A woman’s best reproductive years are in her 3rd decade. At 30 years of age, woman has only 20% chance of getting pregnant per cycle and by 40 years of age, chances decline to 5% per cycle. The average age for menopause is 51, but successful pregnancy is difficult after mid-40s. These percentages are true for natural conception as well as conception using fertility treatment, including in-vitro fertilization (ivf). In india reports suggest that fertility declines earlier as the age of menopause is around 47 years.

As men’s age advances, their testes tend to get smaller and softer, and sperm morphology (shape) and motility (movement) tend to decline but it generally does not become a problem before the age of 40 years.

The number and quality of a woman’s egg deteriorates with age and this makes it harder to get pregnant.
The risk of miscarriage increases with age. The chance of having a miscarriage each time she becomes pregnant is 12-15% (1 in 6 or 7) in 3rd decade as opposed to 50% (1 in 2) risk of miscarriage in 5th decade.
Abnormal chromosome number was seen in about 25% of embryos arising from women in the 26-30 years age group, but the rate rose steadily to 85% of embryos for women of 43 years or older.

Infertility is diagnosed if a woman has not become pregnant after 1 year of unprotected intercourse (i.e., no contraceptive measures used). If she is 35 years or older, the evaluation should begin after 6 months of failure to conceive. If a couple has an obvious medical problem affecting their ability to conceive, such as absence of periods(amenorrhea), sexual dysfunction, history of pelvic disease, or prior surgery, any radio or chemotherapy in the past, they should begin the infertility evaluation immediately.

You will need a complete evaluation by a fertility specialist, who may perform an ultrasound assessment of follicle numbers, called the antral follicle count.
Thereafter, tests such as the amh (anti-müllerian hormone), thyroid and prolactin levels may be advised.

Superovulation with timed intrauterine insemination (so/iui) or in vitro fertilization (ivf)
In women over 40 years, the success rate of so/iui is generally less than 5% per cycle and 10% for women of ages 35 to 40 years. Ivf is more effective but also has relatively low success rates in women of 40 years and older, generally less than 20% per cycle.

In poor ovarian reserve, the use of eggs donated by another woman who is fertile typically in her 20s or early 30s, is highly successful.

Women who wish to delay childbearing until their late 30s or early 40s, may consider methods of fertility preservation such as freezing of eggs or embryos for later use.

Pre-conception counselling is often beneficial as well. Children born to women over 35 years of age have a higher risk of chromosomal problems. It is indicated selectively in older women undergoing ivf, to identify genetically normal embryos for transfer to improve successful pregnancy rates.