Ep 271: The Fertility Clock: Why Age Matters More Than You Think

Join Dr. Laurice Bou Nemer from IVF Florida along with hosts Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center, and Dr. Susan Hudson from Texas Fertility Center for a crucial topic: how age impacts fertility. As women age, both the number and quality of eggs decline, especially after 35. By 40, fertility is significantly reduced, and after 45, natural conception is rare. The doctors break down what happens to egg quality with age, including how older eggs are more likely to have chromosomal abnormalities, increasing the risk of miscarriage or genetic issues. They also tackle the common myth that healthy living can override the biological clock and shed light on the misleading narratives around celebrity pregnancies. This honest conversation is essential listening for anyone considering their fertility future—don’t miss it!

This episode was brought to you from ReceptivaDx and IVF Florida.

Transcript

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Susan Hudson MD (00:22)

This podcast is sponsored by ReceptivaDx. ReceptivaDx is a powerful test used to help detect inflammatory conditions on the uterine lining, most commonly associated with endometriosis and may be the cause of failed implantation or recurrent pregnancy loss. Take advantage by learning more about this condition at receptivadx.com and how you can get tested and treated, providing a new pathway to achieving a successful pregnancy. ReceptivaDx, because the journey is worth it.

Carrie Bedient MD (00:54)

Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am Dr. Carrie Bedient from the Fertility Center of Las Vegas and I am joined by my fantastic, fabulously full of flair friends, Dr. Susan Hudson from Texas Fertility Center and Dr. Abby Eblen from Nashville Fertility Center.

Susan Hudson MD (01:09)

Hello.

Abby Eblen MD (01:14)

Hi everybody.

Carrie Bedient MD (01:15)

And today we are joined by Dr. Laurice Bou Nemer who is from IVF Florida in Miami. I wanna make sure that I specify that, because I think you guys have several versions, but we are so glad to have you here today, Laurice. How are you doing?

Dr. Laurice Bou Nemer (01:30)

Great. Hi, everyone. Thank you so much for having me.

Carrie Bedient MD (01:33)

And you were telling us that you were involved in educational activities last weekend at a conference in Miami.

Dr. Laurice Bou Nemer (01:41)

Well, the conferences in Miami tend to be lots of fun because we can. So we usually have them at a nice resort. So this year we had the University of Miami OB-GYN Alumni Society meeting at a wonderful resort and water park. And so we spent the morning learning, we had our meeting and then...We went for happy hour at the pool, so that was lots of fun.

Carrie Bedient MD (02:09)

So does everybody, and we see this when we go to particularly conferences that are in Hawaii or places that are known for being hot and a little stickier. Is standard conference attire in Miami like resort casual where it's light, no black and gray suits and heels and all of that? Do you guys get to dress a little more casually for the weather?

Dr. Laurice Bou Nemer (02:31)

Remember, outdoors is hot and warm and sticky. Indoors is very cold in Miami. I have a heater in my office. It is cold. So you can wear a suit and heels and everything. We just tend to wear lighter colors. I was wearing orange. I don't wear gray in Miami. I have a gray suit for when I go up north.

Carrie Bedient MD (02:55)

That's fantastic. So do you guys just sit and is it all of the networking that happens at, at the pool with everybody in their cabanas and cocktails and.

Dr. Laurice Bou Nemer (03:06)

Well, I don't know about cabanas, but yeah, after the learning is done, after the conferences are done, yeah, we all go by the pool and people have their families and we tend to have, drinks and just chill. You can learn by the pool, it doesn't have to be.

Carrie Bedient MD (03:19)

That's awesome.

Abby Eblen MD (03:22)

Sure you can.

Susan Hudson MD (03:25)

I went to one of the ASRM-ESHRE conferences and ASRM for our listeners is kind of the American Society of Reproductive Medicine. ESHRE is the European version of that organization. And every few years they do a combined conference. And I went to one of them in at Atlantis in the Bahamas and it was amazing. And it was that type of situation where we had our conference for about three, four hours and the rest of the day was, having drinks or going in, looking at the water or doing whatever you wanted to do to relax. And it was a nice balance of business and pleasure.

