Age and Fertility do go hand in hand and here are a list of facts to explain how age affects fertility in man and women, that i hope will help you plan your parenthood
Listen to the full podcast here: The Fertility, Motherhood & Wellness Show- True Stories with Rd. Rajeev
Mark Twain one said, Age is an issue of mind over matter, if you don’t mind, it does not matter.
But friends, this may not hold true when we talk about Age and Fertility! I think women are deeply interested in a conversation about fertility. It’s not a conversation just for one age group of women, a conversation when you are post 30 or post 35. This conversation is about reproduction, about taking your own power with you and deciding for yourself
Let’s start with understanding how fertility in a woman changes with age?
- Every woman is born with a definite number of eggs, unlike a man who can produce sperms most of his life.
- The number of eggs at birth varies from person to person, race to race but on an average is about 1 million.
- Till puberty, she releases no eggs but after that, the body recruits a certain number of eggs each month say about 15 to 30 under the influence of a hormone called FSH from the brain.
- Out of these only one egg would finally mature and be released around mid-cycle and the rest will perish.
- Unlike popular belief, one can’t borrow eggs from the next month and if one doesn’t have periods, it doesn’t mean the eggs of that month have been saved for later use.
- The rate at which a woman loses her eggs is accelerated after the age of 30 and more so after age 35. Unfortunately, most data that we have are western and it has been shown that Caucasian women have a biological age that is 6 years lesser than their Asian counterparts. This is why you will see many western celebrities getting pregnant at an advanced age.
More often than not, people confuse reduced fertility with menopause. Menopause happens when a woman exhausts her stock of eggs and thus does not have periods for at least a year. A woman may have reduced fertility much before the actual menopause sets in. as I said earlier, fertility starts to decrease after age 30 and more rapidly after age 35. The woman will first notice that her cycles are getting shorter, that is coming more frequently and the flow during periods has reduced. As ovulation reduces, her cycle length gets longer as she starts to miss her periods and then eventually her periods stop.
Moving ahead, let’s discuss what reducing fertility means.
The eggs reduce both in numbers as well as quality. We have already discussed that reducing numbers means. What about quality? As quality reduces 2 things happen.
- Firstly, the probability of the woman getting pregnant naturally and later even through artificial means through that egg starts to reduce because that egg may not be easily fertilized through a sperm. This is why women of advancing age may need to resort to IVF because in this process we may be able to forcefully fertilize an egg but after a point in time even through IVF it gets impossible.
- Secondly, the genetic defects in the egg start to increase. The egg has 23 chromosomes and when it comes to the 23 of the sperm, the resulting embryo has 46 chromosomes. With increasing age, the number of chromosomes that the egg carries may increase or decrease resulting in genetic defects in the embryo. The most common one we know of is Downs syndrome wherein the child has an extra chromosome 21 coming from the egg. While most such embryos will not attach to the uterus, some may attach and then undergo a miscarriage. Very few will grow and will be discovered as an abnormal baby during the tests done in pregnancy.
How does one test to know what her fertility quotient is?
The test for the quantity and quality of eggs is called Ovarian Reserve testing. It is usually done by a combination of 2 tests – A blood tests for Anti Mullerian Hormone and am Ultrasound scan for Antral follicle count (AFC).
AMH: can be done at any time of the cycle and does not even require an empty stomach. It’s a simple inexpensive blood test that has good predictability for the ovarian reserve. However, every test has its limitations and shortcomings. This is why we use this blood test in combination with another test which is done with the help of an ultrasound machine.
AFC: This is a vaginal scan that is done on the 2nd or 3rd day of periods and through this, an expert eye can count the number of eggs which are present for recruitment that month. This is called the Antral Follicle count.
The combination of these two gives a fair idea about the ovarian reserve. For those intending to delay conception, it makes sense to get these two tests done on a yearly basis so we can chart the graph and figure how steeply the ovarian reserve is falling and thus take necessary action.
Why are we today so concerned about age and ovarian reserve and fertility?
The problem is ovarian reserves are going down. At the beginning of my practice 20 years ago, of the total number of IVF’s I was doing, about 10% of women had bad quality eggs and that too these were women were above the age of 35, which is understandable. Today the percentage has risen to about 60 and a lot many of these women are under the age of 30. I don’t know if its stress or pollution or the fertilizers in the food or bad lifestyle but fertility for women is going down and that’s a fact. This is being compounded by several factors which are :
a) Delaying Motherhood: Women for personal or professional reasons are delaying marriage and conception. I am not saying its wrong, but one needs to be aware of the consequences. So if you want to know when I should have your first baby, is it too early or too late then this study will help answer your questions:
There was a very interesting study done in the Netherlands wherein the researchers trying to figure out when one should start having children based on two assumptions:
- How many children does the woman want and?
- Is she ready for an IVF or not?
Based on the above they concluded that:
- In order to have a chance of at least 90% to realize a one-child family, couples should start trying to conceive when the female partner is 35 years of age or younger, in case IVF is an acceptable option. For two children, the latest starting age is 31 years,
- Without IVF, couples should start no later than age 32 years for a one-child family, at 27 years for a two-child family
b) Uterine problems: Owing to diseases like endometriosis or any surgery on the ovary, part of the ovarian tissue gets lost or destroyed thus leading to diminishing ovarian reserve.
c) Uterine Cancer: Some young women, unfortunately, have cancer and for its treatment, they must undergo chemotherapy or radiotherapy which in turn could destroy the ovary.
Thus friends, putting your heads into the sand and expecting the problem not to happen to you because you can’t see it yet, won’t work. God made women tough because their life isn’t easy and advancing age doesn’t make it easier for any woman to complete her desire to be a mother.
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