ATLANTA -- Dr. Randy Martin: Are women in control of their reproductive health?
Dr. Lisa Hasty: They would like to think that they were. But, in fact, they're really not. In fact, we were meant to reproduce when we were much younger, in our mid-20's. That's when our egg quality is the most superior and when it's easier to get pregnant.

We're born with all the eggs we're ever going to have. By the time we reach the mid-30's and into the 40's the quality of those eggs as well as the quality of those that are remaining really is dwindling.

Dr. Randy Martin: What is it about the egg quality in a woman's 20's that makes it the best time to conceive?
Dr. Lisa Hasty. They are able to be fertilized easier. They behave more normally after they're fertilized.

Dr. Randy Martin: It's called Diminished Ovarian Reserve. What exactly is that?
Dr. Lisa Hasty: Diminished Ovarian Reserve means poor egg quality, less change for a healthy full-term pregnancy, and that we need to hurry up and look at a woman's option sooner.

Dr. Randy Martin: In your practice, how many women do you see who are over 35 who are trying to get pregnant for the first time?
Dr. Lisa Hasty: Most of our patients are over 35. I think the average age of patients that I see in any given week is probably around 38 or 39 and that tends to be a lot of couples who are trying for their first baby at that age.

Dr. Randy Martin: There is the option of egg freezing. Tell me about that.
Dr. Lisa Hasty: This is new on the horizon. People have been working with egg freezing for probably the last 10 to 15 years, but it's received a lot more press in the last several years because techniques are improving a little bit. They're improving for younger women, that is. So again, women have to be planful and if someone is interested in egg freezing the prime time to think about freezing eggs is actually in your 20's and certainly before you're 35, which for most women - that is not in their realm of thinking, they're not planning that far ahead. So a lot of patients have approached me - single women in their mid to late 30's, about egg freezing and we look at certain hormone levels, we see if it's appropriate, but they're still dealing with tougher odds because an older egg doesn't freeze as well. An older egg doesn't behave as well in the IFV lab with freezing. So, it's a possibility, but it's a longer shot the older you are.

Dr. Randy Martin: Egg freezing is expensive, isn't it?
Dr. Lisa Hasty: There are some situations right now since the technology is so new where women could possibly get into some kind of study situation that could defray some of the costs. But it's not cheap and in a lot of those situations because the medications that are needed are expensive, the techniques in the laboratory require a lot of tedious effort from specialized providers. So it's not inexpensive.

Dr. Randy Martin: Are these tests to show a woman's reproductive age?
Dr. Lisa Hasty: We can do certain blood tests at the beginning of a menstrual cycle that can give us a gauge of ovarian quality, ovarian function, but it's a limited bit of information in only that it's super predictable if it's abnormal. It can start to tell us if it rises a little bit because abnormal is above a certain value. So if it starts to rise a little bit it can tell us that we might be running out of a bit of time. But it's not an absolute and it's not a perfect test. And it's very falsely reassuring for some women that will come in who are 43 who will tell me that they had a normal test. It doesn't help us because chronological age is much more important than the absolute value of these hormone levels. There's another test that we're trying to use now (that) gives us a better predictor of egg supply. so we're starting to use that a little more in clinical settings. But still, Randy, there's not a perfect test where I can tell somebody they're got six years. So we tend to look at them, and look at graphs, look at statistics based on women who have gone before them based on tests on certain age groups to try to help them to know what their chances are and what options are good for them. So I still think it's useful for women to get tested, but they have to understand, really, the meaning of those tests.

Dr. Randy Martin: What are the options for an older woman who wants to have a baby?
Dr. Lisa Hasty: (We) run through a battery of tests very quickly if their OB/GYN already hasn't done some of the testing. Depending on what you find, if they have blocked tubes, you move directly to IVF. If it's more unexplained, where all the testing comes back within normal limits, you may start some simpler treatment with tablets of medicine to strengthen ovulation methods, sometimes with timed insemination for maybe a cycle or two, but then you pretty quickly after that move into the high-tech options of IVF so that you don't lose time.

Dr. Randy Martin: Is IVF more difficult for older women?
Dr. Lisa Hasty: We have many success stories for older women. We will go up to the ages of 42, 43 sometimes if they have normal ultrasounds and normal blood tests. (The women) are just dealing with lower odds than the older 30 year olds, but we can do quite well with someone in that age group if they have normal testing. They just may not respond as well to the medicine. They won't have as many eggs. They probably won't have any extra embryos to freeze, but they still have a fighting chance to get pregnant and to have a healthy baby.

Dr. Randy Martin: Egg donation is another option, right?
Dr. Lisa Hasty: Egg donation is a very common treatment that people just aren't really aware of because of people keeping it private. But most infertility practices have a very active donor program if they have IVF. We recruit egg donors at a very rapid rate and screen them. They are women that are in their 20's. They've got to be healthy, normal body weight, a non-smoker, and willing to go through a lot of time commitment with shots and going through a small procedure to have their eggs harvested. But for the recipient couple, it's amazing. I mean, it's the highest (success) statistic of anything that we do.

Dr. Randy Martin: What's the hardest thing about dealing with an older woman who is having difficulty getting pregnant?
Dr. Lisa Hasty: I think the thing that breaks my heart the most if when I have a couple that comes in and the woman is 39 and they've been married 10 years and they always knew they wanted a family. And maybe we can. But there are times when she's run out of time. So I think it's just being planful, being smart, and just not thinking that you have all the time in the world. The tough thing we're seeing is people out in the forefront, the actresses, the people in the news, at 44 with their twins, and they're keeping it very private. (Women don't know) they've got a lot of extra help - not just IVF, they got the gift of eggs from a much younger woman. I can understand why they want to keep it private, but other women are just destroyed when they hear that.