Dr. Laurice Bou Nemer (04:02)

Definitely.

Carrie Bedient MD (04:03)

That's fabulous. Okay, well, let's get down to business here. Susan, do you have a question?

Susan Hudson MD (04:08)

I do.

Susan Hudson MD (04:09)

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Susan Hudson MD (04:41)

So our question for today is, Hi all. Your podcast is my current calm in the crazy. Thank you so much for listening. When I was 23, I had a normal and healthy pregnancy. Now at the age of 32, I'm trying to conceive for my last time. I have periods that are all over the place. Sometimes I don't get one at all. Other times I bleed for three weeks. I went to the doctor and was told I have PCOS.

When my AMH was tested, it was only 0.14. Is there still a chance for me to have another baby? What should I do next? Thank you for everything you do and I hope to hear from you soon.

Carrie Bedient MD (05:19)

All right, what do you girls think?

Susan Hudson MD (05:20)

How often do we hear this?

Carrie Bedient MD (05:21)

Way more often than any of us want to.

Dr. Laurice Bou Nemer (05:24)

Yeah. Yes.

Abby Eblen MD (05:24)

And this is probably not PCOS, unfortunately. She's got a low egg count, and typically low egg counts tend to go with premature ovarian insufficiency, which can mimic PCOS in the sense that your cycles get crazy, you have irregular cycles, but unfortunately it's not due as much to the brain not communicating with the ovary as it just has to do with the low egg count that you have and the fact that unfortunately your ovaries are kind of acting chronologically older than you are.

Dr. Laurice Bou Nemer (05:29)

Yeah.

And although her ovaries are acting older than her age as far as the AMH goes, and this is something we're going to talk about today in our topic, the quality of her eggs isn't determined by her AMH, it is determined by her age, which is 32. And for us, in fertility, that is on the younger side. So she is hopefully still producing good quality eggs.

She just may need a little bit of help ovulating.

Susan Hudson MD (06:23)

I would say that this is a great person to have also a little further ovarian reserve testing performed and looking at the FSH and estradiol. FSH is the hormone the brain tells the ovaries what to do. Estradiol is what feeds back to the brain. And I tend to think of FSH as more of the quality measure in addition to age and AMH more of the quantity measure. And we would rather have somebody who has a quantity issue any day over a quality issue.

Dr. Laurice Bou Nemer (06:54)

Definitely.

Carrie Bedient MD (06:55)

Absolutely. So I guess to answer her question, do we think she can get pregnant on her own?

Susan Hudson MD (07:00)

On her own, she probably needs help. So I would say, can she get pregnant? Possibly on her own. If you already know you have an AMH that is that low, go to your REI, go see what other testing needs to be done, really get a full picture because there may be other things that are affecting this. There may could be some male factor there. Like we said, there may be a quality issue.

And that's going to help us get you where you want to be quicker and time is not your friend.

Carrie Bedient MD (07:31)

Exactly. Also, I don't know if the two of you caught this, but she said that we're the calm and the crazy, and she didn't call us the crazy, and I think that's a win.

Dr. Laurice Bou Nemer (07:40)

Ha ha ha.

Abby Eblen MD (07:41)

It is a win.

Susan Hudson MD (07:42)

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Carrie Bedient MD (07:56)

All right, let's jump into our topic today with Dr. Bou Nemer and we're talking about the impact of age on fertility. And this is something that we see time and time and time again. What is the simple one-liner of what is the impact of age on fertility?

Dr. Laurice Bou Nemer (08:15)

The older you get, the harder it's going to get.

Carrie Bedient MD (08:18)

And with that, how do we start to really break that down? Because there are some patients who come to us going, oh my gosh, I'm so old because they're 31. And there are other patients who come to us saying, I'm not old at all. I'm a perfectly healthy 43-year-old. And so what are some of the guidelines and measures that we think about in terms of age when we have somebody sitting in front of us and we don't know anything about them besides what their history is that they're giving us and their birth date.

