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The other day one couple came to my consultation room. Both husband and wife in their early 30’s & married since one year. Both are professionals and have got a wonderful job opening in the US. They came to me for advice regarding contraception as they wanted to get settled first before having a baby. I tried to advise them about the potential risks of postponing pregnancy at their age, especially a first pregnancy. But the wife was very casual with a don’t care attitude.. Her response was…Doc, so many women deliver even in their late forties. And if I do find it difficult to become pregnant later, IVF and other technologies are there to help me get pregnant. Her answer took me aback. And I felt sad. This woman, and many other women like her, who consider themselves very knowledgeable in worldly affairs, have really no idea what they are doing to themselves, and they learn too late. They take their eggs for granted.
I was reminded of a saying by ASRM[American Society of Reproductive Medicine] “As women delay childbearing, there is now an unrealistic expectation that medical science can undo the effects of aging.”
But the truth is,”technology cannot stop or effectively revert the effects of AGING on fertility.”
Age is the single biggest factor that affects the fertility potential of women. Its impact on men’s fertility is relatively less. As women wait longer to have children, due to studies, career or whatever reasons ,their egg quantity and quality decrease, leading to increasing difficulty in becoming pregnant, maintaining pregnancy and delivering a healthy baby.
What is the general trend of age and decreasing fertility?
- Fertility is maximum in the 20’s.
- In the early 30’s there is a slow decline in pregnancy rates.
- In the late 30’s, the decline is more rapid.
- In the early 40’s, the decline is even more rapid.
- After 45, v few women are fertile.
- Miscarriage rates also increase with age.
- Success of IVF and other assisted reproductive methods also decrease with age, especially after 38 yrs.
Have a look at this table.
|twenties||Early thirties||Mid to late thirties||forties|
|Pregnancy rate per cycle||20 -25%||15%||10%||5%|
|Spontaneous miscarriage rates||5-10%||20%||25%||40 to 45 %|
|Incidence of genetic abnormality||1/1300||1 in 700||1/350||1/15 to 1/30|
|When to seek help, in the absence of other known problems||After 12 months of trying||After 9 months of trying||After 4 to 6 months of trying|
|Success with IVF and other methods||good||lesser||less||V less|
How does age affect fertility in women?
With increasing age, both the quantity and the quality of the eggs come down, decreasing the chance of fertilization, maintaining a successful pregnancy and having a healthy child.
But every woman is unique .
Egg quality in an individual woman can be either
- Average for her age or
- Less than average for her age or
- More than average for her age.
Some women in their twenties already have significant egg issues, whereas some women in their mid forties are still fertile.
What happens to the egg quantity with age?
The eggs [ oocytes ] are contained within structures called primordial follicles. These primordial follicles [non growing follicles] account for 90 to 95 % of the follicles at any given time in the life of a female.
These start appearing when the female fetus is 5 months old and are about 6-7 million in number.
Right from this time they start decreasing in number by a process of atresia [Ovarian follicle atresia is the periodic process in which immature ovarian follicles degenerate and are subsequently re-absorbed ] which occurs at a constant rate. At birth, the number of follicles is reduced to 1-2 million. And these are the follicles which the woman is destined to have during her entire life. More follicles won’t be produced at any time later.[unlike sperms which are being produced constantly.]
The process of atresia continues throughout childhood, and at time of puberty, only 300,000 to 400,000 follicles remain.
Of these only 300 to 400 will be ovulated during the woman’s reproductive life from menarche to menopause, and the remainder undergo atresia.
After menopause is attained there will be no follicles in the ovary, and the ovary itself starts shrinking.
The measurement of the number of follicles at any given time is called ovarian reserve testing and it is done by various means. [ I am covering it in a separate post ]
What happens to the egg quality with age?
An important change in egg quality with age is the frequency of genetic abnormalities. This happens mostly because as a woman ages, the egg nucleus often divides abnormally, distributing unequal amount of genetic material, & will have either less or more no of chromosomes instead of the proper 23 chromosomes. When these eggs get fertilized, the defect gets transferred to the embryo as well.
Example is Down’s syndrome, a condition that results when the embryo has one extra chromosome 21.I am sure most of you must have heard about it.
However, most embryos formed thus either fail to implant properly, or undergo early miscarriage.
So, now that you know how age affects fertility, what can be your possible plan of action?
- Those of you who are still in your 20’s, please don’t think of postponing pregnancy for whatever reason.
- Those of you in your early 30’s ,you are not too late yet, but you better hurry and make some fast decisions and act upon them. And if you are not getting quick results, I’d advise you to consult an infertility specialist.
- Those of you in your late30’s, well, no point in regretting that you left it so long. What has happened has happened. Arrange for an appointment with an infertility specialist at the earliest and get going.
- Those of you in your mid 40’s, don’t lose heart completely. There is hope for you yet. Your eggs have aged, but not your uterus. The best options for you would be to try donor eggs.
- Those of you who are tackling various medical issues which might be contributing to your infertility while you helplessly watch your age ticking away…please don’t lose heart. Medical science has advanced so much. Hold on to the hope that you will indeed get to hold a sweet cuddly bundle of joy in your arms.