Can fertility wait? Expert weighs in on reproductive timelines, egg freezing initiation

Key takeaways:

• Nothing can reverse ovarian aging, but earlier egg freezing can help with future family planning.
• A study is underway to assess the effect of rapamycin on reversing ovarian aging.

Reproductive lifespans are limited and there is no current way to reverse ovarian aging, which is why earlier egg freezing is key to better future outcomes when family planning, according to a speaker at the Mount Sinai Women’s Health Forum.

“Even though we are living longer, accomplishing more and have so many more opportunities in the early part of life ... our bodies, unfortunately, have not gotten that memo, and there is still a very finite barrier on when we can conceive,” Tia Jackson-Bey, MD, MPH, reproductive endocrinologist, infertility specialist, OB/GYN and assistant clinical professor in the Raquel and Jaime Gilinski department of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai, said during a presentation.

Compared with previous generations, women today have longer life expectancies, more education, more financial freedoms, less pressure to marry, later childbearing and fewer children, resulting in smaller families. These changes overlap with a critical time for the reproductive lifespan and window, Jackson-Bey said.

“There is not really a good way to reverse ovarian aging,” Jackson-Bey said. “This has not been shown to be accomplished by vitamins, significant lifestyle changes or even medications.”

Changing fertility landscape

Women are born with all the eggs they will ever have at birth, about 6 million to 7 million, Jackson-Bey said. That number falls 50% by puberty, stabilizes until the mid-30s and then sharply drops as women get older.

During the 1600s and 1700s, women in their early 20s had a high pregnancy rate that declined by their mid-30s and then dropped significantly after age 40 years. The rate of chromosomally normal embryos resulting from IVF today mirrors those pregnancy rates, Jackson-Bey said, with a similar decline in pregnancy rates around age 37 to 40 years. Miscarriage rates significantly increase around the late 30s to 40s and older.

“For many people, this would mean that if they were just getting pregnant on their own, there would not be a pregnancy, or they may have a higher miscarriage rate,” Jackson-Bey said.

As women age, the number of oocytes declines, follicles stop growing due to atresia and more meiotic mistakes occur. However, Jackson-Bey said, there are also environmental factors that disrupt the reproductive window such as endocrine-disrupting chemicals and medical treatments that may be gonadotoxic.

In an effort to potentially delay or reverse the onset of menopause and improve fertility odds, researchers are studying of the use of rapamycin, also known as sirolimus, a drug commonly prescribed after organ transplant. Researchers have studied the drug in several settings as an “anti-aging cure-all,” Jackson-Bey said.

The VIBRANT study, a prospective, randomized, double-blind, placebo-controlled pilot study, is underway to recruit 50 women aged 38 to 45 years and evaluate the effect of rapamycin on reversing ovarian aging. No human data currently exist to support use of this drug for anti-aging effects.

“There are things that we can do to try to preserve what we have, but we really don’t have a way to reverse any kind of damage that has already been done, whether that damage is intrinsic, internal or environmental,” Jackson-Bey said.

Recommendations for physicians

Physicians play a crucial role in fertility as their knowledge and expertise on egg freezing, reproductive timelines and building relationships help guide women to the proper sources to help them succeed in their future reproductive goals.

“Ovaries are important, but they also expire,” Jackson-Bey said. “There is a limitation on their function, and we don’t quite have the fountain of youth. At least, not yet.”

Jackson-Bey said it is important for physicians to refer patients 5 years before one might need egg freezing, as younger eggs are more likely to result in a pregnancy in the future.

According to Jackson-Bey, it is important for physicians to be more comfortable in discussing reproductive timelines with patients and what options are available for family planning.

“I want us to build relationships and make sure that we stay connected and know each other, because that makes a huge difference in what we have to offer our patients,” Jackson-Bey said. “Understanding that your knowledge is power and learning as much as we possibly can is always going to be a benefit to each other, and then also to make sure that we are watching out for any gimmicks. If it’s too good to be true, it probably is.”

Reference:

• NewYork/Presbyterian. Advances in Women’s Health: Pilot study evaluates weekly pill to slow ovarian aging, delay menopause. www.nyp.org/advances-womenshealth/pilot-study-evaluates-weekly-pill-to-slow-ovarian-aging-delay-menopause. Accessed Dec. 2, 2024.