How old is too old?
DR. SULOCHANA GUNASHEELA
Age affects a woman’s fertility.
Starting a family: Don’t leave it too late.
Several factors relating to the male and female anatomy contribute to decrease in infertility. Aging in the male is accompanied by decrease in libido (desire for sexual activity). This may be due to sub-normal testosterone levels. Whereas coital freq
uency and impotence are the major determinants of infertility in the male, ovulation disturbance becomes the main reason for infertility in the aging female.
The effect of advancing age on gene defects in the male has been widely studied. Friedman has shown that 33 per cent of children with autosomal dominant mutational changes had been fathered by men over the age of 40. So it is advisable that men have their children before the age of 45. Paternal age is also said to affect sex ratio of the offspring.
How does age affect fertility in a woman? The quality of eggs produced by a woman tends to decline after the age of 25. Early embryonic losses start increasing. These are actually sub-clinical abortions, but the women may not realise it, as most of these embryos are discharged along with the menstrual flow. This is the result of increasing risk of chromosomal aberrations (24 per cent in younger women and 38 per cent in women over 35 years of age) in the embryos produced.
However, apart from oocyte factors, uterine factors also play a major role in age-related female fertility. In a study of oocyte donation, it was reported that oocytes from younger women perform differently when transferred to the uterus of women of different age groups resulting in 10 per cent implantation when the recipient is over 40 years as against 23 per cent when the woman was less than 35 years of age.
A study by Meldrum suggested that the uterus of the elderly woman was less sensitive to the progesterone hormone required for implantation of the ovum.
For every egg released during ovulation in a month, 1000 eggs just perish due to apoptosis. So the egg pool steadily diminishes and may even be completely exhausted by the age of 38 or 40. Such women may continue to have periods, but these are ovulatory.
Theoretically, women should not postpone a first pregnancy beyond 30 years. But women today are ambitious and professionally oriented. Rearing a child is a big responsibility and causes interruption in one’s career.
So one cannot advise every woman to obey a particular dictum but if a career-seeking woman wants to postpone starting her family, she has to work hard to retain her fertility potential.
Women marrying after 35 years should not use any method of family planning. If they do not become pregnant within six months, they should consult a specialist.
Aggressive treatment is recommended for such patients. These consist of ovulation induction with a view to produce multiple ova and Intra Uterine Insemination (IUI) even when the couple is capable of normal sexual activity and later Invitro Fertilization (IVF) when everything else fails.
The writer is a Bangalore-based Gynaecologist and Obstetrician.
Maintain a lifestyle that will not allow you to become obese. Obesity is an enemy to fertility. Obese women produce excessive amounts of insulin, which can disrupt ovulatory phenomena. Excessive insulin also causes other metabolic disorders.
Smoking affects tubal motility and can cause increase in incidence of tubal pregnancy.
Excessive consumption of alcohol can disturb menses. Drinking more than one peg a day can even cause foetal birth defects.
Drinking excessive coffee causes fertility problems and, in some cases, spontaneous abortions.
Extramarital relationships often result in contracting pelvic inflammatory disease causing tubal blocks and chronic endometrial infection.
Aging women may develop high blood pressure, diabetes, endometriosis and myoma. All these can cause problems in conception.
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