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Deborah: You know, going through fertility treatment is an exciting and hopeful time for everyone involved, but there are so many questions around it for women as well as men. Joining us today is Dr. Meike Uhler, who is board-certified in both obstetrics and gynecology and reproductive endocrinology and infertility, and currently a physician at Fertility Centers of Illinois.

This is the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Welcome, Dr. Uhler.

Dr Meike Uhler: Thank you. I'm very happy to be here.

Deborah: Lovely to have you. Now, the statistics overwhelmingly show that women are pursuing motherhood at a later age. Why do you think that is?

Dr Meike Uhler: I think there are several reasons why women are pursuing motherhood at a later age among them are that women may be pursuing other goals in their lives, including their career, the profession. We also have excellent contraception. So I think most women feel that they can contracept until they're ready to conceive. And I think the message that we get from society is that we have control over when we want to pursue motherhood.

Deborah: Absolutely. And I would imagine there are some benefits in waiting to have a baby. Can you share some with us?

Dr Meike Uhler: Yes. What patients tell me why they have waited are also several reasons. They feel more established in their careers. They have found a partner with whom they want to raise children. They feel like their lives are more settled. And I think those are all benefits in waiting to have a baby.

Deborah: I agree completely. Now, we'd like to cover everything around fertility, conception and pregnancy for women that are 40 and over. First, let's start with fertility. How does age impact a woman's fertility potential?

Dr Meike Uhler: So I tell my patients that fertility is most affected by age. And age is a single determining factor to which the likelihood of a patient achieving pregnancy. So age is so important because the egg is so important. So with increasing age, the chance of pregnancy decreases while the chance of miscarriage increases and the chance of having a baby with a chromosomal abnormality increases. So all those three factors are related to the age of the female patient.

Deborah: And there's no getting around that. It's just what it is. Now, are there some do-it-yourself tips that can help women assess their fertility?

Dr Meike Uhler: Yes. I think one of the steps that a patient can take is to check to see if she is obviating. An easy way to do this as to buy one of those over-the-counter kits in the drugstore that measures the hormone LH, which rises right before ovulation. So literally, you urinate on the stick. It turns the color or not in five minutes. And then it helps establish whether the woman is releasing her eggs. So that's an ovulation predictor kit. If she doesn't want to do that, she can track her temperature or check cervical mucus. But I think this is a way to check ovulation at home.

Deborah: Absolutely. Easy peasy. How long should women try to conceive on their own before seeking help?

Dr Meike Uhler: So the definition of infertility is trying to get pregnant with one year of no success for a woman under the age of 35. And that time is shortened to six months at age over 35. And I think that's important because the older the woman is, we want to more quickly ascertain if there's a problem and then potentially start treatment if needed.

Deborah: Okay. And are there any reasons why a woman should see a specialist sooner than that?

Dr Meike Uhler: Yes, I think depending upon the situation. So an example would be a woman has very irregular cycles. She either is many, many weeks between cycles and there probably could be a problem. Perhaps she knows that she has had a problem with her fallopian tubes in the past or endometriosis in the past. So if the patient thinks that she has a problem, then trust yourself. It's better to see a doctor earlier than later.

Deborah: For sure. And what are the chances of conception each month at 40 and above?

Dr Meike Uhler: Approximately 5% per month or less. So it does get harder at age 40 and above.

Deborah: Five percent or less. Wow. I did not know it was that low. Okay. But that's why you're here. Once pregnancy occurs, should women visit an OB-GYN sooner due to risk?

Dr Meike Uhler: Well, I think it's a good idea so that the OB-GYN can monitor the patient more closely. Sometimes, blood tests are needed or an early ultrasound. I think it's prudent.

Deborah: Now, what are some of the risks associated with pregnancy later in life?

Dr Meike Uhler: So some of the risks include an increased risk for cesarean section, increased risk of high blood pressure in pregnancy, diabetes in pregnancy. So these are some of the other things that can be associated with a pregnancy that happens at age 40 or older. So it is important to have a good doctor with a good rapport that understands these potential problems.

Deborah: Sure. And how can women mitigate some of those risks?

Dr Meike Uhler: Well, I think these all have to do with lifestyle changes. So if the woman is smoking, then we of course encourage to stop. If the body mass index is high, then it would be nice to try and lose weight before pregnancy, if possible. Depends on the medications they're taking, if they're taking medications for particular diseases, that it's important to use the ones that are acceptable in pregnancy. So these are things that can be done ahead of time to try and optimize pregnancy outcome.

Deborah: Now, I've always wondered this, is there an increased chance of twins or multiples with age?

Dr Meike Uhler: There is, because as women age, their FSH levels are higher and sometimes this can release more than one egg, which then can increase the risk of twins.

Deborah: Interesting. Unfortunately, pregnancies can end in really heartbreaking losses. What are some common causes for miscarriage?

Dr Meike Uhler: So the most common cause for miscarriage, accounting for 50% of miscarriages and potentially up to 70% depending on which study you read, is a chromosomal abnormality in the pregnancy tissue. So, because of this, we will talk about it a little bit later about genetic testing of the embryos prior to transfer, but chromosomal abnormalities are the most common cause for miscarriages.

Now, besides the chromosomal etiology or reason for miscarriages, the rest of the miscarriages are due to a problem that nature feels is not compatible with a viable pregnancy. So, unfortunately, as I said earlier, increase in age is accompanied by increase in miscarriages.

