Efficient fertility management for older couples

David Ogutu MRCOG
Medical Director and Consultant Gynaecologist

Fertility potential declines with age. A gradual decline in female fertility is noted until 35 years, followed by a sharper fall after 37 and an even sharper decline after 40 years of age. Male fertility also declines over time.
This decline in fertility is accompanied by an increase in miscarriage and pregnancy loss. Whereas most miscarriages occur due to chromosomally abnormal embryos, the rate of which increases with age, other physical factors such as uterine, tubal and ovarian pathology may also be associated with miscarriage.
Increasing maternal age is also associated with a higher incidence of pregnancy complications. Incidence of diabetes, hypertensive disorders in pregnancy (including pre-eclampsia), preterm delivery, still births etc. is higher in women over 40. Pre-conceptual assessment and management of risk factors would decrease the incidence and severity of these disorders.
Efficient fertility management not only aims at increasing the likelihood of conception, but also reducing the risk of pregnancy loss. At Herts and Essex Fertility Centre, we not only provide fertility treatment, but also run a pre-conceptual clinic, fully assessing risk factors and managing conditions that would lower live birth rates before treatment commences.
A detailed medical history and physical examination, lifestyle advice, and close liaison with other specialists ensure that fertility treatment occurs when health has been optimised. Following successful conception, high risk patients are signposted to the appropriate obstetrics service depending on their need.
A prompt assessment and treatment of gynaecological conditions that may lower implantation potential or cause miscarriage (including fibroids, polyps, intrauterine cavity adhesions –Asherman’s syndrome, hydrosalpinges, endometriosis, congenital uterine defects – uterine septum etc.) is performed with state of the art technology. This ensures that problems are managed with no delays to fertility treatment, further increasing the likelihood of a live birth.
Where donor gametes or surrogacy is required, our experienced team with many years of experience providing these complex treatments will provide the appropriate advice, guidance and treatment with no delays.

David joined us as Consultant Gynaecologist and Fertility Specialist in 2011. He graduated from medical school in 1999 and received specialist training in Obstetrics & Gynaecology at the Royal Free Hospital and North Middlesex University Hospital, followed by advanced training in Assisted Conception, Reproductive Endocrinology and Laparoscopic Surgery at King’s College Hospital, London.

David is a member of the British Fertility Society, the European Society for Human Reproduction & Embryology, the British Society for Gynaecological Endoscopy, and the International Society of Ultrasound in Obstetrics & Gynaecology. David regularly teaches and addresses fertility conferences.

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