Pregnancy after forty years in uncommon is considered a high risk. There is a great incidence of spontaneous abortion and gestational trophoblastic disease in elder women. Also chromosomal abnormalities in fetus are more frequent than at younger ages. The risk of infertility also increases with aging. Infertility is defined as a failure of a couple to become pregnant after a period longer than a year of unprotected intercourse.
There are determined several factors that may cause infertility: male reproductive problems, ovulation problems, damage of fallopian tubes, endometriosis, problems with intercourse, and abnormal interaction of cervical mucus and sperm. In many cases the cause of infertility remains unclear. Couples that experience such a problem may opt for professional assistance.
First of all, a patient evaluation is usually made of the both partners. Male patient evaluation begins with medical history (to determine supported infections, exposure to radiation, chemicals, alcohol and other harmful factors), physical examination (can discover some hormonal dysfunctions or structural abnormalities of genital organs), and semen analysis (provide information on volume, concentration, motility, and shape of sperm). Sometimes there can be effectuated supplementary laboratory tests, such as blood test and genetic test.
A female patient evaluation also begins with detailed medical history and physical examination. Special attention is paid to the age of the female patient, past illnesses, infections and surgeries, menstrual cycle characteristics, previous pregnancies and abortions (including medical and spontaneous abortion), and contraception. In women with deregulated cycles firstly must be determined if the ovulation is taking place. For this purpose different laboratory tests are made: ovulation predictor kit, progesterone level, basal body temperature, ultrasound, and endometrial biopsy.
If the tests demonstrate that the ovulation is present, there are performed analyses to discover other possible causes of infertility: hystero-salpingogram (shows if the fallopian tubes are opened and also shows the shape of uterus), laparoscopy (can inform about different morphological abnormalities, endometriosis, adhesions and others), hysteroscopy (shows the inside of the uterus), saline infusion sonogram (a simple procedure that also shows the shape of uterine cavity). Other laboratory tests may include blood test, hormonal levels, and genetic tests.
An important moment in a female patient evaluation is evaluation of ovarian reserve. A woman's eggs reserve is diminishing starting even before birth. If at the 20th gestation week the embryo contains about seven million eggs, at birth this number drops to about 200,000. The number continues to decline until the menopause when no egg remains. As the ovarian age not always corresponds to the chronological age, evaluation of ovarian reserve can provide important information in female infertile patients, especially after age of thirty-five.
In most cases a thorough patient evaluation can determine the cause of infertility of the couple and sometimes can dictate certain solutions for the problem.