Ruchi Sharma, 37, a top executive in a MNC, married since last seven years is desperately trying to conceive since last 2 years but with no results. All her test reports are apparently normal and she is absolutely clueless about what has happened to her fertility. According to Ruchi,” Initial five years of my marriage, i did not even had the time to think about pregnancy, let alone the idea of bringing up a baby. Work, meetings, project deadlines were the only things in my life. When i started thinking seriously about starting my family, it just did not happen. Now i am gradually sinking into depression.” These cases like Ruchi are not uncommon and there is a whole breed of new age women like her who did not choose to have a baby because of work commitments. This new “Professional Hazard” is spreading like an epidemic specially in Metropolitan cities. Professional & personal opportunities have exploded for women over the past 30 years encouraging them to postpone motherhood. Majority of 33% high achieving women who are childless at the age of 41-55 did not choose to be childless & would still like to have children. They simply forgot that their biological clock ticks in unison with time line for other achievements.”
When to see infertility Expert:
According to Dr K.D.Nayar, Chief consultant, Akanksha IVF Centre, New Delhi,” who performs more than 400 IVF/ICSI cycles annually, daily see 8-10 females who are desperate to conceive at the age of 35 or above and their number is sharply rising. Women are known to be born with a limited quantity of eggs. They start to experience decreased fertility rates in their late twenties & this rapidly accelerates as they reach their thirties. As the age increases the quality & the quantity of eggs decline affecting fertilization success, embryo quality & pregnancy rates. Ovarian functions can decline without women even realizing it. Biology of female eggs has not kept pace with career life span of today.
HOW OLD IS TOO OLD?
As a woman ages, a number of changes take place in her reproductive system. For women, the cessation of menses (menopause) is an obvious sign of ageing. But, it is by no means the only change. A transition period lasts for many years before menopause and this occurs because of distinct and dramatic decline in estrogen production. And as a women ages, the genetic quality and quantity of their eggs and the efficiency with which their bodies reject genetically damaged embryos both decline, leading to an increased risk of genetic problems in the baby . This triad of declining fertility, declining hormone levels and increasing risk for genetic problems is what most people mean when they say “biological clock.”. According to Dr Nayar,” Only in 80% of the cases the cause of infertility can be directly traced to husband or wife or both the partners and in rest 20% no specific reason found after investigation and evaluation of couple. This unexplained type of infertility is specifically more common in females above 35 years of age.”
1) WOMEN IN THEIR 20S
Fertility rate/month is – 20-25%
Spontaneous miscarriage rate 5-10%
Incidence of genetic abnormality i.e. Downs’s syndrome is 1 in 1200.
These younger women are physically active & should do moderate exercise in the first & third trimester, should avoid smoking alcohol, caffeine etc.
2) WOMEN IN THEIR EARLY 30S
Fertility rate per month is 15%
Miscarriage rate – 20%
Should start prenatal vitamins.
3) WOMEN > 35 YEARS
Fertility rate per month – 10%
Miscarriage rate – 25%
Risk of Down’s syndrome – 1 in 350
Genetic testing is recommended.
4) WOMEN in their 40s
Sharp decline in achieving pregnancy.
Fertility rate per month is 5%, Even with IVF success rate is 10%
90% of eggs are genetically abnormal on biopsy.
Miscarriage rate is 33%
Incidence of genetic abnormalities is 1 in 38
5) WOMEN above 45 YEARS
Pregnancy is a difficult proposition as virtually all the remaining eggs are genetically abnormal
<1 br="br" chance="chance" eggs="eggs" getting="getting" of="of" own="own" pregnant="pregnant" their="their" using="using"> Miscarriage rate > 45%
Incidence of genetic abnormality – 1/12
Egg donation is the key.
Oocyte donation success rate- 80%
AGING IN MEN: In the last 30 years, there is 50% increase in men who became fathers above the age of 35. The genetic quality of sperm does decline, leading to an increased risk of genetic problems in offspring above and beyond any contribution by the female .Although it’s an idea that has not yet filtered down to the general public, we now know that men have biological clocks too. And those clocks involve the same physiological triad experienced by women. Male fertility and male sex hormone do decline with age. The decline in sex hormones is not as steep or as sudden as with menopause. 1% per year decline in testosterone level after age of 30 years is termed as “Andropause”. The symptoms include decreased libido, erectile dysfunction, loss of muscle mass, weight gain, declining cognitive function and associated with type II diabetes. Older men are at a higher risk of harboring a child with schizophrenia and also risk of having children with Down’s syndrome. Hence now the features of aging have expanded the notion of “biological clock” to include both sexes.
CHIEF CONSULTANT INFERTILITY & IVF, AKANKSHA IVF CENTRE,
MATA CHANAN DEVI HOSPITAL