Dr. Laurice Bou Nemer (08:50)

And I mean, if we were to put fertility in small boxes as this is good, this is average, this is less good, I'd say less than 35 is one category. And then 35 to 37, then 38 to 40, and then above 40 is another category. I'll say 44 and above is another category as well.

Carrie Bedient MD (09:17)

So what is it about the age of 35 that makes it the bogeyman of fertility where it's such a clear divide that we are always talking about. And that's how a lot of us in medicine help shape, what are we gonna do? And it's based on the age. What is it about 35 that put it in the limelight there?

Dr. Laurice Bou Nemer (09:42)

Well, nothing magical happens at 35, right? Sometimes I have patients who come in a month before their birthday and they're in a rush because they want to freeze their eggs during that month before they turn 35 and then their eggs are 35 years old. Nothing really magical happens the day you turn 35. We are in a decline for a long time and the ovaries, the quality of the ovaries, you were born with your ovaries. We're all born with our ovaries. The eggs are in our ovaries and they've been aging every single day since before we were born. But since the day we were born essentially. And what's a little bit different about 35 is where we start seeing in studies where we look at hundreds and thousands of women, we start seeing a little bit of a decline in pregnancy rate, a little bit of an increase in miscarriage rate. And these things are progressive. So we see them, they start earlier than that really, but this is where we start seeing a significant difference. We'll see it again at 38. We'll see it again at 40. And then it gets sharper and sharper as time passes, meaning a 25 and a 28 year old may not have much difference in their fertility rate, but a 35 and a 38 year old do and a 38 and a 41 year old definitely.

Abby Eblen MD (11:00)

So, Laurice, what would you say, and I had this patient this week, and I think probably all of us have a patient like this maybe once every month or two, that's 45, she runs marathons, she's healthy, she eats great, she feels like she's been doing meditations, her stress level's lower, and she's ready to get pregnant now at her age. What would you say to that person?

Dr. Laurice Bou Nemer (11:20)

Right. And Abby, thank you for that question, because I think that is something that is very important to talk about. And I feel like it's not talked about enough. Everyone's focusing on their health. Everyone's eating organic food and running marathons and everyone's focusing on weight. All of that is excellent. It's not wrong.

Carrie Bedient MD (11:39)

And let's just be clear that everyone doesn't refer to at least the three of us here. Laurice, you very well may run marathons, but I'm pretty certain that everyone involved here is not the three of us.

Dr. Laurice Bou Nemer (11:44)

Yeah.

Abby Eblen MD (11:46)

That's really funny.

Dr. Laurice Bou Nemer (11:50)

Neither do I. But we get a lot of patients who are taking such good care of themselves. And we think that fertility is part of that. And of course, the healthier you are, the better your fertility. But we cannot beat age by eating organic food. You and I all know when you get a new patient, and they hand you the new patient form. You don't check if she's eating organic. The first thing, check her age. Yeah, you check her age. Because that is the most important information you're going to get from a patient. And that's the only thing really we can't do much about.

If you have issues with the uterus, we can fix that. If there's issues, with your hormones, we can correct that. Age, we don't have a time machine. And age is about the only thing that really we can't beat yet in a fertility clinic. So, and, that is a very tough conversation to have with a healthy 45 year old who looks and feels 32, and to tell her that your ovaries are 45. We are going to have a hard time getting good eggs out of 45 year old ovaries. That's the reality.

Susan Hudson MD (13:11)

Can we talk a little bit about why the eggs are different at somebody who is 33 versus somebody who's 43? Other than the fact that you just had a decade pass, how are they functionally different?

