Fertility with Women 35 and Older and Vasectomy Reversal Success Rates / 2023 Update
This article, by international vas reversal authority Sheldon Marks, MD, addresses many of the questions, issues and concerns about older women, starting at age 35 and natural conception after a vas reversal.
As women enter into their late 30’s and early 40’s, called “advanced maternal age” or AMA, experts in female fertility tell us that it can become harder to get pregnant, harder to stay pregnant with increased risks for miscarriages and that the risks for birth defects start to increase. This is true when looking at research studies conducted on large populations of women (1).
For an individual female in her late 30’s or early 40’s, though statistically these points and concerns are true, they may or may not have any issues conceiving and having a healthy baby. Some women who are 32 may have issues getting pregnant and there are others that are 40 that have no problems. We continue to be thrilled when many of our patient’s wives announce that they are pregnant and then have a healthy baby, yes even with “older” women.
In our vas reversal practice, we have found that even with this cautionary discussion, many women, well aware of the concerns and risks, still wish to proceed. They understand that having the vasectomy reversal simply gives them the opportunity to try to get pregnant and does not guarantee a pregnancy or baby.
It is important that we don’t want anyone to feel that we are trying to mislead a couple with an older female partner, defined by experts in female fertility as a woman 35 and older. We always emphasize that we are not experts in female fertility, though we work closely with experts in women’s fertility. We just want to make it clear that statistical odds may or may not apply to an individual person. In fact, we have children born to older women where her doctor said getting pregnant was impossible. And to our great joy, none of these children that we are aware of have had any birth defects or psychosocial health issues.
If the female partner is “older” or has any issues or concerns, then we encourage her to see an expert in female fertility called a reproductive endocrinologist (REI), especially if she has fertility concerns, irregular cycles or other hormonal problems. Be aware that even experts in female fertility tell me that the results of the most common blood tests FSH (follicle stimulating hormone) and AMH (anti-mullerian hormone) or an ultrasound egg count are best for predicting the success of in-vitro fertilization (IVF) but are not good at predicting natural conception even after a vasectomy reversal, yet many doctors still check these test results to predict who will get pregnant (2). In fact, a recent review summarizes that these female hormone test results “do not assess natural fertility for women,” (3).
This is because, I am told, to achieve good IVF success rates, the reproductive endocrinologists need to retrieve a number of healthy eggs from the hormone challenges, as compared with natural conception, where only one egg a month is needed.
Even aware of this, we have some wives that do not want to do these hormone tests, and explain that they are going to proceed with the vasectomy reversal, “if it is meant to be, then it is meant to be.”
If anyone has any questions about “older” females, advanced maternal age and vasectomy reversals – our success rates, cost and recovery – and how we are “Making Men Dads AgainTM”, please call us at (888) 722-2929 . At that time we can answer any questions and set up a no-charge phone, Face Time, Zoom, Skype or office consultation with one of our two microsurgeons, Dr. Sheldon Marks or Dr. Peter Burrows.
This page was reviewed, edited and updated January 1, 2023, by Sheldon H. F. Marks, MD.
References:
1.Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One. 2017 Oct 17;12(10):e0186287).
2. Depmann M, Broer SL, Eijkemans MJC, va Rooij IAJ, Scheffer GJ, Heimensem J, Mol BW. Anti-Mullerian hormone does not predict time to pregnancy: results of a prospective cohort study. Gynecol Endocrinol. 2017 Aug;33 (8):644-648).
3. Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, Baird DD. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA. 2017 Oct 10;318(14):1367-1376).