive. If the tests aren’t conclusive, assisted conception may still be successful. The techniques listed are not miracle solutions. Whatever the treatments available, a woman under 35 will stand a much better chance of a successful pregnancy than a woman over 40.
Assisted conception techniques include:

In-vitro fertilization (IVF) – the most well-known treatment. Eggs are removed from the woman, fertilised in the laboratory and the embryo is then placed in her womb. 80% of in-vitro fertilisation (IVF) treatment is carried out privately. Your GP, practice nurse or local Community Health Council (CHC) will tell you if you qualify for treatment on the NHS. You can also visit The Human Fertilisation and Embryology Authority website for more information.
Donor insemination (DI) Egg donation may be an option if a woman is not producing eggs or has a genetic problem. If a man produces no or few normal sperm or has an inherited disease, insemination using sperm from an anonymous donor may be an option.
Gamete Intra-Fallopian Transfer (GIFT) – a couple’s own eggs and sperm, or that of donors, are mixed together and placed in the woman’s fallopian tubes where they fertilise.
Intra-cytoplasmic Sperm Injection (ICSI) – a single sperm is injected into the woman’s egg, which is then transferred to the womb after fertilization.
Counselling and support
Undergoing treatment for infertility is stressful. Lots of hospital visits are involved with long waits in between to see if treatment has worked. It can be easy to despair or get so anxious about having a child that nothing else matters. Relationships, including sexual relationships, can be put under a lot of strain. If you’d like to talk to people who understand what you’re going through, CHILD The National Infertility Support Network and ISSUE (The National Fertility Association) are organizations run by and for people with fertility problems. Support and counselling are also available at specialist fertility clinics.
If treatments don’t work and you feel you cannot give any more time and energy to trying to have a child, ISSUE can help you through this difficult process.

For more information about IVF see related articles:
IVF - what you need to know.
Infertility treatments in the future.
Fertility at forty, or even thirty.
The cost of IVF