The ability to conceive in both boys and girls appears during puberty. The beginning of the fertile age of the fair sex will be marked by the onset of ovulation and menstruation. However, over the years, the reproductive function undergoes changes. The ability to conceive decreases as the body ages, and after menopause, women can no longer become pregnant naturally.
In modern society, infertility associated with age-related changes in the reproductive system has become more common. There are many reasons why many girls start starting families only after 30 years. Today women have more opportunities to take care of themselves and monitor their health, but all this does not exclude an age-related decline in reproductive function. It is important to understand that fertility decreases as a woman ages due to the natural process of decreasing the number of eggs in the ovaries. And this process can begin much earlier than most women assume.
OVULATION AND MENSTRUAL CYCLE
During their reproductive years, women have regular menstrual cycles, during which the ovulation process occurs every month. At the beginning of each cycle, follicle-stimulating hormone (FSH) produced in the pituitary gland stimulates a group of follicles in both ovaries to grow. Usually, only one of these follicles matures and releases an egg (ovulates), the rest stop growing and are destroyed. Pregnancy occurs when an egg is fertilized and anchored in the lining of the uterus (endometrium). If pregnancy does not occur, the endometrium comes out in the form of menstruation and the cycle resumes.
At the beginning of adolescence, girls have "walking" ovulation, which leads to irregular menstruation, but by the age of 16, as a rule, a stable period is established. From this time on, the female cycle will remain stable, ranging from 26 to 35 days.
Unlike men, whose bodies produce sperm throughout their life, a woman is born with a constant number of oocytes with follicles contained in the ovaries. So, at birth, a girl forms about a million follicles. By puberty, this number is reduced to about 300,000. Of the remaining follicles, about 300 reach ovulation during reproductive age. The remaining follicles are not used during ovulation, but only as they undergo a natural sequential degeneration process called atresia.
As women age, fertility declines due to the natural age-related changes that occur in the ovaries. From about 30-40 years old, you can notice that the cycle has become shorter. Over time, ovulation begins to disappear, periods become more and more rare, until they stop completely. It is believed that the stage of menopause occurs when a woman has no menstruation for a year. It is believed that those who like to smoke a cigarette or two go through menopause a year earlier than non-smoking women.
FERTILITY IN OLDER WOMEN
The best reproductive years for women are considered to be the age of 20-30 years. Fertility gradually begins to decline by the age of 30, this trend is especially pronounced after 35 years. A healthy woman of childbearing age has a 20% chance of getting pregnant every month. That is, for every hundred childbearing 30-year-old women who try to get pregnant on the first try, only 20 will succeed, the remaining 80 will have to try their luck again. By the age of 40, this probability is less than 5%. Thus, less than 5 out of 100 women can conceive successfully in each month.
As we have discussed, women remain fertile until menopause occurs, the average age at onset is 51. However, most women fail to conceive a baby already at the age of forty. These indicators apply both to those who are trying to conceive in the traditional way and to those who are undergoing fertility treatments, including in vitro fertilization (IVF). The stories broadcast in the media can lead women and their partners to the mistaken idea that no matter what, you can be guaranteed to get pregnant using procedures such as IVF. But do not forget that a woman's age still affects the likelihood of a cure for infertility. The quality and quantity of eggs gradually decrease with age, which causes a decline in female fertility.
FERTILITY IN OLDER MEN
In contrast to the early decline in fertility, which is observed in women, in men, the change in reproductive function occurs much later. Although sperm quality deteriorates somewhat as a man ages, this is generally not a problem until a man reaches 60 years of age. Although the emerging problems in men are not as sudden and noticeable as in women, changes in reproductive and sexual functioning also occur as they age.
At the same time, the stronger sex does not have an age limit at which a man cannot become a father, which has been proven by gentlemen aged 60-70 who have successfully conceived offspring with their younger partners. However, as men age, testes tend to become smaller and softer, sperm structure changes, and sperm motility tends to slow down. Aging men often develop illnesses that can adversely affect their reproductive and sexual function. Moreover, with age, there is a higher risk of the appearance of gene defects in the sperm. However, it is worth noting that not all men experience significant changes in reproductive or sexual function as they age, especially men who have maintained their health in good condition for many years.
