Fer­til­ity

How old is too old?

Your Pregnancy - - Contents -

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.

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