Fertility for women over 40 years
As a women get older, getting pregnant gets harder. Women were not designed to start bearing children in their late 30s and early 40s but rather to start having children as soon as they enter puberty. As soon as they enter puberty and into their 20s, women are very fertile and it hardly takes a few attempts before they are pregnant. But times have changed. Some women do not even get married in their 20s but rather wait till they are nearing 30.
Today many couples plan their lives with a timeline. Careers get preference and accumulation of assets is a priority. Family planning takes a back seat. The theory that most people follow now is about securing themselves financially before they have a child. That way they can give the child all the material luxuries that they were probably not able to enjoy at a younger age.
The concept of delayed parenthood is a western-notion but is now gaining ground in India as well. The only difference is that in the western culture having children is not a compulsion. In India it is a duty for every couple to produce the next generation. And the older family members ensure that they do not wait too long. Very few couples have been able to get away with not having children. The family pressure is so strong, that couples cannot go beyond delaying the process.
However, when you push things too far there is always a consequence that one has to bear. As a woman crosses 40 she experiences many changes in her life. It is more serious than turning thirty. If your 30th birthday got you depressed, then gear up for the 40s, it comes with a fair share of hurdles and adjustments. Your eyesight suddenly begins to weaken. You don’t havethe energy that you once used to have. You feel that your body is failing you. You become susceptible to medical conditions such as blood pressure, diabetes and heart problems. Your hair begins to grey at a more rapid pace. And to top it all your fertility reduces while your libido increases. But the desire for a baby is stronger now than ever before.
The age for having a first child is slowing increasing. More couples are pushing past the 35 mark before they start a family. The number of women who are planning their first child after 45 has also significantly increased over the last decade. Age does not appear to be a barrier for parenthood any longer. Older couples do not think twice when they decide to have a child past their prime.
Delayed parenthood brings with it a myriad of issues. These are due to the increased maternal ages and the ticking biological clock. Once you hit 40 you are not sure how much longer you have before menopause begins. The wrinkles begin to show as an age reminder and you are not sure if you have much time leftto have a child.
The first step at this stage is to get a thorough medical check-up to ensure that you are still fertile. If you have maintained a healthy lifestyle the probability of your fertility being intact is higher. If you are overweight and have indulged yourself more than you should have, then it is time to get your health in order with a strict health diet and an exercise program.
Getting pregnant naturally at 40
Many women are keen to know what their chances are of conceiving naturally once they have crossed 40. Between the ages of 40 to 45 you have a 20% chance of being able to conceive naturally. If you are generally in good health and have a healthy diet and routine it increases your chances of getting pregnant naturally. Once you cross 45 your chances of a natural conception does reduce, however it is still possible so don’t lose heart. It may take a little longer but it can happen if your fertility is in order.
The only drawback of trying to get pregnant naturally after 40 is that it takes a while. So if you have been trying for about a year and have not been successful it is advisable to visit a fertility consultant. After 40 each day matters. You can't afford the luxury of trying to get pregnant naturally for several years. If it hasn’t happened in a year, then maybe you should opt for some kind of fertility assistance or a fertility treatment program.
Reduced Ovarian Reserve
A woman’s body does not produce eggs. She is born with a fixed number of eggs which will serve her fertility throughout her life. Usually a woman is born with approximately 2 million eggs which are stored in her two ovaries.
A woman fertility cycle begins when she enters puberty. However, it is interesting to note that she has lost almost half the number of eggs by this age. Nonetheless, what she has left is sufficient for her fertile years. Nature has its own way. We may not be able to understand it or do anything about it, so we just have to accept it the way it is.
With the onset of puberty begins the ovulation cycle. Approximately 5 eggs are used up during each cycle. Of these 5 only one egg matures fully and is ready for fertilisation. By the time a woman enters her 40’s she has already run through 25 of her fertile years. This is more than half and she has just about 15 years or less of fertile years left. During these years she has exhausted a large portion of the eggs in her ovaries, which is known as her ovarian reserve. The eggs that are left are of a poorer quality as the good ones get used up first.
The eggs are encased in sac like structures called follicles. Hence the ovaries are filled with follicles. Because the eggs are very small and securely inside the follicles they are not visible through an ultrasound or any other internal viewing technique. Though an ovary may have many follicles it is not definitive that every follicle contains an egg.
There are several tests that are used to try and determine the remaining ovarian reserve. None of these tests are 100% accurate but they give the doctor a rough idea of the decline in the ovarian reserve and how many eggs could still be present in the ovaries.
For pregnancy after 40 it is important for the doctors to know how many eggs there are in the ovaries. When they carry out the ovarian stimulation process they can regulate the medication according to the ovarian reserve.
