Age and Fertility issues with women.
Miss A walks in to my clinic. She looks very anxious. She is working as a CEO in reputed marketing firm. Shestill has not found the right man and she wants a baby of her own.She wants to know how much time is left for her to start her family. She is 39 years of age.
I look at her and tell her that there is not much time leftand perhaps its already too late. She looks at me perplexed, a little annoyed. How can I give such a heavy statement without even checking her, doing some tests. I explained…….
A girl is born with a fixed number of eggs. She does not create eggs every month. Her body only matures the existing eggs. The maturation process starts when she reaches her menarche between 12-15 yrs of age. Every month her body recruits few eggs from existing pool and finally matures one egg every monthly periodic cycle.
She is at her peak fertility in her early 20s and stays so in that decade. From the beginning of the thirty’s the egg pool starts dwindling in number and quality. This reduction is rapid after the age of 35 and dramatic after 35 years of age. The lady will still continue to menstruate till she is menopausal that is between the age of 45-50 yrs of age. However the chance that she will conceive in the last 10 yrs of her reproductive life(40-50 yrs) is sometimes negligible.
She looked at me as though I was churning out an unbelievable story. What about her aunt who had her 3rd child at 42 yrs? And her grandmother who had 7th child at the same age? What about those filmstars who think of planning a baby only after 36-37yrs?
I smiled. I told her it is all true. However if we compare the percentage of women getting pregnant b/w 20-30 yrs, 30-40 yrs and beyond that, the numbers steadily reduce. Yes, there is lot of publicity about famous film stars conceiving after 40 yrs, we are however not aware of what infertility treatment was adopted.
The bottom line is ,it is difficult, not impossible, so why wait? Why not give your body the chance when its ready and its very easy.?
But what about her problem that she has not found anybody yet. I told her we will do some tests, ultra-sound, hormonal evaluation and check her ovarian reserve. There are lot of tests that can guide us as to whether a woman still has a reasonable chance to conceive. These are Anti-Mullerien hormone (AMH), Follicle stimulating hormone (FSH), and Estradiol. These are the blood tests. A simple ultrasound which checks the Ovarian Volume and Follicle Count (Antral Follicle Count, AFC) can also guide us.
God has made men and women differently. Men are fertile till 70 years and even beyond .However the women’s reproductive life ends much before she attains menopause which is around 45 when she is at her peak of personal and professional life. Many women after this age do get pregnant through assisted conception mostly using donor eggs. Science is striving hard to help women to achieve their own genetic child at the time they wish to. Till date it seems a little far away.
My recommendation to Ms. A was to start trying straight away. She needed my advice and married soon. Luckily,today she is a mother of a charming 1 year old daughter!
Dr Kaberi Banerjee
Infertility and IVF expert
MBBS, MD (AIIMS), MRCOG (London)
Commonwealth Fellow in Reproductive Medicine (London)
C-453, Ground Floor,
CR Park, New Delhi 110019