Q&A Sessions:

	-	Most Recent
	-	Age and Fertility
	-	Egg/Embryo Donation
	-	Follicle-stimulating Hormone (FSH)
	-	In Vitro Fertilization (IVF)
	-	Male Infertility
	-	Other Fertility Issues
	-	Polycystic Ovary Syndrome (PCOS)
	-	Tubal/Vasectomy Reversal
	-	Unidentified Infertility

Amarilis asks:
I'm a 42 year-old woman with clogged fallopian tubes, endometriosis that was treated, and two cyst and fibroid surgeries. My uterus is normal? Which options do I have (beside in vitro, which I can't afford)?

Response:
You need to have your ovarian reserve evaluated through a day three FSH and estradiol levels. If these are normal, surgery may be contemplated. Unfortunately, given your age, the success of such procedures is very low.

If your FSH and estradiol levels are abnormal, egg donation, embryo adoption or regular adoption may be your best choices. Embryo adoption, if acceptable to you and your partner, is probably the most financially reasonable of all the options.

Jackie asks:
I delivered my third healthy child at 42. It was an unexpected pregnancy, but we are thrilled. We want to have another so this child will have a sibling close in age (others are 23 and 17), but I will be 44 next week and one year of trying has yielded one pregnancy which miscarried at six weeks LMP (my first miscarriage) six months ago.

I am already pushing my luck age-wise, but does the fact that I have been pregnant twice after age 40, improve my odds of conceiving again even at 44? Thank you so much for your response.

Steven Sondheimer, MD responds:
Your odds of having a child now are better than someone who has never been able to get pregnant or someone who has not had a child at 42. Still you have a decreased chance of conceiving at 44 compared to 42. In addition, you may want to take into consideration that your risk of conceiving a child with Down's Syndrome is greater now than when you were younger.

Elly asks:
I'm going on 40 years old soon. I had one baby in 1995 through artificial insemination. He died 25 minutes after he was born. They said his lung was not fully developed yet! He was supposed to be born in January instead he was born in September. My second child was born the same way; she lived, although she was a preemie. She was born in 1997.

Will all of my children be premies being that I'm at high risk? My fertility doctor told me that my cervical mucus was too thick in order for the sperm to go through to reach the eggs! We want one more child. What can we do about this problem?

Kurt Barnhart, MD, MSCE responds:
I am very sorry that you have had such losses. Your prior difficulties do not guarantee that any future children will be born prematurely, but you are at higher risk than most other women.

Cervical mucus can be a problem in trying to get pregnant, but it rarely is a major obstacle. If you are having difficulty conceiving again you should have a full evaluation for possible issues that may be preventing you from getting pregnant. It is much harder for a women to get pregnant when she is 40 compared to when she is in her early to mid 30's. I would recommend you get a full evaluation with a fertility specialist who will look at the entire picture and offer you options.

Lesley asks:
Due to an ectopic pregnancy, I was forced to have one ovary and fallopian tube remove via surgery. As a result, I was thrown into early menopause at age 37. Is there any chance for me to conceive a child at this stage of my life? I am now 45 years old and recently married. I have read where women as old as their 60's were able to bear a pregnacy and bring it to fruition. What are my chances or should I just forget about it?

Kurt Barnhart, MD, MSCE responds:
I am sorry to hear about your history, but there may be some hope. I would suggest that you get an evaluation of your follicle stimulating hormon (FSH) to see if it is possible for you to get pregnant. Your FSH levels evaluate your ovarian reserve. It is difficult to get pregnant at age 45 for any women, however, some forms of assisted reproductive technologies may be able to help you. It is best to talk about these options with a specialist.

Margaret asks:
News stories about women in their 50's or 60's giving birth to single (or multiple) children are becoming more common. The births are almost always the result of fertility drugs or IVF. What is the oldest age that a woman has given birth naturally (single and twins)?

Response:
That exact answer is somewhat unclear. However, most (almost all) of the cases you hear in the news are the result of pregnancies using donated eggs from younger women. Unfortunately, this aspect of the treatment of these patients is usually not mentioned.

This gives false hope to women hearing these accounts. The likelihood of a spontaneous (natural) pregnancy past age 43-45 is extremely unlikely. In addition, a large proportion of these conceptions result in miscarriage because of genetic abnormalities.

Ella asks:
I am 41 years old and I have four children, the oldest being 19 and the youngest 11. My husband and I want to try one more time for a child. I've tried for the last three months to conceive but all with no luck. Are my chances very slim? Do I need help with fertility drugs? We've never had trouble getting pregnant, but I feel my age could be affecting our results. Please offer some advice.