Poor quality eggs
Once a woman is over 40 years the quality of her eggs deteriorates. Doctors try and ascertain the quality of eggs by checking the ovarian reserve. They believe that when the ovarian reserve is low the quality of the remaining eggs will be poor. If the patient has a higher ovarian reserve she has a probability of better quality eggs being present in her ovaries. This assumption for egg quality is not 100% accurate but it presents an idea of what to expect for the doctors. They can prepare for fertility treatment accordingly.
One may wonder what quality of eggs has to do with fertility. Poor quality eggs are basically weak eggs. An egg that is weak may not fertilise. A weak egg that does fertilise becomes into a weak embryo. The probability of a weak embryo surviving beyond a few days is highly improbable. For a successful pregnancy a woman needs to have at least a few good quality eggs.
Egg quality is not totally dependant on ovarian reserve and the general overall health and wellbeing of the woman has a great influence. If a woman has lived a healthy life there is a good chance that she will have healthy eggs even though she is over 40. On the other hand a young woman in her twenties who has abused her body with alcohol, cigarettes, drugs and other abusive substances may suffer from very poor quality eggs even though she will have a good ovarian reserve due to her young age.
Risk of chromosomal abnormalities
An older woman faces a high risk of having eggs with structural problems. This means that the eggs have a defect with the way they are formed and will also have chromosomal abnormalities. These eggs may not fertilise easily. If they do fertilise the survival rate is low and would result in a miscarriage. In the event that it does develop into a baby there is a risk of the baby suffering from some birth defects which could be developmental, physical or mental.
Neha is 48 years old and has 3 children who are in their teens. Recently she and her husband decided that they wanted to have another child. They had been trying to get pregnant for over two years but were unsuccessful. Neha is physically fit and follows a disciplined and healthy lifestyle. She felt that she would be able to conceive easily but that had not happened so far. She consulted with her gynaecologist, who suggested that she should try IVF treatment.At the fertility clinic they did a test to check her ovarian reserve. Her ovarian reserve test results showed that she had more follicles than the average expected amount at her age. The doctors took this as a positive sign and began treatment.
12 mature eggs were retrieved from her ovaries during the egg retrieval procedure. Only 4 of these eggs fertilised successfully even though the doctor used the ICSItechnique. This came as quite a bit of a surprise as the doctors were expecting a more positive response.Three of the eggs matured to blastocysts. A Pre-implantation genetic diagnostic test revealed that all three embryos had chromosomal abnormalities. Hence the doctor advised against using any of these embryos for the IVF procedure. After a thorough investigation of her case the doctors concluded that even though her ovarian reserve was better than normal the quality of here eggs were very poor and they suffered from structural problems. This was the reason that only 4 eggs fertilised. Neha was then advised to use donor eggs to conceive. In an alternate case Arati was able to successfully conceive and have twins at the age of 46. Arati has a lower ovarian reserve than Neha. Both women were being treated by the same doctor at the same time.
Tips to improve fertility
It is never too late to conceive and 40 is just a number. If you are up for it then here are some tips that can help to boost your fertility and improve your chances of getting pregnant irrespective of the fact that you have crossed 40. Women who are in the peak of health will find it easier to get pregnant and some might even be able to get pregnant naturally without any medical intervention.
As women get older the chances of having a miscarriage increases. The rate of live birth is also reduced for older mothers. To avert all these problems it is important to be healthy and fit. This might take need some changes to your current lifestyle.
Relax: The most important advice for women over 40 who want to get pregnant is to start taking it easy. Till now you have been focused on your career and meeting financial goals in life. You have got used to living a life that is target bound and goal oriented. Pregnancy has a different technique. It is about slowing down and destressing. It is about rest rather than utilising every moment of your time productively.
Right Food: There is no substitute for a wholesome, healthy and nutritious diet.Food plays an important role in our lives. We get the best nutrition from natural foods rather than supplements. Nothing can replace a healthy diet. Cut out caffeine, cold drinks, alcohol, fast foods and processed foods from your diet and fuel up on the good healthy foods like fruits and vegetables. Fish and seafood is exceptionally good for fertility.
Exercise: Technology has made us lazy. We no longer walk to the store, we drive short distances. We use the phone to ask someone something rather than walking to their desk. We order stuff online instead taking the effort to go physically to get it. You need to introduce some physical activity into your life. Go for a daily walk. For more interesting activity join a dance class, yoga class or light aerobics classes few times a week.
Lose weight: If you are overweight you need to lose weight to get pregnant. This does not mean that you go on a strict diet or start a vigorous gym schedule. Your body may not take too kindly to that. Reduce the portion of your meals gradually. Eliminate mid meal snacking. Get physically active at your work place. Get up from your seat and take a walk around the office every hour. This will also increase your productivity and blood flow.