In any case, if a man has problems with sexual desire or erection, he needs to seek treatment from a urologist. Decreased libido may also be due to low testosterone levels.
EGG QUALITY
As women age, they are less likely to become pregnant and more likely to miscarry, as the quality of the eggs deteriorates as the number of remaining eggs decreases. Such changes are most pronounced in women closer to forty years. For this reason, a woman's age is the most accurate test of egg quality.
Important changes in the quality of oocytes associated with the presence of hereditary abnormalities and the frequency of diseases transferred are called aneuploidy (the content of too many or too few chromosomes in the oocyte). During reproduction, a normal egg must consist of 23 chromosomes, then the total embryo will contain 46 chromosomes. As we age, more and more eggs have either too many or too few chromosomes. This means that the number of chromosomes in the embryo will also be either more or less than the prescribed value. Most people know that Down Syndrome is a process that causes the embryo to have an extra chromosome. However, most embryos with too many or too few chromosomes do not lead to pregnancy or lead to miscarriages. This situation explains the lower chance of getting pregnant and the higher likelihood of miscarriage in adult women.
NUMBER OF EGGS
A decrease in the number of follicles containing eggs in the ovaries is called "loss of ovarian reserves." Women begin to lose ovarian reserves before they become infertile and before they stop menstruating regularly. Since women are born with the same set of follicles that they will have throughout their life, the number of follicles waiting to be diminished gradually. As ovarian reserves decrease, follicles become less and less susceptible to IVF and require more and more stimulation of the egg to mature and ovulate. At first, your periods may move closer together, resulting in a shorter cycle of 21 to 25 days each. As a result, the follicles become unable to function properly for stable ovulation, resulting in long irregular cycles. A decrease in ovarian reserve is usually associated with age and occurs due to the natural loss of eggs and a deterioration in the quality of the remaining eggs. However, ovarian reserve can also decrease in young women. This is often due to smoking, a hereditary predisposition to premature menopause, and previous ovarian surgery.
INFERTILITY AND AGE MOTHERNESS
Infertility is diagnosed if a woman fails to become pregnant after a year of unprotected sexual intercourse (including without using oral contraceptive methods). However, if the woman is 35+, the examination should be carried out after 6 months of unsuccessful attempts to conceive a child. If a couple has obvious medical problems that affect their inability to conceive, such as a lack of menstruation (amenorrhea), sexual dysfunction, inflammation, or previous surgery, they are advised to start testing for infertility immediately.
A fertility test usually includes determining the period of ovulation, examination of the fallopian tubes, cervix and the uterus itself. The male partner will need to undergo a semen analysis (semen analysis). Most of the tests can be completed within one month. After the end of the examination, the necessary treatment is prescribed. It is very important to keep track of your overall health. A preliminary consultation with a specialist often also gives a positive result. Doctors may suggest a course of necessary therapy before pregnancy begins, as there are increased risks for older women.
For example, women who suffer from diseases such as high blood pressure or diabetes should consult a doctor before attempting to conceive, as symptoms of these conditions may worsen during pregnancy. In addition, babies born to women after age 35 have a higher risk of being born with the wrong number of chromosomes. Therefore, women at risk during pregnancy may be recommended to undergo a special examination.
It is better for women to discuss the existing risks with their doctor or genetic counselor before planning a pregnancy. During the examination, prenatal testing may be performed after a special check for certain congenital abnormalities. Currently, amniocentesis and chorionic villus sampling are used to identify pathologies. Also, a blood test and ultrasound are used as a diagnostic test. As practice shows, most parents want to know as much information as possible about pregnancy in order to be able to make an informed decision.
