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Baheti Hospital

&Centre for Reproductive health care

 

(Test Tube Baby Centre)

Dedicated to Women's Health

 
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Patient Education
     

How Age Effects Fertility?

 

Delaying pregnancy seems to be a common choice for women in today’s society.  The inverse relationship between age and female fertility has already affected the birth rates acutely in developed countries.  But even Indian females especially in urban areas seem to be following western practices.  At least 20% of women wait to begin their family until after the age of 35.  There are various reasons for delaying childbirth like waiting till a career is established, waiting for a stable relationship, wanting to achieve financial security, or having to support the family as a primary concern and sometimes even waiting for a miracle to happen despite knowing that there is a defect in either partner.

 

It is important that women realize that fertility starts declining in early Thirties, drops gradually in mid-thirties, finally falling drastically after the age of 40.

 

The biological fact is, as the woman ages the eggs in her ovaries also age, making them less capable of fertilization by sperms. 

Ageing just doesn’t affect women; it affects men too; but not as abruptly or noticeably as in females. There is no maximum age at which men are not capable of conceiving a child. Men who maintain good health may not experience significant changes in sexual functioning as they age. If a man does have problem with libido or erections, there are treatments available. It has been scientifically proven that it is not the quality of the sperm but the age of the woman and the quality of her eggs that determines the outcome of the pregnancy.

How does the age of the woman lower her fertility? By the time a woman is nearing 40 she has had more time to develop the gynaecological problems like pelvic infections, endometriosis and fibroids.  The current trend in the young women today of preferring fast food, frizzy drinks and alcohol to normal healthy diet and sedentary habits further upset their oestrogen metabolism and can cause weight gain leading to problems of ovulation.  The second more important factor is that there is continued increase in the risk of chromosomal damage as the woman ages. Disorders like MONGOLISM (DOWNS SYNDROME) are more common in children born to older women. When eggs with chromosomal problems are fertilized, they are less likely to survive and grow. T his is why women around 40 are at increased risk for miscarriage. Unfortunately there is nothing that a woman can do to prevent the age –related decline in the egg-quality.

 

It is advisable that a woman more than 36yrs seeks advice of a physician as well as a genetic counselor to know about her chances of conceiving a successful pregnancy. She can choose to have prenatal genetic testing if pregnancy is achieved. Chorion –villous biopsy and amniocentesis are two methods of prenatal testing.

 

Risk of chromosomal abnormality in newborns by maternal age Source –
“Maternal fetal medicine – practice and principles” (1994)

Maternal Age
(years)

Risk for down Syndrome

Total risk for chromosomal  abnormalities

20

1 / 1600

1/525

25

1/1200

1/475

30

1/950

1/380

35

1/375

1/190

40

1/100

1/65

 45

1/40

1/20

49

49

1/8

 

Risk of miscarriage with increased age Source –
“Reproductive potential in the older woman”

Maternal Age (yrs)

Spontaneous Abortion (%)

15-19

9.9

20-24

9.5

25-29

10

30-35

12

35-40

18

 40-45

34

more than 45

53

   

Women with medical problems like raised blood pressure and diabetes should have them well controlled prior to attempting pregnancy. Their physician may suggests a change in the medications or general health-care.

Modern infertility therapy offers a woman many more options than were possible in the past. However these treatments may have significant financial, emotional and social demands. When traditional treatments have failed or infertility remains unexplained, assistance in achieving pregnancy can be attempted by advanced treatments like intrauterine insemination or in-vitro fertilization (test-tube baby).

 

Treatment options are limited for women over 40 or for women with early menopause. Eggs from a younger donor fertilized by patient's spouse can be transferred after in-vitro fertilization to these women. In case of women who have no ovarian function due to previous surgical removal or treated Cancer resulting in premature menopause, this treatment offers the only chance of pregnancy. The process of egg donation can involve a relative or a friend or an unknown donor. The child will not be the genetics offspring of the recipient and special thought must be given before deciding egg donation. . All parties must understand how this will impact the family and what they will tell the child.

 

 Even on busy IVF units there could be more women requesting egg donation than they have available donors. An alternative option for these women is surrogacy.  This is a controversial issue but can be offered to women who have had removal of uterus or cannot become pregnant for medical reasons.  A surrogate is a woman who agrees to become pregnant for a couple.  A surrogate can be a traditional surrogate or a gestational carrier. It is critical that a surrogate is screened carefully psychologically, medically and legally. Adoption, foster care and childfree leaving are of course other alternative options.

 

In conclusion the message of medical profession to our younger generation is that child bearing is optimal when a woman is in her twenties. Then she’s at her most fertile, her eggs are still healthy and viable and there is a lower risk of having genetically abnormal children. Besides, there are lower risks of miscarriage and birth related complications. Even the career oriented young ladies should be aware of the fact that they can always have adequate spacing between two children. Medical science has gifted the society with very healthy and satisfactory means of family planning. Young ladies today must learn to balance their ambitions and social responsibilities and should give priorities to the right things at the right time.

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