Response:
It may be useful to have your hormones checked (FSH and Estradiol) on day three of your cycle to help in determining your chances of having a child. If you are not pregnant in the next one to two months, you should see a specialist. If you would like to make an appointment with a specialist at Penn Fertility Care, please call 1-800-789-PENN (7366) or visit pennhealth.com to schedule an appointment online.

Lorraine asks:
My husband and I would like to have a second child. Unfortunately, I am going to be 46 in January '07. Are my chances of doing IVF with my own eggs about the same as getting pregnant naturally? My FSH when I had my daugter at 44 was about 12.5. If everything else is normal, what are the percentages and chances at this late age?

Samantha Butts, MD, MSCE responds:
Your intuition is correct regarding the effects of age on your fertility. Your history of and elevated FSH and the fact that you will soon be 47 makes the odds of pregnancy with IVF using your own eggs extremely limited and the odds of pregnancy on your own even less likely.

I would recommend having a consultation with a physician who specializes in infertility so you can understand the odds and risks of proceeding and the various treatment alternatives that exist. If you would like to see a Penn Fertility Care physician, please call 1-800-789-PENN (7366) or request an appointment online.

Dianne asks:
I am 39 years old and had a tubal reversal done in a year ago. Since then I have not become pregnant. My husband's sperm count is good and they checked my progestrogene level and said I am ovulating. I had two HSG's done. The first showed my right tube open and the left closed. The second was inconclusive due to the die not getting into the tubes.

I saw a local fertility doctor and he said my options are to just keep trying on my own or do IVF. Do you think I may have other options or that there could be something other then my tubes also preventing me from getting pregnant?

Kurt Barnhart, MD, MSCE responds:
Sorry to hear about your difficulty in getting pregnant. As you may know, your chance of getting pregnant decreases with time (age) regardless of if your tubes are open or not. Thus, you may have two issues, not just your tubes.

Having said that, you really do have a few options. If your tubes are open you can try on your own, or add fertility treatment in the form of medications and/or an intrauterine insemination. If your tubes are closed, you need IVF. By the way IVF will work even if your tubes are open, and it has the highest chance of working out of all your options.

CJ asks:
I am a 46 year-old female. I have recently married the man of my dreams, and would love to have a child with him. I already have four daughters from a previous marriage. I still have my periods and they are pretty heavy at times. But they come on time. My husband and I have being trying for two years to get pregnant. He works out of town, and we see each other every five weeks. Is there hope? We desperately want to have a baby.

Penn Fertility Care responds:
Considering your age (your chance of pregnancy decreases with time), and that you have been trying to conceive for two years, we suggest that you consult with a fertility specialist to review all of your reproductive options. Women do achieve pregnancy into their mid-to-late forties however, you should have a consultation based on your health history and individual situation. We wish you the best.

Donna asks:
I am 38 years old and my boyfriend is 46. I had a tubal ligation 12 years ago and he had a vasectomy. We have talked about having children and having this reversed. However, I was wondering if that's possible at our age?

Kurt Barnhart, MD, MSCE responds:
What you are proposing is possible. You can get pregnant at age 38 (and with the age of your boyfriend), but you are certainly not as fertile as you were years ago. The decision to try to reverse the tubal, or the vasectomy, or go directly to IVF is a complicated one.

I would suggest you sit down with a fertility expert to go over the options. IVF and retrieval of sperm with a needle (PESA) will be the fastest way to try to get pregnant and may have the best chance of success.

Monica asks:
I am 48 years old, and I just got married. I already have a child from a previous marriage. I am in my menopausal period. I got tests and my ovaries are in follicular rest, but I have still follicles in my ovaries. It is possible to get treatment and try to get pregnant?

Kurt Barnhart, MD, MSCE responds:
Best wishes on your recent marriage! The chance of having a baby at age 48 is very low, possibly lower then 1 percent, but it is impossible to tell you if you can or cannot get pregnant. One piece of advice I can give you is that, with the exception of using a donor egg (which would dramatically increase your chance of getting pregnant to 50 to 75 percent), other fertility treatments would likely not give you a chance much higher than your own natural fertility.

Question:
I just turned 39 years old. My follicle stimulating hormone (FSH) level is 2.5, normal HSG, sperm tests and all other tests. I have been trying to conceive for a year and a half in total. I have been pregnant twice within in the past seven months, both times after only three to four months of trying. Both pregnancies have been lost to miscarriage at 7-8 weeks, one which just happened.

I am at a crossroads. What should we do? Should I continue trying, or is this hopeless? I guess what I am asking is what are the actual chances of pregnancy for a fertile normal woman that is turning 40? Is it really only 5 percent a cycle or 10 percent a year, some statistics I have read? Do we have a good chance of eventual success with our excellent lab results after these two miscarriages at my age?