Dr. Laurice Bou Nemer (13:27)

Right. So because eggs aren't regenerated, we don't make new eggs every month. The egg we're releasing every month, that's an egg we were born with. And that's gone through life with us. It's just, that's it's time to ovulate and it just got released. So an egg at the age of 33, when it gets released, that's a 33 year old egg in general. By the age of 43, that egg has aged 10 additional years. There's a lot of machinery inside the egg that is responsible for getting the egg to do its job, meaning divide the chromosomes appropriately, take care of everything that the egg needs appropriately. And as all these little agents inside the cell get older, they start making mistakes and forgetting a chromosome here, forgetting a chromosome there. And we end up with eggs that are poor quality, which means eggs that have an abnormal number of chromosomes inside. An egg with an abnormal number of chromosome, if it meets a beautiful spermatozoa, still will not make a good embryo because they'll be missing a chromosome or have an additional chromosome. And that's the problem we run into with age is that the quality of the eggs, the chromosomes inside the eggs become abnormal. Essentially, the DNA is abnormal.

Carrie Bedient MD (14:52)

So how do the testing numbers play into these conversations? If you think about ovarian reserve testing as being your AMH, your FSH, and your follicle count, what are, let's start with what are the normal levels by age group for each of those?

What are the average results that we expect to see with each one of those by different age categories?

Dr. Laurice Bou Nemer (15:17)

This is going to vary widely between people, an AMH of 2 to 3 in the early 30s would be nice. As we get older, it's going to get lower by 40 probably. An AMH of 1 would be nice. Anything higher than that is also good. But as we get older than that, we do expect AMHs.

And we do see AMH is less than 1, which reflects just a lower egg quantity. And that's just normal to have a lower egg quantity with age, because eventually we all run out of eggs.

Susan Hudson MD (15:53)

Laurice, how do you respond to your patients who come to you and they're like, well, I had an aunt who got pregnant at 50 or what about that celebrity who got pregnant at 45, 50, 55? How do you translate those unique situations into an individual's reality?

Dr. Laurice Bou Nemer (16:15)

That's, that's very difficult to answer. Right. Because a lot of people come in and they're like, my mom had me at 45. Well, your mom was really lucky.

Abby Eblen MD (16:24)

Yeah.

Dr. Laurice Bou Nemer (16:26)

It is harder to get pregnant. It is not impossible. There are exceptions to the rule and there are people who will get pregnant. I have delivered a 53 year old when I was in residency. She thought she was menopausal and then she came in with abdominal pain and then there was a baby coming out. So I have seen people get pregnant later in life. But she is the exception to the rule. We are the rule.

Abby Eblen MD (16:35)

How much?

Wow, that's impressive.

Dr. Laurice Bou Nemer (16:51)

We have to assume that we are the rule and not the exception, the rule. If IVF was risk-free, pain-free, harm-free, and cost-free, and we could do a thousand cycles of IVF for a patient, we could probably find an egg that is normal at some point, but none of this none of this is true, right? IVF is a on person, hard on the body, hard on the wallet. And we get to an age where the success rate of IVF becomes so low that it becomes a little bit futile essentially to do IVF. When you're above 45, let's say success rates are in the 1 % range. That's a hard one. That's a hard one.

Abby Eblen MD (17:42)

What would you say to a woman who came to you and she was trying to make a decision if she should do oral medicine in IUI versus IVF and say she's good prognosis patient under 35, but say her AMH is like 0.8, it's abnormal. What would you tell her about the success rate with ovulation induction in IUI versus IVF?

Dr. Laurice Bou Nemer (18:02)

And you said she's 35?

Abby Eblen MD (18:04)

We'll say she's under 35. How's that? She's young. Young, young. Yeah.

Dr. Laurice Bou Nemer (18:06)

End of End of 35. Under 35. Okay. Okay. Under 35. Right.

So this patient needs a little bit of counseling about her family goals. It's one thing to get pregnant once, and it's another to have three babies in the late thirties with a low AMH. So if this is someone who wants one more child or just one child and she's under 35. Her AMH is low. So AMH is not going to affect her success rate with IUI. We can definitely start with IUI if she has open fallopian tubes. Obviously if the semen analysis is appropriate for IUI, we can start with doing that, understanding that success rates of IUI are going to be in the 15 % range.

