Nowadays, women are delaying their initial childbirth because of education and career choices. Women are pursuing higher education and reaching new heights in their professional lives, so family planning is delayed. Decline in fertility is an inevitable physiologic process for all women as their age advances. As women age, chances of pregnancy, both natural and after treatment, decline. Therefore, counselling and education of couples on age-related decline in fertility is important. They should understand that this decline in fertility is inevitable. So, they should discuss all the options available with their doctors.
Age-related fertility decline can occur due to several factors. A decrease in egg quantity and quality with advancing age is the main cause. Other factors include reduced frequency of sexual intercourse, an increased risk of complications in pregnancy like diabetes, blood pressure, miscarriage, changes in the ovulation pattern and decline in the health of the uterus.
Unlike males, who continuously produce sperm cells, females are born with a finite number of egg cells. These egg cells, also known as oocytes, mature over time, but no new ones are created throughout a woman's lifespan. The number of eggs peaks when the female is inside her mother's uterus at around 20 weeks of pregnancy (6 to 7 million), and egg count gradually decreases until approximately 32 years of age. After this, the number of oocytes decreases faster until 37 years. There are around 25,000 eggs left in the ovaries at 37 years, which further falls to 1,000 eggs by the age of 51. Therefore, this decline in the number of eggs with age is the primary cause of age-related decline in fertility.
A good quality egg is also important for a successful pregnancy. Egg quality also deteriorates in women with increasing age. As women age, the chances of chromosomal abnormalities in eggs increase. In women younger than 25 years of age, the chances of Down syndrome are approximately 2% as compared to women 35 years or older, when the risk increases to 35%. So, poor egg quality with higher genetic abnormalities leads to higher chances of early miscarriage and infertility in women of advanced age.
Sexual activity also declines with age, which further reduces the chances of pregnancy. In addition, the uterus can have many problems with advancing age that reduce chances of pregnancy and abortions, like fibroids and adenomyosis.
Appropriate counselling of patients should be done so that pregnancy rates increase in women after 30 years, both naturally and using assisted reproductive technology. So, routine counselling should be done before the actual decline or irreversible loss of fertility. Women aged ≥ 30 years of age should be advised to test for ovarian reserve if there is no conception after 6 months of attempting natural pregnancy. This testing can be done early in women with certain risk factors like ovarian cancer, having only 1 ovary, history of ovarian surgery, exposure to chemotherapy or radiation, and unexplained infertility. In case women are found to have decreased ovarian reserve, they can be counselled properly about the most suitable treatment option for them.
Various methods are now available for women to preserve their fertility before it starts declining, even if they want to delay pregnancy. This can be done by freezing eggs or embryos, which are now available worldwide. They can meet their fertility expert and can plan the freezing of their eggs with the help of IVF. This is a boon for all females feeling the pressure of a biological clock. Rather than planning for a child to be under pressure at the wrong time and under the wrong circumstances, they can plan to freeze their eggs. They can use these frozen eggs in future to plan a child.
