Now that many celebs are coming out about their infertility struggles and pushing motherhood off until their 40s, we're left wondering: What is the latest science available to women trying to conceive later in life? Dr. Shahin Ghadir, founder of the Southern California Reproductive Center-one of America's leading fertility clinics-breaks it down for us. By Meghann Foye, REDBOOK.
There's so much talk about what's possible in terms of extending fertility into your 40s and beyond. What are the stats?
The major issue is that more and more women are waiting until later in life to try to conceive. Biologically, this doesn't work for women. The decline of egg quality and count starts before you are even born. It happens again by the time you begin your menstrual cycle, and by 27 or 28 a regular decline in quality and quantity of your eggs begins. Women are coming into my office older and older. They learn that a 48-year-old celebrity had twins, and think, "Oh, if she can do it, then I'll just go to the fertility clinic when I'm ready and have my baby." They have absolutely no idea that there is a very good chance that celebrity used egg donation. And, yes, with egg donation you can get pregnant using the egg of someone between the ages of 20 and 29. That means that you could get pregnant into your 70s if you needed to. Obviously, we would never recommend that.
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It seems like Kim Kardashian's televised doctors visit to test her fertility was the moment when everyone realized, "Oh, if I'm a single woman or if I'm not even thinking about a family yet, I should still get my fertility tested." Is that really the case?
Yes, any woman can have her fertility status assessed at any time-in fact, the Kardashians came to our center. There are excellent new tests that allow you to check your ovarian reserve-meaning how many eggs you have left. It gives you a pretty accurate idea of where you stand compared to other women in your age group. We can also do ultrasounds that look at the ovaries in order to give us information about how useful the ovaries and uterus may be. We can do blood panels that check different hormones that tell us about your fertility. We have one really amazing new test called the AMH, or anti-mullerian hormone, a hormone that's released from the tiny eggs a woman still has in her body. As the level goes down, your egg reserve goes down. You can do it any day of the month, and it's very good for giving you an idea of your reserve.
Should every woman test her ovarian reserve at a certain age in order to know where she stands before making life decisions?
Absolutely, 100 percent. I think it's smartest to do it by age 30.
Depending on what you find, would you suggest then considering freezing your eggs? Is there a certain age at which all women should think about it?
With egg freezing, the younger, the better. So if someone who is 25, beginning law school, and wants to have that corporate job-[someone who] knows there are some things ahead of her that are going to prevent her from having a child for a while-that person would be smart, at age 25, to do it. But if you have not assessed anything by 30, that's when you really need to do it. If by the age of 35 you are not in a relationship and you know that you want to have children, it would be very, very wise to do it right away. Again, the earlier, the better.
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What are the latest advances in IVF that women should know about?
We now have "extended culture medias," which allow us to grow an embryo outside of the body for longer. Before, we used to put embryos back in after two days. Now we are able to allow the embryo to grow to the fullest stage it can outside of the body, which is called the blastocyst stage, where there are hundreds of cells. By that point-about five to six days outside of the body-we have time to do genetic tests, which is another innovation that has become significant in the last couple of years. We're now able to check the embryo for its genetic well-being and make sure that it is chromosomally normal before putting it back into the uterus. We're also able to watch the embryo grow to a stage much further along. So if you have 10 embryos that you've made, we can get really picky and see which one did the absolute best up to day five. It will probably tell us your best embryo.
The one that has the best chance of survival?
Exactly. The one that has grown the most beautifully. And exactly at the times it's supposed to, to the stage it's supposed to, so it's probably your healthiest embryo. One final advance, which is the newest thing we have in the world of fertility, is the EmbryoScope. It's a camera that watches the embryo from the stage where the egg and the sperm come together, all the way up to the time that we put the embryo back inside the body, usually around day five. It watches the embryo grow like a movie.
Wow! Your very first home movie!
Yes, it is. [Laughs] And it tells you not only if the embryo looked good on day five, but whether it has grown and divided normally, which is also very, very important for its well-being.
It is. So we have the environment of freezing and thawing better, we have the genetic testing to test the chromosomes, and we can check to see if the structural growth of the embryo is going well.
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We hear so many stories of women who have been trying and trying, then something shifts emotionally for them and they are finally able to get pregnant. Is stress a factor?
As difficult as it is to scientifically prove, I believe that stress can do anything. I've seen it in my own office where patients have tried for months and months, and months and when they just mentally let go and moved onto the next stage, like an egg donor, for example, it just happened. They were able to naturally conceive. Sometimes patients come into our office and when they know that they are under the care of a good doctor and a good clinic, it just happens.
How about on the male side?
Yes! For men who have zero sperm or very, very poor quality sperm, technology has actually allowed us to extract sperm from the testicle and use it. These are men who, in the past, would never have been able to conceive. There are even examples of men who have had a vasectomy. They can now do a few-minute-long procedure to go in and get the sperm without needing to entirely reverse the vasectomy.
Are there any lifestyle changes that can help increase the chances of conception?
I'm not a physician who thinks you need to change or stop your life, so I don't believe in quitting caffeine, exercising every single day, and doing all of these extreme things. I don't think having one caffeinated beverage a day is an issue. I think that regular exercise and eating healthy is very important. Feeling good about yourself and knowing that you're in the normal-weight category and the healthiest you can be is very important for conceiving.
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