Redesigning your lifestyle takes some effort but when it is for your own good it is worth it. This will also increase your energy levels and boost your overall performance. You will become more agile and even feel younger and active.
Fertility Treatment options
Today getting pregnant at 40 or later is easy with the number of fertility treatment options available. Some of the more popular fertility treatments for couples where the female partner is over 40 are:
Intra Uterine Insemination (IUI): This treatment is popularly known as artificial insemination. The male partner’s sperm is treated and only the healthy and active sperm are selected for the IUI procedure. Once the sperm is ready it is injected into the female partner’s uterus in a simple non-invasive procedure. The IUI procedure is relatively painless and very quick. Many women prefer this treatment however it does not have a very high success rate and works only for some cases. It is also a one of the cheapest fertility treatments available, which adds to its popularity.
In Vitro Fertilisation (IVF): Most fertility treatment centres recommend IVF treatment to their patients as this is the most successful fertility treatment so far. In this treatment the female eggsare extracted from the ovaries when they are mature. These eggs are fertilised in the lab with the male partner’s sperm. Once the embryos are a few days old they are placed in the mother’s uterus through the IVF procedure.
Intracytoplasmic Sperm Injection (ICSI): This is a relatively new technique which is focused on successful fertilisation of the egg. In the ICSI procedure one healthy and good looking sperm is selected and injected directly into the female partner’s egg. Fertilisation of the egg will then take place naturally as nature intended. The ICSI procedure eliminates the short comings of the sperms not being able to penetrate the egg which has been known to prevent fertilisation in the past.The ICSI technique has an 80% successful fertilisation rate. Once the egg is fertilised and the embryo is formed, it is kept in the incubator for a few days and then transferred to the mother’s uterus.
Patient says, “At 44 years of age my husband and I visited Medicover Fertility Clinic with the hope of having a baby. Two previous tries at different hospitals had failed and we were quite disheartened. But at Medicover Clinic it was a totally different experience. We were so pleased to get a positive response from our fertility consultant. The first egg aspiration procedure didn’t go so well and very few eggs were retrieved. The doctor told us not to worry and put me on medication and a strict diet before the next ovarian stimulation treatment. This time the egg retrieval procedure was a success. We had some blastocysts frozen for future use as advised by the doctor. The first and second cycle did not succeed and on my third cycle I was pregnant with monozygotic twins. Since the doctor had prepared us that the first few attempts may not be successful we were not discouraged but excited for the consecutive embryo transfer during the next ovulation cycle. It was a brilliant idea to have the embryos frozen as it made the subsequent procedures so easy for us.”
These are the other fertility treatments that some doctors may suggest for women over 40 who are keen to become a mother. But these are proven to be the most successful so far.
Motherhood does not have to be limited to the younger women only. With Assisted Reproductive Techniques many older women are able to successfully conceive and have babies. Delayed parenthood is a more enjoyable experience.
Fertility Treatment at Medicover
Medicover Fertility Clinic is a reputed fertility clinic in North India and specialises in helping older mothers with their family planning. Each couple that steps into Medicover steps out with a baby plan. This is a detailed analysis of the fertility condition of both partners and the suggested treatment options.
At Medicover couple can be sure of the best quality of treatment under the care of specialised in-house doctors and medical staff. Medicover has a number of well-equipped facilities in and around the National Capital Region and Delhi. It thrives on providing personalised patient care. Each patent is special and has different requirements.
Medicover specialises in advanced fertility treatment techniques which ensures a better success rate. They have the latest technology equipment and infrastructure to help more infertile couples become parents.
Q: I am 44 and we are very keen to have a baby. What is the best option for us?
A: At this age you should visit a fertility clinic and opt for IVF treatment without further delay.
Q: I am 38. The doctors have said that I have a low ovarian reserve. What does this mean? Can I still have children?
A: This means that the quantity of eggs that you have in your ovaries are less. Women who have a reduced ovarian reserve also suffer from poor quality eggs. This will make pregnancy difficult. You could try IVF treatment with your own eggs. If that fails then consider donor eggs.
Q: I have been trying to get pregnant for last 4 years without any success. Now I am 41. What should I do?
A: There could be a number of reasons why you are not getting pregnant. You could be suffering from some kind of infertility problem. Visit a fertility consultant and get a thorough medical check-up to determine your cause of infertility before proceeding for any fertility treatment.
Q: Can a good diet help to improve my ovarian reserve?
A: Your ovarian reserve is determined at birth. Once it is depleted you cannot restore it. You can however opt for donor eggs.
Q: Can I get pregnant naturally at 43?
A: Yes you can have a natural pregnancy if you are physically healthy.However if you are not successful after a year it is advisable to get fertility assistance rather than delaying any further.
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07 January, 2018
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