The Doctor's Column - Dr. Louise Lapensée - SPRING 2011

The Doctor’s Column

Dear Reader, this page belongs to you! Send your question to: info@iaac.ca with Doctor's Column in the subject line and one of our specialists will answer. Of course, this column cannot replace a medical consultation and doctors may not be able to answer questions which are too complex or specific, but you are sure to find valuable advice here. We have asked Dr. Louise Lapensée to launch The Doctor’s Column. Dr. Lapensée is an experienced obstetrician-gynecologist and fertility specialist at both the Hôpital Saint-Luc and OVO Fertility Clinic in Montreal.

Q: I had difficulty conceiving my two daughters. They are now aged 22 and 25 and both want children. Should I tell them not to wait too long?

A: Dr. Louise Lapensée: I suppose you worry that you may have passed on your condition to your daughters, but not all fertility problems are hereditary. If you had difficulty conceiving because you waited until you were 40, because your husband had a low sperm count or because your fallopian tubes were blocked subsequent to contracting a disease, there will be no adverse effect on your daughters’ fertility.

However, if you experienced early menopause due to premature ovarian failure, the risks that your daughters may have inherited this condition are very high (although not 100%). Considering that a woman’s egg reserve starts to diminish 10 years before menopause, if you started menopause at 35, then your daughters may be well advised to plan their family before the age of 25.

Recurrent miscarriages are sometimes due to a chromosome anomaly so genetic transmission is possible, although most miscarriages are not genetic in nature. Did you have severe endometriosis? If so, your daughters’ risks for this condition, which would negatively impact their fertility, are seven times higher.

These considerations aside, your daughters should know that fertility declines sharply after age 35, and begins to decline around age 28. The chances of a fertile couple aged 25 to30 achieving a pregnancy are 30% each month, but they drop to 15% in the 35 to40 age bracket. The risk of miscarriage in women up to 30 years of age is only 15%. However, half of the women aged 40 who try to conceive have to consult a fertility specialist, and their risk for miscarriage is 40 % (it is 75% at 45). As for in vitro fertilization, success rates are excellent up to 37, but they start to decline at 38.

If your daughters’ living conditions are favourable, they have a stable relationship with their partner, enjoy good health and feel energetic, I would recommend that they plan starting their family before the age of 30, when fertility is optimal.