Melanie Cole (Host):  You’ve heard women say, “My clock is ticking” and fertility does decrease with increase maternal age. However, our body’s age and how they age isn’t always directly related to age in years. My guest today is Dr. William Ziegler. He is a board certified specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Ziegler. Tell us a little bit about biological age versus chronological age and what does that mean as a woman ages?

Dr. William Ziegler (Guest):  I want to say thank you very much for having me. In the past, women have been putting off child bearing, especially with the invention of birth control pills. Women are getting further on in the workforce and getting more education and going further into higher positions in companies. That does have a drawback where women are coming to an age where they want to have children but they are older. We know that this often, again, can hinder their personal freedom with having children because, of course, they keep putting it off. However, with the advent of reproductive technology, they feel that that can overcome any obstacle. We have often seen that the median age that women are having their first child is older. Not everybody’s ovaries age the same way. We have some women who go through menopause at the age of 55. We have some women that go through menopause at the age of 35. We need to really take a look at and isolate those patients that are having ovarian dysfunction at an earlier age so we can intervene with more aggressive treatment.

Melanie:  Dr. Ziegler, what are some of the markers of ovarian aging?     

Dr. Ziegler:  The most common one is where you start having menstrual cycle irregularity. For the ovary to function normally, the ovary needs a certain number of what are called “follicles.” The follicles contain the egg. It also has the cells that make hormones to regulate a women’s menstrual cycle. For an ovary to function normally, you need at least 25,000 follicles. We know that when a girl is born, she has around two million eggs. By the time she reaches the time of her period, or menarche, her ovarian egg count is down to 500,000. We know this is a very slow progression. There is a flow that is called “atresia” where the follicles get absorbed. But, once that 25,000 number is hit, we start to see a rapid deceleration in these follicles. We start seeing where the menstrual cycle becomes irregular and it can actually become shorter because the first part of the cycle when it should be around 14 days, is now shortening to 12 to 11 to 10. The cycles become shorter and they also become irregular.

Melanie:  At what age is a woman considered most fertile?    

Dr. Ziegler:  It is under the age of 30. At around the age of 30 is when we start to see a decline in pregnancy rates. It is a slow decline until the age of 35. Then, after the age of 35, it’s a rapid decline until the age of 39. Then, it is an even steeper decline. After the age of 42, a woman getting pregnant using her own ovaries or her own eggs is markedly reduced.

Melanie:  If a woman is waiting until she is in her 30’s, is there anything we can do to preserve our fertility as we age or preserve those eggs in our ovaries?

Dr. Ziegler:  The only way to preserve fertility is basically to freeze a woman’s eggs. We are seeing that more often. Women who are in the corporate world or even those that we see that are that are finishing up medical school. They need to go onto an internship, to a residency and even onto a fellowship, and then they have to establish a practice. By the time they are looking at having children, they are older. We are actually seeing more women coming to us for what is called “social fertility preservation” where, basically, they want to preserve their fertility at this time and by freezing their eggs. There are some corporations such as Google, Facebook and Microsoft that are actually putting that as part of the healthcare plan for them. They have coverage for egg freezing and, again, there are some debates of whether or not that is putting family values, then, above professional values. So, there are some ethical issue with that.

Melanie:  If we’re seeing a decline of hormone expression that causes deterioration in our ovarian function, Dr. Ziegler, would hormones help to preserve some of that function or, no, not so much?

Dr. Ziegler:  It really does not. The way that I look at the ovaries is that the ovary is like a little computer. It knows when your period is going to start, it knows when your period is going to end and you really have very little control over that program. But, in saying that, there are some factors that have been shown to affect ovarian age such as smoking. Women who smoke, we know, have a higher incidence for miscarriage, have a harder time getting pregnant, and they also go through menopause at an earlier age. Women who are around different types of chemicals or environmental toxins, that can also be detrimental to ovarian function. There are some things that we can do within our own life to help not compromise the ovarian function. There is nothing that we can actually do to help preserve it except for egg freezing.

Melanie:  If we get some of that oxidative damage from some of those things that you mentioned and we’re choosing to have children a little bit later in life, do they come back those cells or once they are damaged, once they’re done, they’re done?  

Dr. Ziegler:  Once they’re done, they basically are done, yes.

Melanie:  Do men have a biological age?  

Dr. Ziegler:  Yes, men do. It’s mainly due to chromosomal abnormalities within the sperm. Over the age of 50, we do know there are some chromosomal abnormalities which have been identified within the sperm. Men who are older and if they are trying to conceive with a younger partner or even using donor eggs, then we have seen a lower pregnancy rate if they are using their sperm and they are over the age of 50.

Melanie:  Does healthy diet and lifestyle play any role in our fertility? If a women is in her 20’s but she knows she is probably not going to want to get pregnant until she is in her late 20’s or 30’s, is what she done in her early 20’s, does that have any effect?

Dr. Ziegler:  Outside of smoking and exposure to environmental toxins, there is really not a whole lot that will affect the ovarian function. There are different conditions which could affect a woman’s menstrual cycle, outside of the aging part and that’s basically women who are overweight, women who have a condition like insulin resistance which is a precursor to diabetes. These situations can actually throw off a women’s menstrual cycle and make it harder to conceive or they may need medication to help them conceive. But, that is apart from the biological aging of the ovary.

Melanie: In just the last few minutes, Dr. Ziegler, and it’s such great information, give women listening your best advice about this ticking clock that we’ve been hearing about for so many years and why they should come to the Reproductive Science Center of New Jersey for their care.

Dr. Ziegler:  I think we really need to put it into perspective with regards to a woman’s age. If a woman is less than the age of 35 and they’ve been trying to conceive for a year and she’s had regular menstrual cycles, then it’s time to seek an evaluation of why they cannot conceive. Women who are over the age of 35, we really recommend six months of trying and then be seen at a reproductive endocrinologist’s office. Anybody who has had any other conditions that could compromise ovarian function, like endometriosis, which is a medical condition, or if there is a family history of early menopause. Those are ones that need an early evaluation and that’s what we do here within our practice. We actually take the chronological age but we also look at ovarian age. We want to see what we are actually working with so we’re not wasting a patient’s time in doing a treatment that is not necessary and is not going to get them to the end point in which they want to get to. However, we also want to take into account the entire picture and we also use conservative management, if it’s indicated. We don’t push everybody to the most aggressive form of fertility treatment if they don’t need it. We actually work with the couple and we are the team and we want to do what the couple wants us to do. We do not want to do something that is going to make them uncomfortable. They also have to be psychologically ready to make a step into going for fertility treatments and the type in which they proceed.

Melanie:  Thank you so much for being with us today. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey. If you would like more information you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks so much for listening.