Age is a crucial factor that affects fertility and reproductive health for men and women. Women who delay conception past their mid-30s experience a decline in fertility and an increased risk of pregnancy complications. Men also experience a decline in fertility with age, leading to sperm chromosome abnormalities and semen analysis issues. The age of both partners should be considered when planning to conceive, as pregnancy after 40 is associated with higher rates of complications. Reproductive health is greatly influenced by age, and it's essential to seek medical advice and understand the potential risks associated with age when planning to conceive.
The optimal age for conception and successful pregnancy for women is between 20 and 24 when reproductive health is at its peak. As women age, egg quality and quantity decrease, resulting in risk of miscarriage, premature birth, and chromosomal abnormalities increase.
Men's reproductive health is also affected by age, as lifestyle factors such as smoking, drinking, and consuming drug can impact sperm quality and the chances of conception. For women over 35, fertility treatments such as ovulation induction or assisted reproductive technology (ART) may be necessary.
According to the American Society for Reproductive Medicine, a healthy 30-year-old woman has a 20% chance of getting pregnant each month, while a healthy 40-year-old woman has only a 5% chance. The chance of having a baby with a chromosomal abnormality, such as Down syndrome, also increases with age. At age 25, the risk is 1 in 1,250; at age 30, it’s 1 in 1,000; at age 35, it’s 1 in 400; at age 40, it’s 1 in 100; and at age 45, it’s 1 in 30.
A comparison of fertility rates between younger and older individuals shows that the rates tend to decrease with increasing age. This is supported by demographic and epidemiological studies, which consistently found that decline in fertility begins as early as the middle of the third decade (Figure 1) (Menken et al., 1986; Leridon, 2004). This decline in fecundity is attributed to several factors, such as germ cells not being replenished during life, attrition and utilization of follicles leading to a decrease in the number of oocytes, reduced oocyte quality with age, and a decrease in intercourse frequency with age. Laboratory and dynamic tests have been introduced to evaluate whether chronological ageing or an independent course of ovarian ageing is the dominant factor in a woman and whether declining fecundity might be advanced or retarded in some women.
While age can significantly impact one's fertility and ability to conceive, modern medical science has made it possible for individuals to delay parenthood without compromising their lifestyle. Cryo-preservation of eggs and sperm, egg freezing, and IVF are among the available options that have proven successful in enabling individuals to become parents despite delaying their family planning. It's important to seek advice from a qualified fertility specialist to determine the best plan of action. Age should not limit one's life choices, and with the help of medical advancements, individuals can achieve their family planning goals at a time that is right for them.
What are the causes of decreased fertility with age?
1. Diminished egg quality
As women age, their fertility decreases due to the decrease in egg quality. Women in their mid-to-late 30s are more likely to experience aneuploidy, which is the presence of very few or too many chromosomes in the egg, resulting in a lower chance of pregnancy and a higher chance of miscarriage. This is why it is difficult for women to get pregnant at an older age, when the egg quality is poor.
2. Decreased egg quantity
The ageing of a woman's eggs is a major cause for decline in fertility that is associated with her age. Ovarian ageing leads to a decrease in both the quantity and quality of eggs, thus decreasing a woman's fecundity. Ovarian endocrine function declines more gradually than reproductive function; this together with aneuploidy, which is an increased number of chromosomes in the egg, are the key causes of decreased egg quantity associated with age.
3. Increased risk of hormonal imbalances
As women age, the risk of hormonal imbalances increases due to the decrease in the quality and quantity of eggs, as well leading to hormonal changes. Endometriosis, PCOS, gestational diabetes, placenta previa and high blood pressure during pregnancy may also increase the risk of hormonal imbalances. Men's increased age at the time of conception may also pose health risks for children born.
4. Impaired ovarian function
Impaired ovarian function is a decline in egg quality and quantity due to gradual ovary ageing, resulting in decreased fertility and increased time to pregnancy. This decline is caused by a decrease in follicle numbers, endocrine dysfunction, aneuploidy and a decline in semen parameters. ART can help compensate for some fertility losses; however, research is needed to gain a better understanding of the molecular mechanisms and to identify accurate markers of ovarian ageing to predict treatment outcomes.
5. Increased risk of birth defects and genetic disorders
With increasing age, the risk of birth defects and genetic disorders increases. The risk of having a baby with a chromosomal abnormality is estimated to be higher for older women than for younger ones. Other risks include mental health problems, higher rates of miscarriage, pregnancy complications, and childhood cancer. Fertility may be reduced due to genetic conditions such as endometriosis and polycystic ovary syndrome. A maternal polymorphism for an enzyme involved in folic acid metabolism has also been linked to Down syndrome.
6. Increased risk of ovarian cysts and tumours
As women age, their risk of developing ovarian cysts and tumours increases due to folliculogenesis, a process in which a finite number of primordial follicles are recruited from a pool of resting follicles for further growth. Gonadotrophin levels rise to a concentrated state at puberty, resulting in ovarian cysts and tumours as the endometrium is shed in response to progesterone fall. This is further influenced by the density of follicles in the ovary and the length of the menstrual cycle.
