Fertility

How old is too old?

WITH WOMEN DELAYING their childbearing by years, and sometimes decades, more and more women are having to seek help from fertility experts to achieve their dreams of having a baby in the mid-life. But even the best fertility expert can only do so much, and the idea that age is just a number is, unfortunately, not true.

WHEN ARE WE MOST FERTILE?

Between the ages of 18 to 32, you’re at your optimum fertility, explains specialist gynaecologist and fertility expert Dr Chris Venter of Vitalab, and from 32 to about 37 or 38, there’s a gradual decline. After 38 there’s a steep decline in fertility, and by about 42, in most women, this marks the end of their reproductive career, he says. As you get older, there’s a decrease in both the quantity (ovarian reserve) and quality (age related) of your eggs. In his opinion, “Women get a false reassurance that they can fall pregnant in their late 30s. To conceive naturally at 40, within one or two months, is the exception to the rule,” he says.

WHAT IS OVARIAN RESERVE?

All women are born with a finite number of eggs (oocytes) – about one million at birth. By the time you reach puberty, that figure has reduced to about 300 000, and every year between puberty and menopause, that number declines further, as does the quality of your eggs. The rate of this loss is genetically predetermined – some women will experience a significant decline in the number of oocytes in their 40s, but for others, the decline can happen much earlier. Ovarian reserve describes the number of eggs in reserve in the ovary. It’s an indirect measure of a woman’s fertility potential and chances to achieve a healthy and successful pregnancy. If you have a diminished ovarian reserve, finding that “golden egg” can take longer. Fertility treatment like in-vitro fertilisation (IVF) increases your odds by increasing the number of eggs you fertilise during each treatment cycle. Dr Venter says it’s not the intention to create paranoia, as 90 percent of the population will fall within the normal range, but rather to create awareness among patients to know their reproductive status. Many patients have commented that if only they knew their status, they would’ve started planning their family earlier. The two accepted methods of assessing ovarian reserve are to have a pelvic ultrasound during your routine check-up or a blood test.

WHAT ARE THE RISKS OF WAITING?

For an egg to fertilise each month it needs to split its chromosome number from 46 XX to 23 XX. The older egg has an increased risk to divide unequally and therefore produce an abnormal egg. By delaying your family, your ability to conceive declines monthly and could possibly increase the time it takes to fall pregnant. A female of the age of 20 has a 25 percent chance of conceiving each month. A woman of the age of 40 and above has less than a 5 percent chance to conceive monthly. Not only does the chance of a pregnancy decrease, but also the risks of a miscarriage increase, due to chromosomal abnormalities.

WHEN TO SEEK HELP

If you’re younger than 30 and haven’t fallen pregnant after a year of unprotected sex, then you should consult a fertility specialist. At 20 years old, it takes on average four months to conceive, by the time you’re 30, it will take up to eight months, and after 35, it can take on average up to 18 months to conceive. This is not just an indicator of a decrease in sexual activity, but is also a reflection of the quality of the egg, explains Dr Venter. The older you are, the higher the likelihood that there are other complicating factors, like endometriosis and fibroids. “We always advise couples above the age of 30 that if they haven’t conceived within six months, they should be aware and seek help earlier,” he says.

IT’S NOT ME, IT’S YOU

Although most people believe that age-related fertility issues are only the woman’s problem, the man’s age plays a part too. Studies have shown that although the effects of age are not as pronounced, male fertility begins to decline after 40, when the concentration of the sperm in ejaculate drops and the motility start to decrease. Although a man often stays fertile into his 70s, an older father will take longer to conceive. There’s also an increased risk of DNA fragmentation, which may increase the risk of miscarriage.