Implications of advanced age on fertility and pregnancy

At a Glance:

What is advanced maternal age?

Advanced maternal age is defined as age 35 years or above at conception or delivery (AMA; ≥35 years).

The first menstrual cycle that begins at the age of 12 or 13 years is considered to be the start point of a woman’s “reproductive age” which terminates at menopause, i.e., till the time she experiences her last period.

There is no universal definition of advanced maternal or reproductive age in women. This is partly so because the effects of increasing age do not occur at a specific time, in fact they occur as a continuum. With advanced age, especially after the mid-30s, fertility begins to decline due to deterioration in quality and quantity of eggs. Women above the age of 35, may experience delayed conception, increased risk of undergoing miscarriages and pregnancy-related complications.

With many couples pushing into their late thirties to start a family, pregnancy at an advanced age and delayed parenthood is not an alien concept anymore. Advances in fertility treatment like IUI, IVF, ICSI and fertility (egg/embryo/sperm) preservation, are showing promising outcomes for many women above the age of 35 to conceive and deliver a child successfully.

Why does fertility decline with advanced maternal age?

A decrease in fertility with advancing maternal age is attributed to certain reasons like:

• Aged eggs: A woman is born with all of the eggs she will ever have. Age has an effect on the quality of the remaining eggs in the woman’s ovary. The ovarian reserve starts diminishing too which reduces the odds of conception. Further, with advancing age, the eggs are prone to chromosomal damage which affects their chance at fertilization or conception, thus leading to infertility.
• Reproductive abnormalities: Older woman are more likely to have gynaecological problems like damage to fallopian tubes, presence of uterine fibroids and endometrial polyps. These physical problems can also increase the chances of female infertility.
• Decrease in libido or sexual urge: It is seen that the desire for sexual intercourse declines with advanced age. Moreover, the male partner also advances in age and the sperm quality declines (male infertility).

Infertility in women and their partner (male infertility) should be considered while considering treatment options.

What are the risks associated with advanced maternal age?

A woman planning to start a family after her mid-thirties is highly recommended to seek consultation from her gynecologist and a detailed medical examination to enjoy a healthy well managed pregnancy. The objective of the assessment is to rule out the presence of any underlying medical conditions like those related to thyroid, diabetes, hypertension etc. These medical conditions if not managed well may not only affect the chances of conceiving, but also affect the developing baby directly. Being overweight or obese may influence the pregnancy outcomes. Hence it’s imperative to get a detailed guidance on diet and an exercise regime before and during pregnancy.

A woman should be aware of the risks and take adequate precautions to minimize these risks:

Repeated failure to conceive/become pregnant:  The chances of conceiving decrease as the age advances. The chances of successful fertilization & implantation are lesser in advanced age than that noted in a younger age group. If you are in your mid-thirties and trying to conceive, please seek your gynecologist’s advice if you don’t succeed even after six months of trying.

Increased possibility of multiple pregnancies: Undergoing treatment for female infertility with assisted reproductive technologies like in-vitro fertilization plays a role.

Increased chance of developing gestational diabetes: A type of diabetes called gestational diabetes is observed more commonly in women with advanced maternal age. Gestational diabetes occurs only during pregnancy. For women with gestational diabetes, it is very important to control their blood sugar well through diet and physical activities with or without medicines. Poorly managed gestational diabetes is related with bigger babies due to excessive birth weight (macrosomia). Further, the chances of premature delivery and hypertension i.e high blood pressure also increase in presence of gestational diabetes. This raises the risk of developing complications in the infant after delivery.

Increased likelihood of developing hypertension: Research indicates that older women are at a higher risk of developing high blood pressure during pregnancy. This makes it important for pregnant women with advanced maternal age to undergo regular monitoring of blood pressure and the growth and development of the baby.

Increased likelihood of premature delivery and low birth weight baby: The chances of a premature delivery and premature baby with low birth weight with medical complications increase with advanced maternal age.

Increased probability of a Caesarean or C-section: Increased risk of pregnancy-related complications often call for an increased likelihood of a caesarean section for delivery in women with advanced maternal age.

Higher risk of chromosomal abnormalities: Women with advanced maternal age often have an increased chance of giving birth to babies with chromosomal defects like Down’s syndrome.