Nothing in the 50, 60 % range that we would see with in vitro. Now, IUI is cheaper, it's less medication, it's less invasive. So a lot of my patients like to start with IUI, especially if they're under 35, they'll do two, three cycles, max four. If they're still not pregnant, we'll move on to IVF at that point.

A success rate of IVF is going to be higher, but it depends on what the patient wants. If this is a woman who wants to have more than one child, and we have to talk about fertility preservation when the AMH is low, because she's still at that advantage that she's under the age of 35, she has good eggs, she can put embryos in the freezer for the future.

Because if she's struggling to get pregnant at 33, guess what? She's probably going to struggle to get pregnant at 36 and 38. And if we put embryos in the freezer, then she can just come back in at 38 and we do an embryo transfer and get her pregnant. So she doesn't have to go through that because while she is still at a good prognosis under the age of 35 for IVF, she won't be when she comes back for number two.

At 36 or 37, now her eggs are older, she has less of them.

Abby Eblen MD (20:21)

So can you, just as a follow up, can you speak to what challenge does a 33 year old with a low AMH have when they do IVF that somebody with a normal AMH would not have?

Dr. Laurice Bou Nemer (20:32)

So AMH is essentially a reflection of how many eggs she has in her ovaries. And people who have lots of eggs in the ovaries, the ovary is more generous. So when we do a cycle of IVF, the ovary is going to give us a bunch of eggs. And more eggs is like having more tickets to the lottery. So the more eggs we have, the better our chances of winning the lottery.

That's the advantage of a high AMH. High AMH does not erase the effect of age. High AMH doesn't mean we're younger than where we are. It's just a better chance because every egg is a chance of a baby. And the more eggs we have, the better the chances. That's the advantage of a high AMH. The low AMH at a young age just means we're going to get less eggs. But the reality is we may not need a ton of eggs in a 33 year old to make a baby.

Carrie Bedient MD (21:21)

So what's different about counseling when you're talking with patients, not specifically about the fertility component itself, but just counseling in general as you're talking about, all right, once you are pregnant, this is what can happen. And these are some of the things that are different associated with the mom being 45 versus 32.

Dr. Laurice Bou Nemer (21:44)

Yes, yes. So technically we call 35 and above advanced maternal age. Right, people hate it.

Carrie Bedient MD (21:50)

A man thought of that term, guaranteed.

Abby Eblen MD (21:53)

I had a patient this week that came in and said, I just, I just feel so bad because I'm a geriatric pregnant patient. I said, no woman in our field ever calls anybody a geriatric. That's in the popular media. We don't ever say that to anyone.

Dr. Laurice Bou Nemer (22:04)

I have never said that word.

Susan Hudson MD (22:04)

I hate that term. I hate that term.

Abby Eblen MD (22:07)

Makes me crazy.

Dr. Laurice Bou Nemer (22:08)

Who came up with that? Nobody, yeah, no doctor I know uses that word. I don't know where it came from. Well, yes, so as we age, our bodies age, our heart is aging, our blood vessels are aging, and just the risks of pregnant, the risk of life are higher, but the risks of pregnancy are also higher.

Abby Eblen MD (22:14)

No.

Dr. Laurice Bou Nemer (22:32)

These are patients who are at a higher risk of preeclampsia, other complications of pregnancy, preterm labor, et cetera. And for my patients who are above the age of 45 and looking to get pregnant, we generally send them to an MFM for a checkup. And just to talk about the risks of pregnancy, we send them generally to a cardiologist for a checkup as well, just to make sure pregnancy is a long stress test.

I mean, it's long and it is tiring for everybody, let alone when we get older. So I generally will send my patient to an MFM and to a cardiologist if she is above the age of 45, just to make sure that everything is okay before we get pregnant.

Susan Hudson MD (23:21)

Age-wise do you really start encouraging people to maybe start thinking of other options like third-party reproduction thinking about maybe using donor eggs or donor embryos as opposed to using their own eggs and whether it's age-based or hormone level based?

