Expert Advice On Recent Studies Challenging Long-Held Beliefs About Fertility

Recently, studies have been released that suggest fertility may be extended much longer than was thought possible and even restored in some cases. Howard McClamrock, M.D., director of the Center for Assisted Reproductive Technologies at the University of Maryland Medical Center, answers questions about these studies and addresses other fertility-related topics in the following interview.

Dr. McClamrock is an associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine who specializes in In-Vitro fertilization (IVF) and techniques to improve pregnancy outcomes.

Does Shady Grove Fertility Center at the University of Maryland offer oocyte freezing?

In 2010 Shady Grove Fertility at The University of Maryland launched “Fertility Preservation” a program designed for patients that desire to freeze their eggs for later use.

What advice do you give to women/couples interested in starting a family about the best times to start this process? And what impact does age have, say, for a woman in her mid-30s or approaching 40?

The physiological answer to that question is really the earlier the better, but that is not what we're faced with often. There are life decisions to be made, and there are women who marry later in life and all sorts of good reasons for delaying childbearing. So we don't tell women when to have children; that's a personal decision. The only thing we want to do is educate them as to how age and fertility relate to each other.

Every person is an individual; there are some women who can conceive without significant difficulty at age 40 but most of them do not. In my practice I see many women in their mid-30s who are having age-related infertility issues, but in the general population, some women are quite fertile in their mid-30s. As age increases, the problems become more significant in every woman.

There are a couple of facts that many people don't understand. One is that if you look at embryos (fertilized eggs) in women who are 40, if they're analyzed, it has been shown that the majority of them (more than 50 percent) are genetically abnormal. Therefore, this is our baseline when we do In-Vitro fertilization (IVF) in women at age 40 and explains the need for replacing more than one embryo. This is also why fertility rates are lower and pregnancy losses are higher in women in this age group. Patients that are aware of a delay in child bearing years can have their eggs frozen, which stops the aging for later use when the woman is ready to have children. Patients in their 40’s can also use donor eggs to conceive.

It seems like we're reading more stories these days about women in their 40s and even 50s having babies, thanks to the wide array of fertility services available. Is it true these fertility services have already started to give women/couples increased flexibility in terms of when they'd like to start a family?

There is more flexibility than they would have without the services. Certainly that is true. We can help women in their late 30s and early 40s, more than they're likely to do on their own. IVF, advances with egg freezing, and egg donation have helped tremendously with this.

Speaking of fertility services, what should women/couples with fertility problems look for in a fertility center?

They should want a well-established program and a program that can do the majority of things that could possibly need to be done. Centers with a variety of Financial programs can significantly help patients with out insurance coverage afford the necessary treatment required to conceive.

Talk about the fertility services available at Shady Grove Fertility Center at The University of Maryland. Anything cutting edge?

We are a full service program providing In-Vitro fertilization (IVF) as well as a donor egg program.

We also perform micromanipulation procedures such as intracytoplasmic sperm injection (ICSI), a procedure that uses microscopic instruments to enhance the chances of fertilization of the egg and involves the injection of a single sperm into the egg.

We currently offer pre-implantation genetic diagnosis (PGD) screening for women getting IVF. This technology allows an individual embryo to be tested for a specific genetic disease such as cystic fibrosis or sickle cell disease in certain populations. Also, it is at times possible to screen for conditions such as Down's syndrome. Recent advances in the PDG technology allow us to view all 24 chromosomes to identifying both single gene defects and chromosome abnormalities.

The newest technology at Shady Grove Fertility Center at The University of Maryland is Fertility Preservation. The availability to freeze eggs with success rates similar to frozen embryos has opened several doors for our patients. Cancer patients now have options to preserve they fertility that does not always return post treatment. Patients that desire to delay their child bearing can now have their eggs frozen for later use.

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