As women gradually find their place in society, having a career and family is now an accepted option. But often, this means the decision to postpone marriage and starting a family. By the time women feel settled in their career and ready to take a break for this, their reproductive functions have started to decline with the resultant problems in conceiving naturally. Assisted reproduction treatments may or may not be successful.
This is the compromise that women have to make but often the couple can find a solution to avoid this.
Is age just a number?
No, not at least for women. With advancing age, fertility goes down in women. For women, fertility peaks in the early to mid-20s, declines slightly in the early-30s, and then declines significantly in the mid to late-30s. Advancing age is the biggest limiting factor in fertility; other factors such as tubal defects, hormonal imbalances, and male contributing factors may be managed with treatment.
Women are also less likely to get pregnant with fertility treatment when they are older and are more likely to have a miscarriage if they do get pregnant. Older women are more likely to have a baby with birth defects or genetic abnormalities.
Why does fertility decline with age?
For successful conception to occur, a sperm must fertilize the egg in the female. This egg is released every month from the ovary, and is crucial for fertility. Females are born with all the eggs that they are ever going to have. These eggs form in the ovary during her fetal life. At birth, a woman has approximately one million eggs in her ovaries and this declines to around 300,000 to 400,000 eggs by the time she starts menstruating. Each month one egg matures and is released during the menstrual cycle.
During each cycle, thousands of eggs get lost, and only one matures enough to be released and available to be fertilized. During her reproductive years, only about 400 eggs may mature and be released. By the time a woman reaches menopause, very few or no eggs are left.
With advancing age, the ovary also ages, and the number and quality of eggs decline. This decline may lead to infertility and a high risk of miscarriage. The quality of the eggs is also related to chromosomal abnormalities, for eg: women in their late 30s and 40s have a higher risk of having a baby with Down syndrome also known as Trisomy 21.
This can be correlated to the levels of AMH or the Anti-Mullerian Hormone (AMH) in the blood. This is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.
In addition, with increasing age, the risk of endometrial fibroids and polyps increase, affecting the woman’s ability to have a successful implantation of the embryo.
What are the options for having a baby?
There are options and the couple needs to decide what is best for them. It is important to have a frank discussion as a couple about your priorities. You could decide to have a baby, and then go ahead later to pursue your career. Or, take a break during your career for your family. There are some organizations that support women in this decision and make it possible for her to resume her professional life after a short break. If you decide to postpone your pregnancy, you should seek professional advice about the options available, should natural conception not occur.
There are options with ART or assisted reproductive technology to treat a failure to conceive depending on the reasons. However, success rates do depend upon the age of the woman if she uses her own eggs. With donor oocytes or eggs, success rates do not change with the age of the woman.
With advancements in ART, one more option is worth considering-fertility preservation. Women may opt to freeze their eggs, when they are young. These oocytes can then be used in IVF treatments when the woman is ready to have a baby later in her life. Surrogacy and adoption are other options for some couples that may be right for them.
