84. Fertility and Age: Why Restorative Reproductive Medicine Beats IVF

Is fertility doomed after age 35? In this episode, Dr. Monica Minjeur breaks down the science behind age and fertility, separating fact from fiction. Learn real statistics, key strategies to optimize fertility naturally, and why age isn’t the only factor that matters. Dr. Minjeur shares an inspiring success story, explores the role of egg and sperm health, and discusses how restorative reproductive medicine has superior outcomes to IVF. If you’re trying to conceive later in life and feeling uncertain about your fertility, this episode is a must-listen! Schedule a free discovery call to explore your options: https://radiantclinic.cocm

Transcript

Monica: 0:07

Before we get into the episode today, I want to make sure you know about my free discovery calls. If you are interested in learning how the medical services I provide would be a good fit for you, go to our website radiantclinic. com and click on the link that says book free discovery call. You can choose a time to chat with me about our process and how I can help you achieve your menstrual cycle and fertility goals. I'm looking forward to visiting more with you soon. And now on to the episode. Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health, and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. We oftentimes hear that fertility drops off after age 35. But is that really true? Does age make or break your chances of conceiving? Today, I'm going to dive into the science behind fertility and age. What's fact? What's fiction, and what you can do no matter where you are in your journey. We're going to talk some real numbers as far as the science, as well as how to optimize both female and male health with advancing age when it comes to fertility. And finally, I'm going to share some real birth outcomes and what numbers actually matter so that you can make a best decision moving forward. As always, let's get started with a story about a past client of mine who we'll call Veronica. Now, Veronica came to me when she was 43 years old. She had had a couple of pregnancies prior and actually had two pre term births. Both of her past babies were born prior to 32 weeks. One was conceived with IVF and the other was a natural pregnancy. She thought she maybe wanted to have one more baby but was very concerned about her age at 43 and knowing that this was going to be a bit more challenging. So as always, we got her started with some fertility awareness based charting. We ordered labs and worked on optimizing her cycles. Her labs did reveal that she had a lower AMH or anti Mullerian hormone. And we're going to talk about this a little bit later in the episode, because it's a number that is really nefarious and can sometimes be misconstrued. Veronica also had low progesterone as well as thyroid dysfunction, even though she was on thyroid medications. Through cycle after cycle, we worked to optimize her medications, adjusted her supplements, and continued to work on reducing stress on a regular basis. She conceived naturally about five months after starting with us. And throughout her entire pregnancy, I was a persistent advocate for continuing to do hormone support where it was needed for progesterone and estradiol level. We also helped to advocate for a cervical cerclage given her past very preterm births. And I'm happy to report that she was able to deliver a healthy baby at just over 35 weeks, which was much, much later than her past pregnancies had been. So age alone doesn't make the whole story. And that's why I share this story, is because every situation is unique. But it's important to be able to optimize those factors in a way that's meaningful. and works with your body. So, let's back it up a little bit, and talk a little as far as the science of age and fertility. Now, when a female fetus is still in her mother's womb, she has about six to seven million eggs in her ovaries. Women are born with all the eggs that they will have in their entire lifetime, and that number steadily declines over time. In fact, by the time a female baby is born, she's down to about 1 to 2 million eggs. And by the time she hits puberty and starts having cycles, she's down to about 300 to 500, 000 eggs. Roughly 10, 000 eggs dying off monthly before that point in time. Throughout your menstrual cycle years, you will continue to lose about 1, 000 immature eggs per month. Now if you are a smoker or have significant health conditions or unfortunately need to go through any type of cancer treatment, sometimes that will escalate that process and you will lose eggs a bit more quickly. However, by the time you're in your mid 30s, you still have somewhere between 50 to 100, 000 eggs remaining, which is more than enough. By the time you hit menopause, that number drops to somewhere less than a thousand. Now over time, the quality of your eggs can also decrease. So the egg itself is still going to always be there, but the egg that is the most highest quality is likely what's going to be released with ovulation each month. And as that pool becomes smaller to choose from, sometimes the quality of the egg changes as well. And this can be part of the reason why we see an increased chance of chromosomal abnormalities with women who are a bit older when they deliver a baby. Now this isn't always the case, and typically your chances of having a chromosomally normal child are always going to be higher than if you have a child who has a chromosomal abnormality. Statistics are that natural conception rates in your 20s, 30s, and 40s will start to slowly decrease, but there isn't just this abrupt drop off. In fact, many women conceive naturally well into their late 30s and 40s. The other factor that plays a role here is, of course, male fertility and age. Now, men continue producing sperm throughout their entire lifetime. However, the quality of sperm can decrease over time. One of the factors that we pay attention to is DNA fragmentation. And if you have a higher amount of fragmentation or broken DNA, that can create increased problems with trying