Dr. Laurice Bou Nemer (23:41)

Right. I will start having that conversation. I will say at 43, although I do a lot of IVF at 43, but I will start that conversation where, all right, this is the success rate we're having given the status of your ovaries, your AMH and your age. This is the success rate we have. This is the success rate we're going to have after two cycles or three cycles. Now don't despair. If things don't work out, there is a plan B which is to use donor eggs. I will say the age at which I will really recommend not to even try in vitro fertilization with the patient's own eggs is probably 45. This is where I say really, it's going to be exhausting. It's going to be a lot of trying. It's going to be a lot of ups and downs and the success rate is very low.

I have had patients who have said, I'll take my chances. I want to try and we try, right? IVF has very low risks. So if the patient's healthy and she's still responding to hormones, I'll say, I'll probably try. But at 45, I generally recommend not to do IVF.

Carrie Bedient MD (24:57)

What are the genetic impacts of all these things? So we've been talking about both age and AMH levels. What are the general impacts of age on the genetics of the baby? And how does that play a role in all of this?

Dr. Laurice Bou Nemer (25:13)

Right. So that all goes back to the egg quality, which we talked about earlier. So if we start off with an egg that doesn't have a correct number of chromosomes, we're going to end up with an embryo that doesn't have a correct number of chromosomes. And that is why everyone knows there's an increased risk of having, let's say a baby with Down syndrome with age. That's something that patients mention all the time. They're concerned about that.

There's an increase in miscarriage rate. There's an increase in infertility with age. All of those have the same reason. It is because we have a higher probability of making an egg with abnormal number of chromosomes. So that is why with advanced age, when we do in vitro fertilization, we start offering patients pre-implantation genetic testing to test those embryos for chromosomal abnormalities. Now everyone's asking, is this for Down syndrome? Yeah, it will show Down syndrome, but it will show hundreds and thousands of other chromosomal abnormalities that no one has ever heard of because they're not compatible with life. And that's why we do that testing to select the best embryo for transfer.

Susan Hudson MD (26:30)

What are some treatments or adjuncts that are out there that you think may or may not have a lot of appropriateness when we're battling the effective time on ovarian reserve?

Dr. Laurice Bou Nemer (26:47)

Yes, thank you so much, Susan, for this because there is a lot of people online who want to take advantage of our patients and our patients who get desperate, meaning they have, there is nothing they can do about the fact that they're aging. There is nothing they can do about their AMH is being low. And they find people online or around town who are offering all sorts of miracle treatments to improve their AMH or to improve their egg quality or to get them more fertile. The reality is there is really not much we can do to reverse the effect of age on our body, on our eggs. Now, there are things we can do proactively to stay healthier, not to smoke. right? Smoking is about the worst thing we can do for our eggs.

There are things we can do ahead of time to age more, to age better, but we cannot take an infusion or medication or anything that will reverse time. I have had patients who have taken, who have been, scammed, I will say online and have taken six months off from IVF treatment to detox. There's no such thing as detoxing.

Abby Eblen MD (28:08)

Amen! I agree with that.

Dr. Laurice Bou Nemer (28:10)

There is no such thing as detoxing and taking six months off to get better ovaries. It's just like saying, I'm going to take six months off and come back younger. It doesn't happen. Time is linear. You're going to come back older. Right. So, I will say yes.

It is very important to live a healthy life and have a healthy diet and exercise and take vitamins and take CoQ10, which is one of the things that was shown that may be in the appropriate quantity at the appropriate dosage from a trustworthy vitamin provider can help a little bit with egg quality. I put all my patients on a prenatal and CoQ10, but do not stand in your own way. The most important thing you can do is not waste time because that's the one thing you can't buy in a vial or get it infused.

Abby Eblen MD (28:59)

Mm-hmm.

