In this fast track life and daily hustle bustle we often neglect the decision of having a baby basis our biological clock. A lot of women are delaying pregnancies and embracing motherhood in later reproductive years. There are so many reasons for this decision including late marriage, career priorities, education, financial reasons, to be the major ones. As per Dr. Aindri Sanyal, Fertility Consultant at Nova IVF Fertility, Kolkata, a woman’s peak reproductive years are somewhere in between the late teens to late 20s. Upon entering the 30s, fertility begins to decline and by the woman reaches late 30s, her pregnancy becomes challenging. This phenomenon is at least partially responsible for the epidemic of age-related infertility. Know more about advanced maternal age and its effect on maternal health in this article.
What is advanced maternal age?
Any conception post 35 automatically comes under the ‘advanced maternal age’ (AMA) category. However, one should not be overwhelmed only by the label, as successful pregnancy after 35 is still possible with or without assisted reproduction, but usually, it is not advisable as a few complexities might occur while trying to conceive naturally. After a certain age, embracing motherhood may become difficult but it is not impossible. While some women suffer complications in their early 30s, there are many women who have given birth through normal delivery in their 40s also. This basically depends on several factors including menopausal age, present health condition, to name but a few. Keep reading to know more about the chances of getting pregnant as per age, risks of late pregnancy for the mother and child and what are some necessary pointers that you must discuss with your doctor before conception.
What is Assisted Conception and How It Can Aid Late Reproduction?
Career focus, lifestyle shift and late marriages are leading to late pregnancies which has increased the number of women with advanced maternal age (AMA) opting for assisted reproduction. Women should be well aware that there is an age-related complexity to fertility, and it is time-sensitive, including a decline in the number of oocytes, quality and reserve in addition to an increase in the number of oocyte chromosomal aberrations.
As the maternal age advances, the success rate of ART or assisted reproductive technology reduces. Women with advanced maternal age, therefore, have different fertility options. These include embryo freezing, IVF or in-vitro fertilization, embryo donation, etc. However, these methods have their own pros and cons. Women should consider the risks of these conception methods. Besides, they must also undergo medical screening for any underlying condition to ward off the risks post conception. These can cause a strong impact on the maternal health and health of the newborn.
Risks of Late Pregnancy
Any elderly Women who become pregnant at an advanced maternal age are at higher risk of caesarean delivery, gestational diabetes, preeclampsia, and preterm delivery of a baby with a low birth weight of a new-born baby. However, these risks vary widely, depending on the woman’s health status, and increase with maternal age at delivery.
The natural deterioration in female reproductive ability, particularly in AMA, has two primary reasons: either it is progressive depletion of the number of oocytes in the ovary or else a notable decrease in oocyte quality because of age. In this scenario, the most advisable reproductive choices can be Social egg freezing (SEF), Embryo freezing or IVF.
Late pregnancy has a high risk of miscarriage and stillbirth
Amongst all the other possible risks of conceiving late, one of the very common is the risk of stillbirth or miscarriage. Threatened miscarriage may also occur. The risk of stillbirth and miscarriage increases with increasing age. The higher risk is in women aged between 40-44 years. About 33% of women suffer a miscarriage if they get pregnant in this age group. The primary reason for this is that the eggs of older women can cause chromosomal issues in the embryo.
Talking about stillbirth, women who decide to get pregnant in her 40s are at maximum risk of giving birth to a still child. Other than this, they are also highly likely to develop preeclampsia or gestational diabetes which increases the risk of stillbirth in them. The risk is correlated to gestational time. The longer the time, the greater the risk. In order to prevent this risk, the doctor advises planned induction to the couple. Natural labour can increase the risk.
Other Paths to Achieve Successful Conception in AMA
Apart from normal conception, there are many other ways through which a woman in advanced maternal age can embrace motherhood. Fertility consultant Dr. Aindri Sanyal has listed out these methods that can help achieve successful conception in women of advanced maternal age:
- IVF with donor eggs: This process includes achieving pregnancy using hormones. Instead of going for a usual egg retrieval to later fertilize and transfer, women at AMA can opt for an embryo transfer using embryos created with donor eggs that are fertilized with either your partner’s sperm or donor sperm.
- Egg freezing: In case of a planned AMA pregnancy, one might consider opting for freezing their eggs before turning into 35. If you freeze your eggs in your early 30s and plan to use them in your 40s, your odds of having a healthy baby relate to your age when you froze your eggs and not your current biological age.
- Embryo adoption: Whether you choose to do IVF yourself or to use a surrogate, embryo adoption is another favourable option in case of AMA cases. In this scenario, embryos are generally frozen and donated by couples who aren’t using them in their own ART procedures.
There are several risks associated with advanced maternal age where miscarriage and stillbirth are the worst. Doctors suggest that women should either plan their pregnancy before their early 30s or they can opt for egg freezing that would help them in getting pregnant at a later age when they are ready to embrace motherhood. There are many other methods also that can help in conception later while securing maternal health. It is better to consult a gynaecologist before planning your pregnancy to rule out the complications.
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