By Evelyn Minaya, MD, OB/GYN Vice President of Women Caring for Women
As women, we face challenges every day, whether it is at work, home or in our personal relationships. It is especially difficult when we talk about the challenges women face when having a baby. Not only can a woman face difficulties in becoming pregnant, but complications can also arise in terms of keeping the pregnancy and giving birth. Presented here is some purely factual information about fertility and age.
Women are born with approximately 2,000,000 to 5,000,000 eggs in each ovary. By the time you get your first period, you have depleted your egg count by 250,000 in each ovary. That’s still a lot of eggs! The eggs are all “suspended” in time in meiosis (this is the a stage of cell division). An egg will remain this way until it is fertilized by sperm and then completes the division process.
The problem at the time of conception begins with division. The older the cell is, the greater chance it has of making mistakes at the time division is completed. For example, trisomy 21 (which is Down’s syndrome) happens most commonly because the genetic material does not divide properly and it gives you three copies of the number 21 chromosome when it should be only two.
The risk of Down’s syndrome and other chromosomal abnormalities increases with age. For example, the risk of any genetic abnormality at the age of 25 is 1 in 1100. If the woman is 35, that chance increases to 1 in 250 and by the age of 40, it is 1 in 50. If at the time of conception the woman is 45, the chance of a genetic abnormality is 1 in 25. It is does not matter how healthy we are, age determines the increase in the chromosomal abnormalities, as well as the increase in miscarriages as a consequence of these abnormalities.
Recent data suggests that more mature men also increase the risk of chromosomal abnormalities. For example, men in their 50s married to women younger than 35 are at the same risk as if the woman were 35 or older.
Another major drawback is also the inability to become pregnant to begin with. Although the reasons for infertility are the same for everyone, i.e., endometriosis, scar tissue from previous sexually transmitted diseases, fibroids, etc, age does play a role in the quality of the egg. The egg, at the time of ovulation, needs to produce enough progesterone in order to make the lining good for implantation. If the progesterone level is not sufficient, it could lead to a miscarriage.
Once pregnant, caution has to be taken to maintain the pregnancy. Complications like high blood pressure, pre-eclampsia, diabetes, premature delivery, and small infant size can all be affected by age. The more mature we are, the higher the chance we have for cardiovascular disease that can affect the placenta and, thus, the baby.
It’s not all doom and gloom. Many women have been able to conceive naturally after the age of 40. Being as healthy as possible, not smoking, and having regular checkups with your physician can reduce the medically related problems once you are pregnant.
Having realistic expectations of what can happen and also what cannot happen is a conversation between you and your physician. The more prepared you are, the better you will be able to handle the stresses that come with raising a family.
Our biological clocks are ticking – set your alarms and start working!