AGE RELATED INFERTILITY(ARI)Part 1

Scientific evidence shows thatin women,fertility peaks in mid 20sand starts a steep decline in mid 30s despitethisso many people still postponestarting a family.Somemodern womenwant tofocus on education,buildtheircareer,and of course some wantstable financial base, or theright manmay not be coming,so the need to wait forthe perfect partner. Whatever the reasonsfor delaying parenthood are, it is however unfortunate that the natural clock doesnt stop ticking hence the human body keeps aging inevitably.It is a fact that in todays society, inability to conceive due to age is becoming much more common because women arewaiting until their 30s and 40s to have children. Although many women are healthier in later lifeand taking better care of themselves, this doesnot stopthe natural age-related decline in fertility. Recent reports from the European Society of Human Reproduction and Embryology (ESHRE) haveshown that more women are delaying childbearing at the present time than previously. This trend is expected to cause a corresponding rise in the mean age at which women first present with infertility and thisbringsusto the discussion for this week:AGE RELATED INFERTILITYas it affects both males and females.

WHAT IS AGE RELATED INFERTILITY: This is the decline in fertilitythat comeswith age, seen in bothmen and women.It is a known fact thatage relatedInfertilityaffects both sexes, its effect ishoweverseen much earlier in women than in men. Women30years and abovehave reducedquantity and qualityof eggs in their ovaries while male fertility starts to decline after 40 years when sperm quality begins to decrease. Allthese automatically increasetheriskfor chromosomal abnormalities like having too many or too few chromosomes(aneuploidy)which might result in conditions suchas,implantation failure,Down syndromeandeven higher chances ofmiscarriages. Older women are alsomorelikely to have health problems that may interfere with fertility makingpregnancy and delivery of a live birth more difficult.

The Facts: Women, Age and Fertility

Womenin their 20shave a20-25% chance of achieving pregnancy during their ovulation period. This drops to15-20% for women between the ages of 31 years and 35 years and to less than 10% for women ages 35 years and older. By 40years womentypically only havea 5% and by 45-49 years a 1%chanceof becoming pregnant without fertility treatmentper month.

Women are born with all the eggs they will ever have, unlike men who typically make new sperm throughout their life. Each month many eggs begin to develop, onlyone or tworeaches maturation and eventually ovulates(releases), the others undergoa process called atresia (degeneration). This process occurs in intrauterine life(before birth), before puberty, and during a womans reproductive years, even while pregnant or on oral contraceptive.

This progressive loss of eggs over a lifespan results in low egg numbers(quantity)that resultin lower pregnancy rate beginning usually in the 40s. There is also a corresponding loss in the quality of the eggs over time. As eggs age,they becomeless able to fertilize or evenimplantnormallyand aremore likely to result in a pregnancy that miscarries.

In addition,for a variety of reasons theprocess is accelerated in somewomen whose egg quantity and quality is low at a muchyounger age e.g.those diagnosedwith Premature Ovarian Insufficiency (POI).

Although the average age of menopause (no remaining egg) is about 51years. The decrease in the ability to conceive due to low egg quality and quantity occurs long before,usually beginning in the 30s and becoming more pronounced in the early 40s.Womenin their late40s rarely have a spontaneous pregnancy and if so, one in three will miscarry. It is due to this sense of urgency that women 35 years and aboveshouldconsider visitingfertilityexpertsforevaluation and havetheir fertility profiling doneas soon as they suspectdifficulty becoming pregnant.

If a womans egg quality or egg number is lower than expected for her age, there may be a discoverable treatablecause.

Are thereotherfactors that can decrease ovarian functionin women apart from agesuch asEndometriosis,Severe pelvic adhesion,Previous chemotherapy or radiation,history of smoking, ovarian surgery or removal ofa portionor all of an ovaryor both, genetics (Turners syndrome)etc.

However, decreased ovarian functioncan also occur in women without these predisposing factors. The cause of an early loss of eggs in some women is sometimes not clear, but it is thought to be due togenetic factors with or without a family history of early menopause.

The rule of 3s- ifa healthy woman irrespective of age, has conceived and made it up the first trimester, her odds of the pregnancy resulting in a live birth are almost the same regardless of age. The chances of having a good outcome and a healthy baby are very high. Of course all routine testing are still recommended during prenatal care.

It isworthy ofnote that the process of egg loss happens at a predictable and steady rate even if a woman takes good care of her health and looks young physically.Both egg quantity and quality determines a womans ability to conceive and both are influenced by ageand it is important to note that pregnancy is often possible with the right combination of treatment by fertility specialists.

To be continued.

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The Facts: Women, Age and Fertility - THISDAY Newspapers