How to fix the link between fertility and age?
1. Fertility assessment
Fertility assessments can provide couples and individuals with necessary information to understand their fertility status and associated risks. Tests such as ovulation detection, hormone levels, and ovarian reserve can help gain a better understanding. Additionally, online resources like FertiSTAT, the IVF Success Estimator, and the RLP website provide timely assistance. With this knowledge, couples and individuals can understand the risks associated with age and make informed decisions.
2. Fertility treatment
Fertility treatments help people struggling to conceive due to age-related issues. Hormone therapy, IVF, ICSI, artificial insemination, and oocyte cryopreservation may increase the chances of successful conception. While no medical technique can guarantee success, these treatments can help to improve the chance of successful pregnancy.
3. Ovarian Reserve Testing
Ovarian reserve testing helps assess a woman's fertility by providing an evaluation of her egg quality and quantity, based on her age and risk factors. By testing blood FSH on the 3rd day of the menstrual cycle, it is possible to determine the percentage of ovarian reserve remaining at different ages. On average, women have 12% of their reserve at age 30 and only 3% at age 40. Ovarian reserve tests can also indicate the rate of follicle depletion, which can give insight into when a woman may experience infertility. These tests can also help identify if a woman has reduced ovarian reserve, even if she has no known risk factors.
4. Sperm Quality Testing
Sperm quality testing can help identify any age-related issues that may be affecting fertility. With age, the quantity and quality of sperm decrease, leading to decreased fertility. Testing can detect changes in sperm morphology, motility, and count that may indicate a fertility issue due to age. Early detection of any issues can help men take steps to improve their fertility, as well as provide them and their partners with vital information to make informed decisions about their fertility options.
5. Egg Freezing
Egg freezing allows women to postpone pregnancy, countering the age-related decline in egg quality. It provides increased chances of future pregnancy, potentially without needing a male partner, and peace of mind to pursue goals. Although chances of conceiving is low with frozen eggs for women at the end of their reproductive life span, yet it gives an opportunity to achieve the potential family goal.
6. Cryo-preservation
Cryo-preservation is a method of fertility preservation that enables women to delay childbearing. Embryo freezing is a well-established and successful technique that requires a male partner or donor sperm. Egg freezing is a newer technology that has potential, but outcomes of assisted reproductive technology cycles using frozen eggs decrease as the woman's age increases. Cryo-preservation allows women to freeze and store viable eggs or embryos until they are ready to use them, thereby preserving their fertility for later use.
When to Seek Help?
When it comes to fertility care, there are certain circumstances when it is appropriate to seek help from a fertility specialist. For those under age 35, it is advised to see a doctor if you are not pregnant after one year of trying to conceive with well-timed intercourse. For those over the age of 35, it is recommended to see a doctor after six months of trying to get pregnant, and for those in their 40s experiencing difficulties, it is recommended to seek an assessment immediately. Additionally, even if you are still within the recommended timeline, if you suspect there may be an issue, it is always a good idea to seek insight rather sooner than later.
Signs of infertility and fertility issues may include irregular or infrequent periods, heavy periods, painful periods, pelvic pain, and pain with intercourse. Other signs to look out for include abnormal hormone levels, thyroid issues, and abnormal morphology and motility of sperm. Age can also be a factor in infertility, though there may not be any outward symptoms.
Fertility tests and treatments may include blood tests, sperm tests, checks for sexually transmitted infections, an ultrasound, hormone therapy, IVF and variations such as intracytoplasmic sperm injection (ICSI), and artificial insemination. Seeking fertility care can help you to understand available options and receive support as you go through the emotional rollercoaster of infertility.
Tests and procedures for diagnosing fertility
Lab Test
Lab tests are used to evaluate hormone levels and check ovarian reserve. These may include blood and urine tests to measure progesterone levels to check if ovulation has occurred, as well as testing for the hormone prolactin, thyroid function, and sexually transmitted infections.
Imaging Test
Imaging tests may include hysterosalpingography (HSG) which is an x-ray procedure to determine if the fallopian tubes are open and to assess the shape of the uterine cavity, transvaginal ultrasonography which is an ultrasound to check the uterus and ovaries for the presence of fibroids or ovarian cysts, and sonohysterography which is an ultrasound after filling the uterus with a sterile fluid to detect abnormalities such as polyps, fibroids and scar tissue.
Age is an important factor to consider when it comes to fertility and family planning. However, it should not be a limiting factor in achieving one's reproductive goals. Proactive steps can be taken to preserve fertility and increase the chances of successful conception.
Milann is a renowned fertility clinic that offers a range of advanced and specialized services to address infertility issues. With state-of-the-art technology and a team of experienced specialists, Milann provides personalized care and treatment options tailored to individual needs. In addition to in-vitro fertilization (IVF) and intrauterine insemination (IUI), Milann also offers cryo-preservation options for preserving fertility. By freezing eggs or sperm, individuals can increase their chances of conception in the future, regardless of their age. With Milann's expertise and cutting-edge technology, individuals can take proactive steps to preserve their reproductive health and achieve their family goals.