TREATMENT OPTIONS AND ALTERNATIVES
Assisted reproductive technologies
When determining the cause of infertility, doctors may suggest special treatment. However, sometimes there are cases in which it is not possible to find any specific problems and the cause of infertility is considered "unknown". In case of undetermined infertility, or when traditional methods of treatment have not worked, assisted reproductive technologies, such as superovulation using intrauterine insemination (IUI) technology and in vitro fertilization (IVF), can be used. In the IUI cycle, infertility is treated with drugs to increase the number of eggs in the ovaries. When these eggs are ready to ovulate, the sampled sperm from the partner is placed directly into the female ovaries. This procedure is called intrauterine insemination (IUI) technology and does not cause any discomfort. IVF is a procedure for taking an egg and fertilizing it with the partner's sperm in the laboratory, then the finished embryo is placed in the uterus. In each of these procedures, the sperm of the donor can be used instead of the sperm of the woman's partner.
With any of the treatment options, the woman's age directly affects the onset of pregnancy. Among women over 40, the likelihood of effective intrauterine insemination is less than 5% per cycle. In comparison, the probability of a successful outcome in women aged 35 to 40 years reaches approximately 10%. IVF is considered a more productive technology, but the success rate among women 40+ is relatively low, only 20% per cycle.
Egg donation
If other therapies do not work, the woman is over 42 years old, or has Ovarian Fatigue Syndrome (Premature Ovarian Failure Syndrome), also known as early menopause, the options for treatment are narrowed. In this case, egg donation, which is the use of eggs from female donors between the ages of 20 and 30, is considered a fairly successful procedure. The high likelihood of getting pregnant with an egg donor confirms that age-related egg quality is the primary barrier to conception in older women. If you are over 40, then the chances of successfully getting pregnant using an IVF cycle using a donor egg are much higher, but many couples or single women in their 40s prefer to use their eggs, although the probability of getting pregnant in this case is lower. By the age of 43, the chance of getting pregnant through IVF is less than 5%, and by the age of 45, the only reasonable rational alternative is to use a donor egg.
With this method of treatment, the egg donor takes medications to stimulate the production of many eggs in the ovaries. At the same time, the egg recipient (the woman who receives the donor egg) receives hormone therapy to prepare her ovaries to receive fertilized eggs (embryos). After receiving the eggs from the donor, they are fertilized with the partner's sperm in the laboratory. A few days after this, the embryos are placed in the recipient's uterus. Any embryo that has not been used can be frozen (cryopreserved) for later use.
Egg donor IVF gives women the opportunity to get pregnant, give birth and experience the joy of motherhood. However, one must understand that a child conceived in this way will not be genetically related to the woman who gave birth to him. At the same time, he will have a biological connection with the father and the egg donor. Many programs recommend counseling to ensure that all parties to an egg donation agreement understand the ethical, legal, psychological, and social aspects of the issue. Since the success of the procedure is highly dependent on the quality of the donor's eggs, women between the ages of 20 and 30 with proven fertility are considered ideal donors.
DELAYED MOTHERHOOD
Women who want to postpone childbirth until over 38 years of age may consider methods such as freezing embryos after IVF or retrieving and freezing an egg for later use. The success of freezing the embryo (cryopreservation) is well known, but it implies that the woman has a male partner or that donor sperm are used. Egg freezing to delay motherhood is a promising new technology. However, there is a problem in using the voluntary egg freezing method. As the woman gets older, the end result of the assisted reproductive technology cycle is less and less successful.
PREIMPLANTATION GENETIC SCREENING
Currently, new technologies are being developed that will allow testing embryos for chromosomal abnormalities. This method is applied to embryos created using IVF. It can be especially beneficial for older women. With preimplantation genetic diagnosis (PGD), a small number of cells are taken from each embryo and examined. Chromosomally correct embryos are selected for transplantation into the mother's uterus. This procedure is expected to result in a high pregnancy rate and transmission of an embryo with genetic disabilities.
CONCLUSION
Fertility naturally declines as you age. Despite the fact that the time of decline in fertility and the onset of menopause varies significantly in women, this period occurs in the life of every woman. As a rule, fertility begins to decline around the age of 30 and drops noticeably at the age of 35. Women who decide to postpone pregnancy until the age of 35 or beyond should be realistic about the chances of success, be aware of the possibilities of conception and, if necessary, the use of fertility therapy. After reviewing all the options and realizing their needs and goals, the woman and her partner will be able to make the best decision.
