ARTICLES

AGE AND FERTILITY

More and more women today are postponing childbirth due to other priorities, like settling down in a good job, buying a house, being stable financially before starting a family. Unfortunately, fertility in a man or a woman has a time stamp on it. As we grow older, the reproductive organs in the human body, begins to age and the ovaries and sperm lose their vitality.

Fertility in either gender is unpredictable and especially with the lifestyles in vogue, today, the probability of becoming pregnant is becoming a big question. Therefore, postponing childbirth (having the first child) to an age where the biological clock has started clanging the alarm bells, is opening up a range of risks such as miscarriage and other medical complications. The consequences of a late first pregnancy creates a stressful situation for the patient, obstetricians and gynaecologists, and for the families of the pregnant mother.

Older first time mothers:

Research and statistics show that more women are choosing to become pregnant, for the first time, at 35 and beyond. The thought process in the population has had a significant shift in the past 30 years, with women becoming pregnant after 35 years of age and rearing smaller families.

Deciding to conceive later in life leaves many women in the high probability bracket of not being able to get pregnant. Even though the medicine of Assisted Conception Techniques is quite advanced, the same cannot be inferred with reference to Fertility in a person whose biological clock is striking its knell.

Past and present:

Changing trends in the past 3 decades have raised the age bar for first pregnancies:

Year - Mean Age to have First Baby
1968 < 18 years
1978 < 21 years
2008 25 - 29 years

Statistical data shows that women in the age group of 30 - 34, are attempting their first pregnancy and the number of women in this age bracket is twice that of women in the age group of 25-29, which is the ideal time to have the first baby.

The Physiology of Declining Fertility:

Reproductive aging is an ongoing development, which begins even before the birth of a child and carries through the years to menopause. Within a few weeks, after conception of the female foetus, the number of eggs is determined. Depletion in the ovarian pool of growing follicles is the first phase. In comparison to the rest of the organs in the body, the female reproductive system ages rapidly reaching the point of failure at a relatively young age (average age 51 years). Menopause is an easily recognizable end-point in the lifespan of the reproductive system, wherein it becomes dysfunctional, as a result of aging, which begins several years before the final stages.

Men are not spared either

Similar to menopause, men experience a stage called Andropause or decreasing levels of androgens, as age sets in. This decrease causes dwindling sexual activity, alterations in testicular morphology coupled with deterioration of quality of semen in terms of volume, motility and morphology.

Is Assisted Reproductive Techniques the solution?

ART or Assisted Reproductive Techniques, may seem like the miraculous answer to incapability to conceive and perhaps help a postmenopausal woman to achieve pregnancy but this technique has been observed to be, inversely proportional to an increase in infertility.

Logically speaking:

Opting for childbirth at the optimal ages and preventing infertility treatment, considering its efficacy, is the best solution. It cannot be emphasized enough that age is the key factor to amenable action. The ideal age for first time pregnancies are between the ages of 20-30, for a woman to conceive naturally or above 30 years of age to conceive through ART and 40 and above, the chances are very slim.

IVF cannot make up for the delay and physiological decline in the quality of gametes.

Beware of Media

Mixed media messages about fecundity or IVF may also be partially responsible for exacerbating the delay in starting a family, 'sensationalizing' breakthroughs and giving women a false sense of security or, alternatively, a false sense of alarm and anxiety. Discount what the media has to say, instead remember, regardless of quantum leaps in medical technology, there is no solution to defeat the aging process of your reproductive system. Don’t leave it, till it is too late. Finally, low fertility does not, mean no fertility!

Article By Dr. Karpagambal Sairam, Consultant - Obstetrician, Gynaecologist, Fertility specialist