Assisted Reproductive Technology For Older Women

OVERVIEW

Effective contraception, career compulsions and late marriages has led to the social trend of delaying child birth till late thirties or even forties. This often leaves many women finding themselves subfertile towards the time that they intend starting a family. Women are born with a finite number of eggs which continuously reduces as the years go by. Natural fertility is generally known to decline with maternal age. A significant percentage of women in the general population are at risk of experiencing an accelerated decline of their reproductive potential towards late thirties and early forties.

However assisted reproductive technology has advanced by leaps and bounds, so much so that physicians are now able to achieve conception in many couples who would have been incapable of doing so a few decades ago.

HOW DO YOU PREPARE

If you are already 40 years of age and have only now decided to plan for a family it is best you contact a fertility specialist at the earliest to check your reproductive potential. The Fertility Specialist will most probably do a few blood investigations to check for hormone levels as well as an Ultrasound scan to check for the follicle count. Based on these results your doctor will advise if you can try naturally for a couple of cycles or whether it would be advisable to start treatment immediately.

Certain lifestyle and dietary adjustments can improve the chances of conception through IVF. A balanced diet with plenty of protein and healthy carbohydrates and fats can support fertility. Quitting smoking, reducing alcohol & caffeine intake and increasing consumption of fruits and vegetables can enhance the overall quality of eggs. It is also advisable to start a prenatal vitamin to boost your folic acid levels. Coenzyme Q 10, DHEA, Vitamin D and Omega 3 are some other supplements which may be advised.

TREATMENT OPTIONS

Assisted Reproductive Technology:

Once you have decided to start treatment your fertility doctor will most probably advise IVF or more likely IVF-ICSI. This is a process in which you will be given hormonal injections to enhance egg production while simultaneously monitoring the growth of ovarian follicles through ultrasound to titrate the dose of hormones. Starting from Day 2 of your menstrual cycle you will be monitored until you are ready for your eggs to be retrieved. This could be anytime between the 12th to 15th day of your cycle. On the day of egg retrieval your spouse or partner will be asked to provide a semen sample ICSI is a procedure by which a single sperm is injected into a single egg to form an embryo. Depending on the number of embryos that you get, your doctor may decide to do a fresh embryo transfer or freeze the embryos and do a frozen embryo transfer in subsequent treatment cycles.

Oocyte Cryopreservation:

Rapid advances in technology have made oocyte cryopreservation a safe and effective procedure. Oocyte and ovarian tissue cryopreservation mainly centered around fertility preservation prior to chemotherapy for oncological /autoimmune conditions and is now extended to women with genetic predisposition for premature ovarian failure and age-related fertility decline. This shift in fertility preservation from medical to nonmedical indication has been a topic of debate.

The age at which women choose to start a family is steadily increasing as more and more women find it important to complete their education, pursue a career which makes them economically independent and have a stable relationship before embarking on motherhood. Social oocyte freezing is seen as a welcome change, as it is offering women more “reproductive freedom”, so much so that IT companies are encouraging women employees to avail these facilities.

The age at which a woman decides to go in for cryopreservation of oocytes is important. The best time would be in their early thirties. After 35yrs of age there is a rapid decline in the quality of oocytes leading to low fertilization and implantation rates.

Oocyte Donation:

A woman’s reproductive age, once a dictate of nature, has now been artificially extended. The reported success of oocyte donation to older women makes pregnancy feasible in virtually any woman with a normal uterus, regardless of the age or absence of ovaries and ovarian function. With many of their career responsibilities behind them, older parents often have more time available to devote to raising their children. With the improved standard of living and increase in life span, a woman who becomes a mother at 50 could raise a child for much longer than was true before.

Egg donation is one of the newest forms of family building and many of these couples are able to conceive a child who is genetically related to one of them. The intended parents can attempt to achieve a pregnancy using the male partner’s sperm and eggs provided by an oocyte donor.

RISKS INVOLVED

Pregnancy complications in older women

It is important to pay attention to pregnancy complications in older women. Some of the common risk factors are increased propensity to develop hypertension, gestational diabetes, preterm delivery, cardiovascular complications, risks related to multiple pregnancy and operative delivery.

However, in a study published in the Journal of American Medical Association researchers concluded that postmenopausal women aged 50 and older have success rates similar to those of younger women when they become pregnant through oocyte/embryo donation. Though the study did note a greater risk of complications during pregnancy than their younger counterparts they concluded that there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.

With new horizons arising in assisted reproduction in the field of oocyte cryopreservation, any woman can arrange to preserve her gametes for future use even after menopause.

Medical, psychological and ethical factors weigh heavily in the decision to have a child at any age. Assisted reproduction technologies have created choices for every one. Proper selection of cases should be made after considering the woman’s health, medical and genetic risks and provision for child bearing. Post menopausal women should be aware of their weaning fertility potential and counselled about the realistic chances of success with each of the possible treatment options.

If you have any further queries, please reach us at info@milann.co.in or to schedule an appointment with one of our doctors, call us at +91-9513310580. We would be happy to be of assistance.