Age and Infertility

Dr Richa Sharma,  Dr Samit Sekhar

The average chance of becoming pregnant each cycle is only 20%.It takes 5 to 6 months for the average fertile couple to conceive. One out of every six couples has trouble conceiving and/or carrying a child to term. Over 1.2 million deliveries worldwide using assisted reproduction.
Women are born with all the eggs they will ever have. Some are ovulated, but several hundred are pre-programmed to die each month. Accelerated egg loss happens due to- smoking, ovarian  surgery, pelvic radiation, chemo agents.Irrespective of whether the patient is undertaking any fertility related treatment or not, there will be a decline in the ovarian reserve with age and its rapid especially after 30 years of age.That’s why the success of an fertility treatment is dependent of the age of the female partner.To determine fertility potential, we as clinicians are dependent upon the clinical,biochemical and sonological parameters that’s called as Ovarian Reserve Assessment(quality and quantity of eggs in a particular age range)
* Many women today are attempting pregnancy at older ages, when they are biologically less fertile.
* Pregnancy rates sharply decline after age 35.
* The exact age at which a  women can no longer conceive varies widely.
The trend in delaying fertility may be due to a greater emphasis on establishing a career, later marriages, and remarkable improvements in the area of contraception
Pregnancy rates related to age of female-
Woman’s Age (y)        % Conceiving in 12 Months
20-24                            86
25-29                            78
30-34                            63
35-39                            52
15 – 20% of  all couples will experience difficulties with conception, but this increases up to 50% at age 35 – 40.
Reasons Of Decreased Pregnancy chances with age-
* Conception rate of normal fertile couples (~ 20% /month)
Probability of clinical pregnancy following intercourse on most fertile day of cycle:
19-26 yrs old         50%
27-34 yrs               40%
35-39 yrs               30%
*Poor quality of aging oocytes
*Chromosomal abnl., morphologic abnl.
*Decreased ovarian reserve
*Altered hormonal environment- ovulatory dysfunction
* More conditions in older women- polyps,endometriosis, fibroids…
Sexual factors- decreased coital frequency
Treatment Options-
* Ovarian hyperstimulation with IUI generates more eggs and sperm to be present at the optimal time of conception.
* IVF (in-vitro fertilization)- vital to older when time         is critical , tubal pathology (live birth rate drop from 32% in women<35 to         10% in women 41-42 yrs)
* Oocyte donation- option for older women Pregnancy rates are determined by age of donor, but   pregnancy complications by age of mother.
* Delaying childbearing may increase infertility and the chance of developing chronic medical conditions.
* If no pregnancy after 6 months of trying, refer to specialist!! Time is vital for these patients.
Risks to the prospective pregnancy-
There are various ways to quantify the risks associated with advancing maternal age-
There are multiple tests today to quantify a women’s risk of chromosomal abnormality:
* nuchal translucency
* first trimester serum screening
* quad screen in 2nd trimester
* invasive testing- CVS , amniocentesis
What patients need to know ?
As doctor, we are supposed to give clear picture to the patient about impending risks of adverse outcome of pregnancy in the form of
* preterm birth
* growth restriction
* stillbirths
Besides that we should discuss the risks of Hypertension, Diabetes mellitus, low  socioeconomic class….all influence outcome
* Advanced maternal age is associated with reduced fertility and increased risk of adverse pregnancy outcomes.
* Associations are due to poor oocyte quality, age-related changes in uterine/hormonal function.
* Fortunately, the prospects for couples to conceive are better than ever with advancing age with advancement of science and introduction of ART and especially the Third Party Reproduction
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(The authors are Senior IVF consultant Gurgaon Fertility Centre,GFC) and Executive Director, GFC)