Good day readers, Let me congratulate you for still holding on to your dream of parenthood. As the year 2022 is passing close by, it is worthwhile to talk about the fertility journey ahead. Every couple’s parenthood journey is different, and every twist and turn needs confidence to move ahead. Many articles and research papers on IVF success rates are published. A lot has been spoken about age and egg number, the limelight being the quality of the eggs. Let’s know the relationship between the quality of eggs and fertility in this blog. Many women have a strong belief that their egg count is the main indicator of their fertility. But, while egg count is part of the truth, the true driver of fertility is egg quality, and science has proved that egg quality deteriorates with advancing age. As we all know, women lose eggs each month, about a thousand immature eggs (follicles) a month after puberty—and by age 35, they have only about 6% of their remaining egg count. Can these lost eggs be replenished? Absolutely not! Actually, that’s not even required. You see, every woman is born with her full complement of eggs – about 20 to 10 lac. However, by puberty (commencement of menses), this comes down to around 4 to 5 lacs. After puberty, they lose about 1,000 immature eggs (follicles) in each menstrual cycle during which, only 1 follicle from only 1 of the 2 ovaries will go on to release a matured egg. In the next cycle a follicle from the other ovary will release 1 mature egg. This prevents twin or more births, in most women. Older eggs are more prone to DNA damage and probably will have abnormal DNA. What happens when an abnormal egg ovulates? If the egg is fertilized by sperm, implantation does not happen as the body has a mechanism to know about the abnormal egg. Such embryo implants will result in miscarriages. That is why miscarriage is so common. 1 in 4 pregnancies ends in miscarriage, which too usually in the first trimester. As an embryo is likely abnormal and unable to progress. There are instances of babies born with genetic defects. Odds of natural pregnancy concerning age within one year of trying. Women’s Age groups Chance of Getting Pregnant by Age Within 1 Year 20-24 86% 25-29 78% 30-34 63% 35-39 52% By now, we know what are the chances to get pregnant naturally in each decade of life. What are the chances of miscarriages as you age? What about having a chromosomally normal baby? And, if you need to do IVF, then, how successful will IVF be at that age? Let’s dive in to know more. Getting Pregnant at 30, 35, 40 yrs or later. The older a woman is, the higher the chance she has abnormal eggs. How old is old? This is where a biological clock comes into existence. A woman’s peak fertility is in her mid to late 20s. This simply means, there is a higher percentage of normal eggs during these periods. As a woman gets pregnant after 35 years of age, called advanced maternal pregnancy, there are higher rates of miscarriage, genetic disorders or pregnancy complications like high blood pressure or gestational diabetes. Is it really hard to get pregnant at or over age 35? 35 is a scientifically proven age criterion when fertility starts to decline more rapidly. A decline in fertility means the quality and quantity of eggs in your ovaries decrease. Is it impossible to get pregnant after 35? It is possible to get pregnant but at the same time, there is an increased risk of complications. How are advanced maternal-age pregnancies treated by doctors? They are not treated differently. It calls for additional precautions. There are precautions of genetic screening tests and if these tests indicate your baby may have a congenital disorder, then a maternal-fetal medicine specialist will be called for. This speciality deals with high-risk pregnancies. There are more frequent prenatal visits during her ANC cycle. For example, an earlier glucose test (to check for signs of gestational diabetes) More ultrasounds or fetal heart rate monitoring to ensure the baby’s growth. For the risk of preeclampsia, your doctor may recommend medications and monitoring. How important is prenatal care for advanced-age pregnancies? Prenatal care is more important as you age, not just because of increased risks for certain conditions but also because managing them well in time safeguards the health of mother and child. Maintaining a healthy body weight along with other vital parameters is very important. Eating a healthy diet and supplements as per instructions is necessary. Can menopause be reversed to get pregnant? No, once menopause has started, you just can’t reverse the process. If you are delaying pregnancy or concerned about preserving fertility, freezing your eggs or embryos is an option. What if my egg quality / quantity is not good? As informed earlier in the article, it is the quality that matters. Even if we are able to generate 2 to 4 good quality embryos using IVF/ ICSI/ IMSI technology, you can look forward to pregnancy within a few cycles, all else being normal. Sadly, with advancing age, all else being normal is itself abnormal! Conditions like high BP, thyroid abnormalities, Diabetes are very common, which further add to the fertility burden. However, technology allows you to achieve pregnancy using eggs derived from another unrelated (ususally) woman. This is termed Donor Egg IVF. Can I lower my risk of complications, if older than 35? If you are over 35 and trying for pregnancy, you can do the following to lower your risks and increase your chances of pregnancy Maintain a healthy weight & appropriate BMI Manage any preexisting ailments effectively. Consciously work to reduce stress and get enough good night’s sleep. Exercise regularly and eat a healthy diet. Quit smoking or tobacco products. Stop drinking alcohol. Eat a colourful healthy diet with plenty of fruits, vegetables, lean meats and whole grains. We, at Pearl women’s hospital & Yash IVF, are happy to share the experience of Mrs Urjita Jain, 42 yrs, who also had a serious co-morbidity. Despite her advanced age and the presence of endometriosis, she conceived and delivered a healthy baby without any complications. Surgical intervention with laparoscopy for neutralizing endometriosis, followed by IVF treatment enabled her to finally experience the joy of motherhood after three prior miscarriages. Suffice to say, if you remain Wishful, Yashful you will become!
