Navigating the Complexities of Female Infertility: Age-Related Changes and Causes with Dr. Labeena Wajahat

Infertility affects millions of women worldwide, but the causes can vary dramatically with age, making a one-size-fits-all approach to diagnosis and treatment ineffective. From the complexities of ovulatory dysfunction in younger women to the natural decline in egg quality and quantity as age progresses, understanding the nuanced landscape of female infertility is essential. In this blog post, we delve into the most common causes of infertility across different age groups, providing insights that are both enlightening and practical.

To shed light on these varied causes, we turned to our own Dr. Labeena Wajahat. In this blog post, she offers her expertise and knowledge to help demystify the conditions that affect women’s ability to conceive across the spectrum of adulthood.

What are the most common causes of infertility in women, and how do they vary by age group?

The most common identifiable causes of female infertility are conditions associated with ovulatory dysfunction (such as PCOS, thyroid disease, hyperprolactinemia, and obesity), endometriosis, pelvic adhesions, tubal and uterine factors, and unexplained infertility.
In young women, the most common cause is ovulatory dysfunction. However, as women age, the quality and quantity of the eggs in the ovaries decrease, which makes it more difficult to achieve successful pregnancies and carry them to term! The chances a woman can get pregnant in any single menstrual cycle is 25-30% in her 20s or 30s. But after age 40, that chance drops to it to 10% per menstrual cycle! Additionally, other factors that reduce fertility such as fibroids, tubal disease, and endometriosis also increase with age.

What are the initial steps of diagnosing infertility in women? What kinds of tests or evaluations are typically involved?

The first step is taking a GOOD, thorough medical history! Make sure to ask about a patient’s menstrual history, surgical history, GYN and sexual history, as well as what medications they may be taking, just to name a few! Otherwise, a basic infertility workup includes both blood tests and imaging studies. These tests focus on checking the ovarian reserve, ovulatory function, and structural abnormalities in the reproductive tract- and will include testing anti-mullerian hormone (AMH), follicle- stimulating hormone (FSH), and estradiol levels. An ultrasound can also be done to check the antral follicle count. Other ways to evaluate for ovulatory dysfunction are with a midluteal phase progesterone level, thyroid function testing, and prolactin levels. Other imaging modalities such as a sonohysterogram (SIS) or hysterosalpingography (HSG) allows us to take a good look at the uterus and fallopian tubes, to see if there are any structural abnormalities that can be causing infertility!

What are the current treatment options available for women facing infertility, and how do you determine the best approach for each patient?

Once a cause is identified, treatments should be aimed at correcting the reversible causes of infertility or trying to overcome the irreversible ones! Lifestyle modifications are the first step to treating infertility, as it’s so important to make sure that we set our patients up for success in not only achieving a pregnancy but also maintaining it. Reducing excessive caffeine or alcohol intake, smoking cessation, and timing intercourse appropriately should be prioritized. Other treatment options can include medications, surgery, or procedures that are conducted by our wonderful REI specialists- such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

How do you discuss the success rates of various infertility treatments with your patients, and how do success rates vary by treatment type and patient characteristics?

Better question for an infertility specialist, I don’t typically discuss success rates of IVF/IUI with my patients as I do not perform these procedures!

In what ways do lifestyle factors such as diet, exercise, and stress levels impact fertility, and what lifestyle changes do you commonly recommend?

Lifestyle factors make a HUGE impact on fertility! For example, obesity is often associated with PCOS, which is the most common cause of ovulatory infertility. One of the first things I counsel my PCOS patients on- before even discussing medication options with them- is that weight loss of as little as 5% of your body weight can decrease circulating androgen levels (i.e. improve those bothersome symptoms of acne and facial hair growth), cause spontaneous resumption of normal menses, and improve pregnancy outcomes drastically! In general, women who are underweight, overweight, or who exercise too much may have a harder time getting pregnant!

Dealing with infertility can be emotionally challenging. What kind of support and resources do you recommend for women and couples going through this?

Thankfully, there are so many resources such as books, websites, virtual and in-person support groups, and other types of support for patients who are experiencing difficulties with infertility- whether they be faith-based or with friends or family members who have gone through similar experiences. I also make it a point to let my patients know that I am here with them to help support them, as I feel that feeling supported by your provider can make a big impact!

How often is male factor infertility a contributing issue, and what steps do you recommend for couples when this is the case?

Male factor infertility is a cause of infertility in 40-50% of couples! Because of this high percentage, a basic workup for infertility in a heterosexual couple should include a thorough evaluation of the male partner as well! In addition to a medical history, a reproductive/sexual history and a semen analysis should be completed!

Infertility treatments can be expensive. How do you address the concerns related to the cost and accessibility of treatments?

Because infertility is becoming a much more prevalent (and less stigmatized!!! J) condition in our day and age, some infertility specialists are starting to accept insurance- which is great! I know that for many people the cost of infertility treatments and medications can be a significant barrier to seeking care, however I always encourage patients to seek out opportunities to alleviate that burden- whether it be by asking physician offices if they offer treatment plans or medical discounts, or even by having patients contacting their employers to see if they offer any family planning assistance! I once had a patient who won free IVF through a radio contest!

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