Susan Hudson MD (28:59)

I think that's something that we often see and we see it within all of our practices is we have people who they end up getting information that their ovaries aren't working well and they spend so much time trying to figure out how can I make this not be my reality. They waste that time when they should be doing something proactively and sometimes, I mean, we've all seen it like well, talk to somebody, the person will go off and do whatever they're going to do. And they come back one, two, five years later and they're like, okay, I'm ready. And it's just like, yikes. The scary thing is for people with diminished ovarian reserve, I mean, we know on average what happens with age, but if you start out with a lower diminished ovarian reserve, in most cases, and with the exception of people who've been through like surgery or chemotherapy or those types of things, we don't know, did you just start out with fewer eggs than the average person or are you losing eggs faster than the average person? And the only way we're gonna know that is time and time is not your friend.

Dr. Laurice Bou Nemer (30:12)

Yeah, sometimes it's a hard pill to swallow to come to a fertility doctor. And I empathize with my patients. Sometimes they come in and all I have is bad news and I feel bad. But if I don't tell you that I'm doing you a disservice and we do have to be honest. I had a 46 year old lady show up once, very educated, in healthcare.

Abby Eblen MD (30:22)

Yeah, we have to be honest.

Dr. Laurice Bou Nemer (30:38)

Very educated person comes in, wants to have a baby. AMH is very low. She is 46 years old. I'm not going to do IVF. I recommended donor egg. And she looked at me. She was very upset. She looked at me and she said, no one has ever talked to me like this in my life. And I, I was, mean, I know I just gave her very bad news and I felt I felt bad. And I thought to myself, maybe if someone had three years ago, there was something I could have done then. But no one wants to have these conversations with women. And they go through life thinking that fertility is eternal and, the Kardashians and everyone else get pregnant in their forties and I'll be fine. When really people aren't disclosing how they're getting pregnant at 44, 45, and 46, and 50. These women either have eggs frozen from before, embryos frozen, donor eggs. They have something done to help them. But nobody talks about it. It's a very hard conversation to have with women. OB-GYNs don't have the time to discuss all of that. They have to do pap smears and breast exams and mammograms and all of that. So they cannot have a 45 minute conversation that we can have with women about their age and their egg reserve. And that's why I recommend, I tell my OB-GYN friends, your patients who are in their early thirties, not yet trying to get pregnant, not yet in a relationship that is going to lead to that, need to have a talk.

Send them to me. I'll talk to them. They don't need to do anything about it, but at least there is a seed that needs to be planted. Women need to be thinking about their fertility in their early thirties. Otherwise, their life decisions are going to be made for them.

Susan Hudson MD (32:37)

And the nice thing is we now have the ability to freeze eggs very efficiently. And I've actually had more people in the last few months who have had diagnoses of diminished ovarian reserve. And, one challenge when you're going through fertility treatment is we usually have two sets of patients.

If you are a couple and you're in that situation where you're not using a sperm donor or something like that, not everybody's always on the same pathway. And we've all seen a woman who is like, I need to act on this. And he's like, I'm not quite ready to go there. It is important to know that sometimes there you may need to turn to options like freezing your eggs now so that you preserve that chance so that when the two of you are on the right page, you haven't lost that opportunity because we've all seen that situation where a couple's not on the same page, they decide to take a break. And when they come back, guess what? He can still have his biological child and she can't. That's a crappy conversation. I hate those conversations because they're like, well, what was it three years ago? And I'm like, Well, three years ago it was here and now three years later it's here and I can't reverse that.

Dr. Laurice Bou Nemer (33:58)

People underestimate how fast it deteriorates. Three years is a long time in the mid to late 30s. It's a long time.

Abby Eblen MD (33:58)

That's absolutely true, yeah.

Carrie Bedient MD (34:09)

So what's the impact, we've been talking all about women, what's the impact of aging on men and fertility?

Dr. Laurice Bou Nemer (34:15)

Well, they're not excluded from the effect of age. However, it is much less of a problem. We see men having babies in their 50s, 60s, even 70s, they can still produce sperm. They're probably going to make less sperm. It's going to be less motile. We can still make a baby with that. There are increases in some diseases, or disorders in advanced paternal age.