Deborah: So naturally, I have to ask, how does age factor into pregnancy loss?

Dr Meike Uhler: So the eggs, the quality of the eggs is a factor, because the older the woman is, the less of the good quality eggs remain. So all women are born with as many eggs as they will have the rest of their life. And when all those eggs are used through menstruating every month and releasing the egg, then approximately age 50, all women will undergo menopause. In which case, there will be no eggs left. So it makes sense that the better quality eggs are released first and then towards the end of the reproductive life, then those eggs are lower quality and eventually, there will be no eggs left. That is the definition of menopause.

Deborah: So, is there anything women can do to improve the health of their eggs?

Dr Meike Uhler: There are some vitamins that can be taken to help improve egg quality. We also like complementary medicines such as acupuncture, is supposed to increase blood flow to the ovaries or other forms of treatments such as yoga. These are things and also the lifestyle changes that we talked about earlier, stopping smoking, be moderate in alcohol and caffeine intake and, of course, no other drug use unless prescribed by a physician for a particular medical illness.

Deborah: Now, this is a sensitive one. At what point should someone consider donor eggs?

Dr Meike Uhler: That is a good and a hard question. So usually, if a woman has undergone several cycles of IVF and the egg quantity and/or quality has been low, then it makes sense to consider potentially going to donor eggs. The success rate is very good with donor eggs. The donors are young. They're usually between 21 and 30 years old. And the average age of the recipient, which is the woman receiving these eggs, is in the 40s. So the pregnancy rates are quite good. And I think that is because of the egg quantity and the egg quality of the donors.

Deborah: What fertility treatment is commonly done for women over 40?

Dr Meike Uhler: Generally, we do recommend in vitro fertilization. So we can try and have the woman produce as many eggs as possible, take them out, put them together with a sperm in the test tube and then transfer the embryo back to her a few days later or do genetic testing of the embryos so that we can transfer back a normal chromosomal embryo.

Other treatments such as intrauterine insemination or mild fertility drugs are less successful. And therefore, we do want to prescribe the best treatment for a woman who is 40 or older.

Deborah: Yes, that that's my next question I was going to ask up. For women over 40, is it often recommended to start with the more advanced fertility treatments?

Dr Meike Uhler: I would say yes, because we do want a patient, if she's 40 or older, to get pregnant as soon as possible and not be waiting any longer to try lesser fertility treatments with lower success rates.

Deborah: Got it. Okay. Absolutely concur. Genetic health is also a consideration. What should couples know about genetic disease in relation to aging?

Dr Meike Uhler: So this comes back to, again, the question about the age and its effect on the eggs. So it is possible that if a woman were to do in vitro fertilization, we can take out her eggs, put it together with our husband's sperm. And when the embryo develops to what we call the blastocyst stage, which is about five days after the initial retrieval of the eggs, then these embryos can be tested for chromosomal abnormalities, and we can optimize pregnancy outcome by transferring back an embryo that we know has normal chromosomes.

Deborah: And of course, modern science allows for embryos to be genetically screened prior to transfer to the universe. Can you tell us about the screening options?

Dr Meike Uhler: The screening test is called PGT, which is preimplantation genetic testing. So the IVF lab embryologist will take a few cells out of the outer layer of the embryo, send it to genetic lab, and then it would take two weeks to get the answer back. So we would freeze that embryo. And then we would know within two weeks' time which embryos have normal chromosomes or not. And we would transfer back the embryo that has a normal chromosome to the patient.

Deborah: You have an incredible job. Amazing. Now while conception and pregnancy can be harder with age, we want people to know that the odds are in their favor. Can you share some positive statistics with us?

Dr Meike Uhler: Yes. And I think this points to what I just said earlier about the embryo, if we can transfer back one embryo that we know has normal chromosomes, then that substantially increases the chance of pregnancy in women over 40 to approximately 60 to 65%. That would be a very, very good statistic for transferring back a normal embryo.

Deborah: Agreed. And what would you say to someone who's trying to conceive and is nervous or afraid to seek help?

Dr Meike Uhler: You know, there are many people in the same situation. You may or may not know about it, but there really is according to all the statistics. And the doctor, her OB GYN is very familiar with infertility over 40, so please go and ask for a referral. Talk to your friends. Go see an infertility doctor. There is no reason to be nervous. And if you are nervous, then I'm sure the doctor can put you at ease. I know that in our practice we have clinical psychologists who help patients who need extra coping and extra help along the way from an emotional point of view. So there is a lot of assistance throughout this process. It can be time-consuming and it can be emotionally draining, but we feel that we have the resources to help patients through it.

Deborah: Can you share some words of hope with our listeners?

Dr Meike Uhler: Yes. I think the most important thing is that you are not alone. We have many women in the same situation and there is help. Science has advanced considerably in the last few years and more and more advances are being made every day. So take advantage of the fact that we have excellent technology to help. And please seek out help because chances are there is help there for you.

Deborah: I love it. Well, Dr. Uhler, we can't thank you enough for being with us today. It was very inspiring.

Dr Meike Uhler: Thank you very much. It was my pleasure to be here.

Deborah: Dr. Meike Uhler, a physician here at Fertility Centers of Illinois. Call (877) 324-4483 or visit us at fcionline.com to schedule a telemedicine consultation with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library, and be sure to give us a like and a follow if you do.

This has been the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Have yourself a terrific day.