Kurt Barnhart, MD, MSCE responds:
You are not alone in your situation. Getting pregnant at around age 40 is difficult, but not impossible. The fact that you have been recently pregnant certainly gives you some hope. However as you mentioned the chance of getting pregnant is lower at this age. I would suggest that you consider aggressive treatment to optimize your chances. You should consider in vitro fertilization. This would maximize your chances. Good luck to you.

Patty asks:
I am 50 and am only now trying to get pregnant. My age suggests a need for donor eggs. For perhaps 20 years, my periods were extremely infrequent. They only became regular about 10 years ago. Wouldn't that mean I wasn't ovulating all those years? Is it not possible that I might have a larger than usual reserve of "good" eggs left despite my age?

Kurt Barnhart, MD, MSCE responds:
While I undestand your logic, unfortunately your egg reseve declines with age regardless of the number of times you have ovulated. I agree donor egg is a good option for you to consider. Penn Fertility Care does offer a donor egg program for those in need of egg donation.

Sherri62 asks:
I am 43 and my husband is 47. We have been trying to conceive for a year now. I had blood work and ultrasounds and I am fine. I am worried that we are running out of time, what can I do?

Samantha Butts, MD responds:
Female age is certainly a very important consideration when having difficulty conceiving. That being said, there are many other potential causes of infertility that could be contributing to your difficulty getting pregnant.

For this reason, I would recommend that you see a physician who specializes in the treatment and evaluation of infertility so that you can have a comprehensive work up. At that time, he or she will arrange to do a thorough work up and discuss in depth your odds of conceiving based on your age and any health history while making recommendations on the best treatment options for you.

To make an appointment, call 1-800-789-PENN (7366) or you can also request an appointment online. Best wishes to you!

Susanval asks:
I am 46 years old. I had my first child at age 41 and conceived very easily (one night). Last year we decided to try for a second child. After two months of no success, we went to a fertility specialist. On the second round of injectables and IUI, I became pregnant but miscarried at seven weeks (last week). Is there any chance I can have a viable pregnancy, and if so should I continue on the injectables or consider IVF?

Steven Sondheimer, MD responds:
Every women is a little different and every history is different. In general women at 46 years of age almost never achieve a successful pregnancy with IVF (and their own eggs). Success with IVF at age 46 usually occurs with the use of a donor egg from a younger women. You probably have a better chance of success than a women who did not have a successful pregnancy at 41.

You and your doctor need to decide on a plan based on what pregnancy rate you would be willing to accept in order to proceed with further treatment. A 46 year-old's chance of having a baby after a single cycle of injectable gonadotropin and IUI is less than 1 in 20.

Lem asks:
I am 56 years old and my husband is 57 years old. I have not menstruated for about two years and had a tubal ligation 25 years ago. My husband and I would like to consider having a child. Is there any chance I could have hormone replacement to allow me to conceive and carry a child to full-term?

Kurt Barnhart, MD, MSCE responds:
It sounds to me like you have passed into menopause. The average age of this is about 52 years old. By definition that means you do not have any more eggs, and thus cannot conceive even with the help of hormones. Your only option would be to have a younger women donate her eggs to you. Those eggs could be fertilized by your husband. Theoretically you could then carry the pregnancy.

MJ asks:
I am 45 years old with two children, ages four and six (both conceived naturally). My husband and I would like to have one more child, but is it too late? Also, what would the options be?

Samantha Pfeifer, MD responds:
At age 45 the chances of conceiving either naturally or with fertility treatments is very low. In addition, the risk of miscarriage is higher than it would be for a woman who is under 35 or 40 years of age. This decline in fertility and increase in miscarriage rates is attributed to decreased ovarian reserve or poor egg quality. This is a condition that we are unable to correct.

If attempts at natural conception are not successful, then trying to increase the number of eggs produced in a month by using fertility drugs and combining this with intrauterine insemination with the husband/partner's sperm can be attempted though success rates are poor.

In vitro fertilization is an option but success rates in a 45 year old woman using her own eggs are poor, less than 5%. Receiving a donated egg is the most successful option for conceiving with success rates of 50-60%, this involves using another woman's eggs combined with your partner's sperm. Penn Fertility Care does provide a complete donor egg program. If you would like to discuss your options, please give us a call.

Question:
Is it possible for a 50 year-old woman to have her eggs extracted and examined? Then, if any might be healthy, to be inseminated and in vitro used to put back in her womb?

Steven Sondheimer, MD responds:
If only this was possible. Presently there is no way to assess the health of an oocyte (egg) and still have it available for fertilization from a woman of any age. It is only after actual fertilization that an evaluation of the embryo is possible and even this has limited success.

With in vitro fertilization programs around the world and here at Penn you may read about successful pregnancies in women over 45. This almost exclusively occurs with the use of donor eggs from younger women. As far as I know no women at age 50 has had a successful in vitro fertilization pregnancy with her own egg.