In man, some changes occur in the sexual functions. Testieses soften and becomes smaller with age. Sperm shapes also become smaller and their motility decreases. Despite these changes, there is no age limitation for a man to have a baby: a 60-70 years old man can have a baby from his younger spouse. Frequently, due to the decrease in testosterone level, sexual desire (libido) also decreases. Difficulty in erection is seen in declining ages. These changes in libido can not only be explained by declining age; generally accompanying diseases, stres, drug usage are among its reasons. However, this problem may not be seen in healthy men.

Today, most of the women postpone their desire to have a baby. Especially university graduates and working women would like to have a baby in their 30’s or 40’s. In western countries 20% of the women wait till they are over 35 to establish a family. Many social factors play a role in this decision: Having a carreer firstly, waiting for a healthy relationship, guaranteeing their lives economically or being sure that marriage is wanted. Conceiving and the probability to have a healthy pregnancy become difficult in later years, but this issue is not sufficiently explained.

It is a fact that pregnancy chance decreases with age. Though the probability to conceive for women under the age 30 is nearly 20% a month, this ratio is only 5% for women over 40. Even if infertility treatment is received, (test tube baby) the pregnancy rate decreases, miscarriage rate increases. Before starting infertility treatment, pregnancy should be sought at least for a year, and if the woman can not conceive within this period, then infertility analysis should be started. This period is 6 months in women over the age of 40.

Changes in ovaries (Decrease in the ovary reserve)

For couples over 40, in addition to the problems leading to infertility, changes in the ovaries due to advanced age also plays an important role.

The hormones released from the hypothalamus and the pituitary gland in the brain regulates ovulation and periodical menstruation. Hypothalamus stimulates the pituitary gland and has it release the “folicule stimulating hormone” (FSH) and “luteinizing hormone” (LH). These two hormones pass into the blood circulation and provide the development of oocytes in the ovaries and the production of the feminity hormone, estrogen.

There are approximately 300.000 primordial folicules (undeveloped oocyte) present in the ovaries of a young woman during adolescence. Every month, one oocyte develops through the cycle and becomes ready for fertilization. However, again every month, at least 500-1000 folicules are degenerated before completing their developments. When a woman approaches menopause (generally between the ages of 40-50), only a few thousand oocytes are left. Since these oocytes can not respond to FSH and LH sufficiently, the pituitary gland increases its FSH and LH levels to stimulate the ovaries more. Though the ovaries partially respond due to the increasing hormone levels, after a couple of years the ovaries can not repond at all despite the increasing FSH and LH levels.

Increase in the FSH level in the blood at the 3rd day of menstruation shows that the respond of the ovaries to the stimulations of the pituitary gland has been decreased. That is to say, ovary reserve is diminished. This lack of response leads to oocyte production of lower quality. Due to the insufficient response of the ovaries to FSH and LH released from the pituitary gland, estrogen and progesterone levels produced by the ovaries also decrease later on. Therefore, the oocyte and hormone production by the ovaries decrease in the course of time. Irregular menstruation can be seen in woman approaching this period. The interval between the two menstruations shorthens first, and then begins to prolong. Sometimes no menstruation can be seen for 2-3 months. During the irregular menstruation, generally healthy oocyte development can not also be accomplished. Estrogen and progesteron hormones are also necessary for the development of the womb layer (endometrium) of the uterus.

Since the number and the quality of oocytes decrease with age, their ability to be fertilized by sperm also decreases. And also even if the fertilization occurs, risks of genetic diseases of the embryo increase. For example, the risk of "Down syndrome" which is a chromosomal disease seen in the children of women giving birth in declining years increases. Even if an oocyte having chromosome disorder is fertilized, its chance to stay alive and develop decreases. Therefore, the probability of a miscarriage increases over the age of 40.

When embryos developed from the oocytes of women in their 20’s-30’s are transferred to the uterus of a 40 year old woman (test tube baby with donor oocyte) pregnancy rates similar to young women occurs. If oocytes of a woman in declining ages do not develop or she can not conceive with her own oocyte, then test tube baby application with a donor oocyte is recommended in countries in which this is legal. By this way, the problem of having undeveloped oocytes and the quality of the oocyte is overcome.

If a woman between the ages 37-40 can not conceive within 6 months, though trying, she should be directed to an infertility specialist. The necessary analysis of infertility should be completed as soon as possible. Especially FSH, LH and E2 levels, determined on the 2nd-3rd day of menstruation is very important. The levels of these hormones determine the response that the ovaries give and the chance to conceive during the treatment. Though it is known that the probability to conceive is low in women over the age 40; the increase in FSH and LH levels on the 3rd day of menstruation expresses that this chance is diminished more. After these results are evaluated, the patient should be provided with correct information and the treatment options should be discussed with the patient.

Since babies of women over 37-40 have a high probability of chromosomal disorders, when they decide to have a baby, they should be provided with genetic consultancy by a gynecologist or a genetics specialist. "Amniosynthesis" must be recommended if pregnancy occurs. If test tube baby application is decided to be provided to the patient, then they should be informed about pre-implantation genetc diagnosis (PGD). If there is apossibility to apply PGD, the patient can obtain many benefits from it since normal embryos are selected and transferred.

After all necessary tests are conducted; couples should be given detailed information on the treatment methods and the rates of success. Some couples would like adopt a child instead of an infertility treatment or would like to receive test tube baby application with donor oocyte if legal in their country.

After the first evaluation, if a reason is determined, a treatment method directed to that reason can be recommended. However, in some cases, the reason of infertility can not be determined and considered to be due to declining age. In these cases or if the treatment fails, intra-uterine insemination and test tube baby application are recommended.veya tüpbebek uygulaması önerilmektedir.

The treatment methods are limited for women who had no success with various treatment methods before or for women in declining ages. In this case, obtaining an oocyte from a younger woman is a treatment method. A woman diagnosed to undergo early menopause can only conceive like this. Chance to conceive is high with the test tube baby application, conducted with an oocyte taken from a young woman with healthy ovaries. The donor can either be known or not. Generally, donors having similar physical properties are selected. In this method, it should be noted that the baby will possess the genetic properties of the donor.

This method, which can not be applied due to legal limitation in our country, has been successfully applied in some European countries like Belgium, England, Spain, also in Ausrtalia and USA. However, it is prohibited in some countries such as Germany, Switzerland due to legal, religious or ethical reasons, including Turkey. Patients applying to our centre related to this subject are treated in Belgium.