Extending Female Fertility for Longer and Healthier Life

Dr. Jennifer Garrison says that lengthening female fertility could extend their longevity and contribute to a more equal society.

Human ovaries start aging decades before other tissues in the body. And that significantly impacts women’s fertility, health, and quality of life.

Science still does not have an answer on why human ovaries start aging so early. But Dr. Jennifer Garrison thinks it is a solvable problem, a question that has not been asked before. That’s why she launched the Global Consortium for Reproductive Longevity and Equality.

“Soon women, who are born today, might live more than half of their lives after menopause. We can no longer accept that this is the case,” Dr. Garrison, who is also an assistant professor at the Buck Institute for Research on Aging, said in an interview for Healthnews.

What effect does the aging of ovaries have on women's overall health and lifespan?

The aging of ovaries has two effects on women's health: first one we are very familiar with — is the effect it has on fertility, causing things like birth defects and infertility.

But ovaries also produce hormones; chemicals that are key to general health. When ovaries stop functioning in the middle of a woman's life, risk for a whole host of different diseases is increased, including heart disease, cognitive decline, stroke, and osteoporosis.

The risk of depression and other mental health issues also increases after menopause. That certainly has to do with the declining function of the ovaries.

Dr. Jennifer Garrison
Dr. Jennifer Garrison

Do we start feeling the effects of aging of the reproductive system gradually during life, or only after menopause?

Ovaries start to decline in function when a woman is in her late 20s and early 30s.

Menopause is defined as the point in a woman’s life when she hasn’t had a period for twelve months. The transitionary period before this is perimenopause, which can last as long as a decade for some women, and is a period of declining ovarian function when changing levels of hormones can wreak havoc on daily life.

Could you tell me more about your research on lengthening female fertility?

I co-founded and direct the Global Consortium for Reproductive Longevity and Equality, a global effort to accelerate reproductive longevity research. We have three different arms. Our primary goal is to facilitate and accelerate the translation of basic science discoveries happening in the lab into women’s hands.

We fund grants to academic scientists to stimulate research in the field, but we also are trying to build the overall ecosystem around female reproductive longevity science. We want to bring not only academic scientists but also clinicians, people who might fund this research, governmental bodies who make the decisions about the funding, and ambassadors who can spread the word about what we are doing.

We really want to make this a sustainable field and to grow it as fast as possible to make progress on these questions. This is not an unsolvable problem.

Does it mean that you are not simply trying to improve treatment for menopause symptoms but getting rid of menopause?

Yes, we are not trying to treat the symptoms, although that is a very important and plausible goal. We should do everything we can to help women to do that.

But our goal is to understand what causes that decline, so we can intervene to slow it down. Ideally, we would eliminate menopause and the negative health consequences of the decline of the reproductive system. I would call that a moonshot goal.

In the short term, a very achievable goal is just to try to understand what leads to that reproductive decline and see whether or not we can extend the number of years women have healthy eggs and healthy functioning ovaries in order to impact lives positively.

So you are focusing on making women healthier for a longer time, not necessarily being able to conceive for a more extended period?

It is a complicated conversation because fertility and general health are intertwined. They are both governed by hormones made in the ovaries.

Our goal is not to have geriatric mothers — there are real risks associated with having pregnancies at very late ages. However, I think that if we can understand why ovaries are declining in function so early, we could potentially have a beneficial effect on fertility.

It's not only the number of eggs that declines with age but also the quality of eggs. One important goal would be to understand what causes that. Increasing the number of quality eggs that women have when they are 40 by 1 or 2% would be a game changer in terms of fertility, health, and reproductive lifespan.

It is also important to understand that having a baby takes more than functioning ovaries.

In one of your previous interviews, you said that IVF is giving women promises we don't really understand. Could you elaborate on that?

Egg freezing is promising for women, but we may not fully understand it. The idea that egg freezing and IVF is a cure for every fertility problem women have is a flawed message, partly because we still need to understand what makes a good egg, and also because we are not very good at freezing and thawing them.

IVF is a band-aid, but it's the only band-aid we have. I would never tell a woman not to do IVF because it is the only option for some women.

But IVF is also not an option for many women for various reasons, such as genetic predispositions to certain things or unavailability to go through the hyperstimulation cycles that are so important to have IVF to work.

There is a lot of hype around IVF which is not necessarily true. And it's doing women a disservice if we don't fully inform them of what the process entails, the risks, and the possibility that it won't work.

Many women freeze eggs and think they are done, have an insurance policy, and don't need to worry about fertility until they are much older. Then, they may face the harsh reality that just because they froze their eggs does not guarantee they will be able to have a child later.

How does improving women's reproductive health help to ensure equality?

The fact that women go through this reproductive decline right in the middle of their lives, when everything else is functioning wonderfully in their bodies, creates an inherent inequality because men don't have this consideration.

The fact that I am a woman means that from the moment I become an adult, I have this ticking clock in the back of my mind for every major decision I make. My decisions about family, career, and education are overshadowed by the ticking biological clock in the background. Whether I want to have biological children or not, something I have to consider.

Most women go through menopause, and their ovaries stop working right when they hit the peak of their careers. For some, the perimenopause transition is dramatic — over 75% of women develop actual symptoms. Some symptoms, such as hot flashes and brain fog, impact women's quality of life and the ability to do their job.

For some women, the risk of heart disease, stroke, and osteoporosis quadruples. That is also a profound inequality.

We are making huge progress in extending healthy longevity. However, if we don't address the reproductive span, it will stay exactly where it is now. Soon women who are born today might live more than half of their lives after menopause. We can no longer accept that this is the case — we are talking about half of the population here.

Is there anything an individual woman can do not to accelerate the aging of ovaries?

I am not a medical doctor, so I would never give medical advice. However, from the research that has been made, it is clear that diet choices, exercise, and sleep; things that have beneficial effects on the rest of the body, also positively affect ovarian aging.

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