Effective contraception and the social trend of delaying childbirth till late 30s or even 40s find many women subfertile by the time they intend to start a family. A significant percentage of women are at a risk of experiencing an accelerated decline of their reproductive potential towards their late 30s. Natural fertility is known to decline with age. Normal women experience their peak fertility in their early 20s. Utilising the advances in assisted reproduction technologies, physicians are now able to achieve conception in many couples who would have been incapable of doing so a few decades ago.
A woman’s reproductive age, once a dictate of nature, has now been artificially extended. The reported success of egg donation to older women makes pregnancy feasible in virtually any woman with a normal uterus, regardless of her age or absence of ovaries and ovarian function. With improved standard of living and increase in lifespan, a woman who becomes a mother at 50 can raise a child for much longer than was true before.
Rapid advances in technology have made oocyte cryopreservation or egg freezing a safe and effective procedure. Cryopreservation of eggs and ovarian tissue prior to chemotherapy for cancer or autoimmune conditions is now extended to women with a genetic predisposition for premature ovarian failure and age-related fertility decline. This shift in fertility preservation from medical to non-medical reasons 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 that 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 egg freezing is important. The best time would be their early 30s. After age 35, there is a rapid decline in the quality of eggs, leading to low fertilisation and implantation rates.
Pregnancy complications in older women
Some of the common risk factors are increased propensity for hypertension, gestational diabetes, preterm delivery, cardiovascular complications, risks related to multiple pregnancy and operative delivery.
However, a study published in the Journal of American Medical Association found that postmenopausal women, aged 50 and older, have success rates similar to those of younger women when they become pregnant through egg or embryo donation. Though the study did note a greater risk of complications during pregnancy, it 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.
Medical, psychological and ethical factors weigh heavily in the decision to have a child at any age. Assisted reproduction technologies have created choices for everyone. Proper selection of cases should be made after considering the woman’s health, medical and genetic risks and provision for childbearing. Post menopausal women should be aware of their weaning fertility and counselled about the realistic chances of success with each treatment option.
Dr Rao is medical director, Milann-The Fertility Center, Bengaluru.