Age and Infertility
The ageing of the ovaries is a part of normal ageing changes that affect all organs and tissues. Majority of the women have about 300,000 eggs in their ovaries at puberty. For every egg that matures and is ovulated during a menstrual cycle; at least five hundred eggs do not mature and are absorbed by the body. By the time a woman reaches menopause which happens normally between 47-50 years, only several thousand eggs are left. As the woman ages, the remaining eggs in her ovaries also age, which makes them less capable of fertilizing & the resulting embryos less capable of implanting.
With increasing age several issues come into play:-
1. Pregnancy at a higher age is associated with increased risk of having genetic abnormalities e.g. Down's syndrome. A 20 year old woman has a 1 in 5000 risk whereas a 40 year old lady has a 1 in 20 risk of having chromosomal abnormality.
2. An older woman has an increased chance of having gynaecological problems like pelvic infection, fibroids, ovulatory problems, endometriosis, TUBAL damage etc.
3. Sexual function decreases with age
4. There is an increased risk of autosomal dominant diseases such as Marfans Syndrome, neurofibromatosis etc in older woman carrying a pregnancy
5. The effect of ageing on endometrial receptivity is controversial but evidence suggests that it decreases with increasing age.
Why does fertility decline so rapidly with age?
As women age, number of factors make it more difficult for them to conceive. These include:
1. Ovarian reserve: - This is the number of functioning follicles that are still left in the ovaries with increasing age, lesser eggs are viable.
2. Menstrual cycles tend to become shorter and irregular with advancing age.
3. The endometrial lining becomes thinner and less receptive to the embryo.
4. The vaginal secretions may become hostile to the sperms.
5. Some conditions might damage the reproductive organs with the passage of time like endometriosis, Chlamydia infection, PCOS etc.
6. Chronic illnesses associated with increasing age may also have an adverse effect on fertility.
7. Being overweight or underweight may also make pregnancy difficult to achieve
In women over 40 or in patients with premature menopause many treatment options are available
1. Egg donation: Eggs taken from a young donor are more likely to result in a pregnancy even if carried by an older woman.
2. Embryo donation: In older couples were the male partner also has a problem with his sperms.
3. Surrogacy: A Surrogate is woman who agrees to become pregnant for a couple using the male partner's sperms and her own eggs (traditional surrogate) or the male partner's sperms and the female partner's eggs (gestational surrogate).
4. Adoption: An alternative choice for having a family.
5. Accepting child free living in case they are unable to have their own child or they decide not to take treatment for their problems.