Dr Sumana Gurunath, Consultant Infertility & Reproductive Medicine, Department of Obstetrics & Gynecology, Cloudnine Group of Hospitals, Bengaluru
It was Mira’s 36th birthday. She had never felt happier. She had received her letter of promotion that morning and was now Vice President of her organization. She looked back at her fulfilling life – doting parents, academic successes, education at the best universities, foreign travel, great social life and a husband who adored her. The only missing bit was a baby and motherhood. She realised that it was time to move forward and experience those tender moments. Many questions crept into her mind. She had heard many celebrities getting pregnant at 40 and thought to herself that it should not be difficult considering she was still 36. And of course, if she couldn’t conceive on her own, she knew about IVF and how successful it was.
Will it be difficult for me to get pregnant at this age?
Fertility declines as a woman ages. A healthy woman in her 20s has a 1 in 4 chance of conceiving every month. But at 40, she has just a 5% chance of getting pregnant per cycle. With age, it may take longer to conceive.
A woman is born with all the eggs she needs in her whole life. As eggs are ovulated every month, they are constantly utilised and the residual number and quality reduce with age. After 30, fertility starts to decline and becomes more rapid after 35. A woman’s ability to conceive largely depends upon how many eggs are left and what quality they are – medically called ‘Ovarian reserve’.
How do I know how much time I have?
Reproductive time can be determined by estimating the ovarian reserve. Hormone tests such as Anti-Mullerian Hormone (AMH) and Follicle Stimulating Hormone (FSH) and a detailed ultrasound of the ovaries are used to understand the ovarian reserve. This matters because the fewer eggs in your ovaries, the lower the chances of conception.
How long should I try before I seek help from a doctor?
After 35, women are advised to try naturally for six months and seek the early help of a fertility specialist if unsuccessful.
Will pregnancy be complicated after 35?
There may be a greater chance of complications in pregnancy such as developing hypertension, diabetes, delivering preterm and needing cesarean section for delivery.
How healthy will my baby be?
The likelihood of miscarriage climbs with age. While a 25-year-old has a 10-12% chance of miscarriage, a 40-year-old has about a 40% chance. Older eggs tend to contain an abnormal number of chromosomes. This results in increased risks of Down’s syndrome after 35. The risk of having a baby with Down syndrome is 1 in 1200 at age 25, 1 in 250 at 35 and 1 in 100 at age 40.
She had heard many celebrities getting pregnant at 40 and thought to herself that it should not be difficult considering she was still 36.
Egg reserve is highly individualistic and no two people of same age have similar egg reserve. You must consult a doctor to understand your body better and determine what is right for you. 10% of women lose eggs quickly and age early. This condition is called premature ovarian ageing. This means that in some women, ovaries are older than their actual chronological age.
And of course, if she couldn’t conceive on her own, she knew about IVF and how successful it was.
Success rates of all fertility treatments are dependent upon the age of the woman and her egg reserve. IVF success rates decline with lesser number and quality of eggs. It is important to remember that treatment cannot reverse the effect of ageing.
What is a reproductive life plan?
All women should think about whether and when they would like to have children. This is called a reproductive life plan. If you wish to delay your pregnancy, it would be wise to consult a fertility specialist to understand more about your egg reserve – to determine how long one can safely delay pregnancy without compromising one’s fertility.
Can anything be done to preserve my fertility?
Options such as egg freezing (if the woman is not married) or embryo freezing are offered for fertility preservation. But these methods do not guarantee pregnancy at a later age.
In this millennial generation, Mira is not alone. Many urban professional women are choosing to marry and conceive much later than before. It is vital for every woman to be aware of the impact of ageing on fertility so that she makes the right reproductive choice.