Glamour (South Africa)

Fer­til­ity over 40

Here’s why more women are choos­ing to have chil­dren later in life.

- Words by Shan­non Manuel

rest as­sured, most healthy women who get preg­nant af­ter age 35 and into their 40s have healthy ba­bies, but one of the bar­ri­ers to preg­nancy in your 40s is your fer­til­ity. While some women have no is­sues get­ting preg­nant well into their 40s, sta­tis­ti­cally speak­ing, you’re less likely to get preg­nant and more likely to need fer­til­ity treat­ments the older you are when you’re try­ing to con­ceive. Here, Dr No­math­am­sanqa Matebese, from the Cape Fer­til­ity Clinic, ex­plains what th­ese treat­ments en­tail and an­swers our burn­ing ques­tions about preg­nancy over 40.

G: In­tro­duce your­self to our read­ers. Dr No­math­am­sanqa Matebese :

I qual­i­fied as a med­i­cal doc­tor in 1993, then as a gen­eral ob­ste­tri­cian and gy­nae­col­o­gist in 2003. I com­pleted a fel­low­ship in Re­pro­duc­tive Medicine (which in­cluded fer­til­ity treat­ment), and I reg­is­tered as a re­pro­duc­tive medicine spe­cial­ist in 2006. I also have a Mas­ter of Medicine, and wrote my

dis­ser­ta­tion on the psy­choso­cial im­pact of Turner syn­drome, which is a ge­netic con­di­tion that causes in­fer­til­ity. I’m a mother to two beau­ti­ful chil­dren. I help cou­ples ex­pe­ri­enc­ing in­fer­til­ity.

G: What are women’s chances of fall­ing preg­nant nat­u­rally af­ter the age of 40?

Dr NM: Less than 15%.

G: Are birth rates ris­ing among women over 40?

Dr NM: Yes, due to an in­crease in the num­ber of women who have ac­cess to as­sisted re­pro­duc­tive tech­niques.

G: What are the risks of preg­nancy af­ter 40 for both mother and child? Dr NM: For the mother, th­ese in­clude an in­creased risk of med­i­cal con­di­tions re­lated to preg­nancy, mainly preeclamp­sia, ges­ta­tional di­a­betes and preterm labour. There’s also an in­creased risk of mis­car­riage due to the in­creased in­ci­dence of chro­mo­so­mal ab­nor­mal­i­ties in their ba­bies. Risks for the child in­clude an in­creased chance of chro­mo­so­mal ab­nor­mal­i­ties such as Down’s Syn­drome, and risks as­so­ci­ated with pre­ma­tu­rity, the most sig­nif­i­cant be­ing neu­ro­log­i­cal ab­nor­mal­i­ties.

G: At what age does preg­nancy be­come ex­tremely high-risk to both mother and child?

Dr NM: From age 50.

G: How does a woman’s age af­fect her fer­til­ity?

Dr NM: It de­creases with age due to the fact she pro­duces fewer eggs, of lower qual­ity, from the age of 35 on­wards.

G: Does it also af­fect labour and de­liv­ery?

Dr NM: The main risks are pre­ma­ture labour and preterm birth. Labour and birth tend to be more com­pli­cated in your 40s due to changes in your health. A woman who has a chronic con­di­tion is more likely to ex­pe­ri­ence com­pli­ca­tions than a woman who doesn’t. Chronic con­di­tions such as di­a­betes, high blood pres­sure or thy­roid dis­ease, can com­pli­cate your preg­nancy and po­ten­tially in­crease your risk of mis­car­riage and preg­nancy loss, in­clud­ing still­birth.