That we do see, but again, much less pronounced than what we see with the effect of age on women. The reality is, because women are born with their eggs and we just have less and less and less and less as time goes by, we are different from men who keep making sperm. They keep making new sperm. So that makes that their sperm is always going to be younger than our egg.

Carrie Bedient MD (35:02)

All right, what questions are we missing related to the impact of age on fertility? Are there any big topic areas that we have not hit yet?

Susan Hudson MD (35:11)

I think we hit a lot of them. I would like to recap that, especially when you're reading about people in the media who have beaten the odds. As Laurice mentioned, you don't have the whole story. Okay. And how they actually conceived and it's like, my goodness, I can't imagine how this actually happened. A lot of that. It's, it's, it's a persona. It's, it's not a reality. And so just remember that if you multiply, if you have really bad odds, multiply those odds against the chances of becoming that famous. And I think you're almost probably as likely to get a free trip to Mars on some of these. So just make sure whatever you hear.

Abby Eblen MD (35:54)

Yeah.

So you're saying the chances are really low is what you're saying.

Susan Hudson MD (36:00)

Yes, the chances are really, really low. Know that there are always more things to a phenomenal story than what you have access to.

Carrie Bedient MD (36:11)

Absolutely.

Dr. Laurice Bou Nemer (36:13)

And we, what we talk fertility doctors, we talk all the time about age and that's not really to scare people. And someone told me I was all doom and gloom the other day on a consult with a 43 year old doing IVF. So, we talk about age to educate and to set expectations where they need to be. Meaning if you are still on the young side, use that to your advantage. If you have the opportunity to freeze your eggs, freeze your eggs. If you are in a relationship that is uncertain or you don't know, you're not sure he wants to have a baby, you're not sure he's the guy, freeze your eggs. If you're in your mid to late thirties, you haven't frozen your eggs yet and you're not trying to get pregnant, freeze your eggs. Yes, know, 38 year old eggs are not going to be as fresh as 32 year old ones.

But those are much better than 40 year old eggs. So yeah, it's never too late. It's always better to freeze eggs than not to have anything left. And if you want to have a baby and you are 40 or above, just go and get a consultation with a fertility doctor. Don't wait until you try and fail. Yes, you may get pregnant from the first month and whatever the fertility doctor is doing is not going to prevent you from getting pregnant. So you keep trying while getting tested. But if there's an issue, you want to find out right away because every month you're losing in the 40s is precious.

Carrie Bedient MD (37:48)

The other place that all of that applies is if you are in a position where you know you're going to be using a sperm donor. Let's say your partner had chemotherapy at a young age. Let's say that you're in a same sex relationship or a relationship with someone who doesn't have their own sperm and you're going to need to outsource that portion of it with a sperm bank. If you're asexual and you know you want a family, but you're unlikely to achieve that in the old fashioned way.

Those are all things to start thinking about your future now because you want to be able to address that in your early 30s, not when you might actually be ready in your late 30s, early 40s.

Dr. Laurice Bou Nemer (38:21)

Yeah. And people with genetic diseases as well, genetic disorders. I do a lot of PGTM for BRCA carriers, for example. So if you know you're going to want to test your embryos for that, that's IVF. The younger you are, the more eggs we have. Again, the better chances at the lot.

Carrie Bedient MD (38:39)

Exactly. Thank you so much for joining us. We've had Dr. Laurice Bou Nemer with us today from IVF Florida in Miami. So thank you so much, Laurice. We have loved having you here.

Dr. Laurice Bou Nemer (38:48)

Thank you so much.

Thank you so much for having me.

Carrie Bedient MD (38:52)

And to our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday's episode pop up automatically for you. Be sure to subscribe in YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (39:04)

Visit fertilitydocsuncensored.com to submit specific questions you have and sign up for our email list.

Susan Hudson MD (39:11)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we'll talk to you soon. Bye.

Dr. Laurice Bou Nemer (39:20)

Bye.

Carrie Bedient  MD (39:20)

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