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Women are advised to use contraception even when they ’ re well into their 40s to avoid unplanned pregnancies . Not surprisingly , many couples are of the opinion that their chance of conceiving stays the same throughout their reproductive life , notwithstanding the age of the female partner . That ’ s a myth . Women ’ s fertility drops significantly after the age of 35 . All too often , men and women take fertility as a given and do not anticipate struggling with infertility as a possibility . Our social structure , cultural beliefs and familial values have groomed us into a false sense of security where fertility is concerned .

Women are born with a finite number of eggs , which cannot be replenished . With advancing female age , there ’ s a rapid decline in not only the quantity of eggs , but also their quality . As this remaining pool of eggs shrinks , the number of genetically abnormal eggs will begin to outnumber normal eggs , leading to a lower chance of conception either naturally or via advanced fertility treatment . This shift starts to occur from the mid-30s . And if pregnancy does ensue , an older woman tends to have a higher risk of miscarriage due to a higher likelihood of a chromosomally abnormal conception .

Couples are delaying having children to settle into a stable relationship , pursue education , gain financial independence and achieve job security . This upward shift in ages of couples attempting parenthood , towards the tail-end of their 20s or in their early 30s , is a phenomenon that ’ s seen worldwide . There are also more women in their �0s becoming first time mothers now than there were in our mother ’ s time . Couples need to be aware that , barring egg donation or adoption , there is no other alternative for the age related decline of a woman ’ s fertility .

With more people going through fertility treatment to conceive these days , in all likelihood , most people know of someone who has needed assisted reproductive technology ( ART ) to have babies . People are aware of the concept of infertility and that aging reduces fertility . However , there is a lack of awareness of the actual cut-off when female age starts to become a major hurdle in childbearing , and a widespread misconception that ART can overcome the age related decline in fertility by a large margin .

Lower fecundity can occur in primary infertility ( pregnancy naïve women ) and secondary infertility ( women who ’ ve had previous pregnancies ). So , simply assuming that a successful previous pregnancy is a guarantee and testament of future fertility is another common misconception . Advanced maternal age at first birth also leads to a narrower window for second and subsequent children , since the single most important determinant of a successful pregnancy , be it naturally or following fertility treatment , is the woman ’ s age . Older women also have a significantly higher risk of pregnancy complications such as diabetes , hypertension , premature labour and stillbirths .

As depressing as this may sound , couples need to be aware that , the older they are during childbirth , there ’ s a possibility that they may not be around to see their offspring graduate or marry or have children of their own . Having said that , it has to be emphasised that infertility is a problem that can occur at any age . Postponing childbearing until the late 30s or early 40s can even lead to permanent childlessness or a smaller than planned family size , attributed to the aforementioned age related fertility decline .

Not forgetting men , increasing paternal age , beyond 45 years has been shown to lead to lower fertility rates , albeit , the effect of increasing paternal age is not as profound as in women . There is however , a trend towards higher miscarriage rates , autism ,

schizophrenia and learning disabilities in children from older men .

Those who are intending to postpone childbearing should take measures to try and protect their fecundity , by avoiding sexually transmitted diseases , quitting smoking , cutting down on alcohol , consuming well balanced diets , exercising and maintaining a healthy body weight .

The silver lining for women who are considering delaying having children or are ambivalent on the prospects of starting a family , is that , they have the option of somewhat safeguarding their fertility by freezing their eggs . Social egg free�ing is an option to stall the effects of aging on female fertility . The younger the woman is at egg freezing , preferably below 35 , the better the quality and quantity of eggs she ’ ll have frozen . And , as for men , especially those who have sperm of diminished quality , they too have the option of freezing and in doing so , preserving sperm for future use .

Couples looking to postpone parenthood might want to consider a fertility assessment so that they have all the relevant information prior to decision making which can help them plan a timeline for their fertility journey . The simplest tests that can be performed are a sperm check for the man and , an egg reserve test as well as an ultrasound scan of her reproductive organs for the woman .

For those who are experiencing issues pertaining to conceiving , the general guide is to seek fertility consultation after 1 year of trying unsuccessfully if the woman is less than 35 years old ; but after 6 months of trying unsuccessfully if the woman is more than 35 years old . However , if there are known pre-existing problems such as irregular menstrual cycles , ovarian cysts or pelvic surgeries , this should prompt an assessment sooner rather than later .

At Sunfert International �ertility Centre , we offer fertility services , from basic assessment to advanced fertility treatment and finally , to fertility preservation for both , men and women .

�all us at ���� ���� ���� or visit www�sunfert�com to �nd out more . Be ‘ Fertility Aware ’.

Dr . Sumithra Devi Valiapan Fertility Consultant , Obstetrician & Gynaecologist Sunfert International Fertility Centre

GlobalHealthAsiaPacific . com SEPTEMBER 2022

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