G: What options are avail­able to par­ents strug­gling with in­fer­til­ity? Dr NM: Your first port of call would be to visit a fer­til­ity spe­cial­ist, who may pre­scribe treat­ments in­clud­ing ovu­la­tion in­duc­tion, ar­ti­fi­cial in­sem­i­na­tion, and In-vitro fer­til­i­sa­tion (IVF), us­ing ei­ther your own eggs or ones from a donor. Sur­gi­cal pro­ce­dures to treat en­dometrio­sis or re­move fi­broids (non-can­cer­ous growths that de­velop in or around the womb) may be nec­es­sary. The male part­ner may un­dergo a pro­ce­dure to re­trieve sperm di­rectly from the testis (a tes­tic­u­lar biopsy) if they have ob­struc­tive azoosper­mia (when there’s no sperm in the ejac­u­late). Us­ing donor sperm is an­other op­tion. Ge­netic test­ing of em­bryos for known ge­netic con­di­tions is also pos­si­ble with IVF treat­ment.

G: Briefly de­scribe the types of fer­til­ity test­ing do doc­tors per­form. Dr NM: The fe­male part­ner has a full pelvic ex­am­i­na­tion, in­clud­ing a transvagi­nal ul­tra­sound scan, to ex­clude struc­tural ab­nor­mal­i­ties of the re­pro­duc­tive or­gans. Blood tests for hor­monal eval­u­a­tion are per­formed, in­clud­ing one to as­sess ovu­la­tion. A valu­able blood test is an An­tim­ul­le­rian hor­mone (takes care of the eggs), which helps doc­tors as­sess a woman’s ovar­ian re­serve (egg num­bers). Test­ing for fal­lop­ian tube

“I sup­port women who wish to fur­ther their ca­reers be­fore start­ing a fam­ily”

pa­tency is done ei­ther at a ra­di­ol­ogy depart­ment or via a la­paro­scopic sur­gi­cal pro­ce­dure (used to ex­am­ine the or­gans in­side the ab­domen). The male part­ner has his se­men an­a­lysed (sperm test). Other tests such as ge­netic ones may be re­quired de­pend­ing on the pa­tient’s med­i­cal his­tory.

G: Are fer­til­ity treat­ments and IVF safe for women over 40, and is there an age limit to IVF treat­ment?

Dr NM: Yes, it’s safe. The age limit for IVF treat­ment us­ing a woman’s eggs is around 43, as, af­ter the age of 43, her chances of suc­cess are much lower (less than 5%). Doc­tors don’t rec­om­mend IVF treat­ment, even with donor eggs, af­ter the age of 50, due to the in­crease in preg­nancy re­lated risks.

G: Most women over the age of 45 can’t get preg­nant nat­u­rally. Do you agree?

Dr NM: Yes, this is true, mainly due to lower egg qual­ity af­ter the age of 45.

G: How long should cou­ples try to con­ceive be­fore see­ing a doc­tor Dr NM: If the woman’s over 35, she and her part­ner should see a fer­til­ity spe­cial­ist af­ter six months of try­ing.

G: Most women’s bod­ies have re­minded them the clock’s tick­ing. Is there a prime fer­til­ity win­dow?

Dr NM: You have less chance of get­ting preg­nant af­ter the age of 35. Doc­tors ad­vise women who aren’t plan­ning to fall preg­nant by the age of 33 to con­sider freez­ing their eggs to en­sure they have lots of good qual­ity eggs should they strug­gle to con­ceive af­ter the age of 35.

G: What can women do to en­sure a safer preg­nancy af­ter the age of 40? Dr NM: Be­ing over­weight is strongly as­so­ci­ated with preg­nancy com­pli­ca­tions, which is why we en­cour­age all women to have a nor­mal BMI prior to preg­nancy. You can achieve this by hav­ing a health­ful diet and ex­er­cis­ing reg­u­larly. Take folic acid at least six weeks prior to con­cep­tion to pre­vent spinal birth de­fects in the baby.

G: Many women feel put off hav­ing chil­dren un­til later in life be­cause society views it neg­a­tively.

Dr NM: Women have rights, and they should be al­lowed to de­cide when to start a fam­ily. I sup­port women em­pow­er­ment, and fully sup­port women who wish to fur­ther their ca­reers be­fore start­ing a fam­ily. One of the main rea­sons gen­der-based vi­o­lence ex­ists is that women are fi­nan­cially de­pen­dent on their male part­ners. Women must em­power them­selves to have fi­nan­cial in­de­pen­dence, and they de­serve the same re­pro­duc­tive free­dom as men.

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