to conceive, as well as early miscarriages. And we're going to talk a lot more in next week's episode all about male factor fertility. So make sure you tune in next week to hear all about that side of things. Now, as I mentioned previously, a lot of women feel like after age 35, fertility levels just significantly drop. And again, it's a gradual decline, not an abrupt drop, and many women feel as though there's nothing you can do after that point in time. It's just a matter of your age. And the reality is that there's actually a lot we can do to help improve egg and sperm health after age 35. These treatments focus on dietary adjustments. lifestyle changes, targeted supplements, hormone optimization, as well as balancing overall health concerns like thyroid dysfunction, insulin resistance, or cortisol deficiency. All of these things can help to improve fertility after age 35. Many women are told that if you're over the age of 35 and you have been trying unsuccessfully to get pregnant, that you should go to IVF because this is going to be the fastest option. Especially if you're over the age of 40, it's oftentimes the one thing that women are told as far as trying to be able to conceive. The reality is that egg health, sperm quality, and hormone balance all matter way more. In fact, IVF rates after age 35 do drop off significantly. If we look at SART data, so this is going to be the Society for Artificial Reproductive Technologies across the entire United States. Most recent full year data that was published was in 2022. And if we look at data with patient's own eggs, the live birth rate per patient from age 35 to 37 years old is 40%. If you're 38 to 40 years old. That live birth rate per patient drops down to 27% with IVF. If you're 41 to 42 years old, that drops to 14%, and if you're over the age of 42 years old and using your own eggs for IVF, that rate is only 4.7%. Now, a lot of women are then told, well just use donor eggs, use the eggs of someone who is much younger than you, and your chances of IVF will improve. And although the outcomes are higher, live birth rates for women using donor eggs are still only at 38 to 45 percent at best. So in my world, 45 percent outcome is not fantastic and that's not something I want to hang my hat on. Now, oftentimes, women are told, get some lab evaluation done, let's check an AMH level, and that's that anti Mullerian hormone I was talking about earlier. Now, oftentimes, that AMH is low, and that's why women are shuffled quickly into IVF, because there's a certain threshold at which IVF is not recommended to be done, depending upon your age. Many women feel as though a low AMH level means I don't have any other options. Or, oftentimes I get women that come to me and they're told, my AMH was so low they told me I have the eggs of a 52 year old. Now the reality is AMH doesn't work exactly like that. AMH was created as a marker to see what is the chance of success on an ovarian hyperstimulation cycle that we are going to be able to retrieve enough eggs for a round of IVF. And so many women are falsely understanding that this AMH means I don't have any eggs left or I don't have enough eggs left when the reality is you likely still have thousands of eggs. Colleagues of mine that work in the field of restorative reproductive medicine, as well as myself in our own practice, have seen conception occur naturally in women that have an AMH as low as 0. 02 to 0. 05. We see this often because it is not just about what that number shows us, it is all about where are we optimizing all of the other factors that play a role so that we can focus on a good quality egg that's being brought up with each ovulatory cycle. So again, our key strategies with restorative reproductive medicine focus on supporting egg quality with lifestyle changes, adequate sleep, dietary changes, supplements when needed, stress reduction wherever possible. Most importantly, this hinges on an understanding of your cycle health and ovulation tracking so that you are able to perfectly time intercourse during that fertile window. We also focus on addressing hormone imbalances like progesterone or estrogen dysfunction, thyroid, inflammation, adrenal insufficiency, DHEA, and testosterone imbalances. All of these factors play a huge role when it comes to women's fertility, regardless of their age. As far as the male side of things, we also can improve sperm health through targeted supplements, dietary and lifestyle changes for balancing testosterone. Improving sperm motility and morphology by reducing oxidative stresses like smoking, excess alcohol, and excessive heat exposure. And then when we put it all together we have these medical and restorative interventions of restorative reproductive medicine to identify and treat root causes regardless of your age. By charting your fertility to optimize conception timing, we have real talks about when it's important to consider medical support, whether that's irregular cycles, sperm issues, low progesterone, or whatever the case may be for your unique situation. Age is just one factor that plays into fertility, and it's not the only thing that matters. Although we do see some changes that start to happen with advancing age for women, it does not mean that it's the end of the road for you. If you're feeling overwhelmed by the numbers or have been told data and you're unsure of your next steps, let's talk. There's a better way forward to addressing fertility after age 35 instead of IVF. Schedule a free discovery call with us. So we can share more about how our unique approach to treating fertility is tailored specifically to you. Even if you're feeling or have been told that you're too old, let's talk through your options to improve your health and promote fertility. If you're ready to work with our elite team of health care professionals, go to our website, radiantclinic. com, to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in the states of Iowa, Illinois, Minnesota, Wisconsin, Michigan, Connecticut, Florida, Texas, and more coming soon. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.