Increased risk of early pregnancy loss or spontaneous abortions: As the woman’s age advances, risk of early pregnancy loss due to spontaneous abortions, miscarriage increase. This is further aggravated due to associated medical conditions of chromosomal abnormalities in the developing baby. It is also suggested that many a times; advancing age of the father i.e the paternal age may also pose health risks for the developing baby.

How to increase the chances of pregnancy in advancing maternal age?

Currently, many couples delay parenthood due to many reasons. As a result, more number of women are starting their family after 35 years of age. Sometimes, a second child may be planned after mid-thirties. Being aware of the effect of age on fertility is essential.

• A woman who is older than 35 years should receive evaluation and treatment after six months of failed attempts to conceive.
• And in women older than 40 years immediate evaluation and treatment is needed.

Some of the precautionary measures that a woman who is considering pregnancy after her mid-thirties include:

Adopt a healthy lifestyle:

• Have a diet rich in nutrients, folic acid, calcium, iron, vitamin D etc. One can take prenatal vitamins after consulting a doctor a few months before conception to compensate for dietary inadequacies.
• Maintain a healthy weight. Indulge in regular physical activity to prevent unnecessary weight gain and improve health. It also helps in muscle toning for easy labour.
• Avoid consumption of substances like alcohol, tobacco etc.
• Medications or supplements if any should be taken only after consulting a doctor.

Seek consultation with your gynaecologist:

• A pre-conception check-up and consultation with the doctor helps in understanding the risks involved and best course of treatment in case of female infertility or if male infertility is suspected.
• The doctor would undertake detailed family history of the couple, rule out any underlying medical problems, and suggest investigations and advice treatment options.
• Many a times a genetic counselling may also be recommended to women above the age of 35 to assess the risk of having a baby with genetic abnormalities.

What are the treatment options for women with advanced maternal age and those with female infertility?

Even though advanced maternal age is associated with certain risks, advancements in technology have made it possible for women after 35 with infertility to not only conceive, but also continue a health pregnancy and deliver healthy babies. Assisted reproductive techniques and treatment options like IVF (In-Vitro Fertilisation), ICSI (Intracytoplasmic Sperm Injection), IUI (Intrauterine Insemination) and egg freezing are all proving to be of immense benefit to such women.

Depending on the overall health status, age and family history, a woman considering pregnancy in advanced maternal age has the following options:

Conceiving naturally

The chances of conceiving decrease with age. However, this decline is not consistent. The rate of decline changes with the woman’s age group. So, a woman under 30 years has a 25% chance of getting pregnant naturally in each month (cycle), which falls down to 20% after 30 years of age, and by 40 years, it comes down to 5% each month.

While conceiving naturally is the best option, it may take a while or may not happen at all. With ageing, the chances go further down and considerable amount of time may be lost. Hence a woman who has been trying to conceive without success in an advanced maternal age should consider consulting an infertility specialist as soon as possible.

Conceiving with Assisted Reproductive Techniques (ART)

With advancing age and passing months, the chances of having a baby are getting limited. Assisted reproductive techniques increases the success rates of in getting pregnant in advanced age. The eggs are retrieved after ovarian stimulation, and fertilized in the lab (IVF ),followed by embryo transfer. For women with limited quality eggs, IVF with donor eggs may be considered. Since successful implantation is also important for conception, the procedure may also involve assisted implantation by means of laser hatching.

How can Yashoda Hospital help women to conceive in their advanced age?

Yashoda Fertility & Research Institute, Secunderabad is one of the best hospitals for fertility treatments in India, Hyderabad. Infertility concerns are more prevalent than ever before. The Yashoda Fertility & Research Institute believes in taking a comprehensive, personalize approach toward patient care to identify and target the problems in getting pregnant. With state-of-the-art technology, advance treatments and technical expertise of our IVF specialist doctors and embryologists, we have been helping older women in conceiving.

Advances in assisted reproductive technologies (ART) have made combating infertility, both male infertility and female infertility, fairly simple and safe. With the best fertility doctors in Hyderabad, Yashoda Fertility & Research Institute has successfully accomplished several IVF procedures.