- What is advanced maternal age (AMA)
- Why does fertility decrease with age
- The risk associated with AMA
- What can be done to increase the chances of pregnancy in older women
- What are the treatment options for advanced maternal age
- How can medicover fertility help women to conceive in their advanced age
- What is geriatric pregnancy
- What age is high risk to have a baby with genetic problem
- Is advanced maternal age high risk
What is advanced maternal age?
Advanced maternal age (AMA) or advanced reproductive age is a term used to define women who conceive when they are 35 years or older. With advanced age, there is a trend of decreasing fertility, as the quality and quantity of eggs deteriorate. A woman not only finds it difficult to get pregnant, but the chances of miscarriage also increase. And if also she conceives it would be a high-risk pregnancy.
As we know the ‘Reproductive Age’ of a woman starts with her first menstrual cycle at around the age of 12 or 13, and it continues until her last periods, i.e., until the onset of menopause. So, with advancing age, her fecundity (fertility) starts declining, that means she doesn’t remain fertile throughout her life. So, elders in the family always focus on saying that there is a right age to have a baby and the best time period to have a baby is 25 – 35 years.
But nowadays, the concept of delayed parenthood is slowly increasing. More couples are pushing past the 35 years age mark before they start a family. Many women are planning a second pregnancy after 35. The number of women who are planning their first child after 40 has also significantly increased over the last decade. While getting pregnant at 40 has its own risk, but age does not appear to be a barrier to parenthood any longer. Older couples do not think twice when they decide to have a child past their prime. All thanks to advances in fertility treatment like IUI, IVF, ICSI, and they can also opt for egg freezing.
Why does fertility decrease with age?
- Ageing of eggs–With age, the remaining eggs in a woman’s ovary also ages. Aged eggs are exposed to DNA damage, and hence they are not suitable for fertilisation, and if also they fertilise the resulting embryos won’t be able to implant in the uterine lining.
- Gynaecological problems - It is common to find damaged fallopian tubes, uterine fibroids and endometrial polyps in older women which in a way can also affect a woman’s fertility.
- Decrease in libido – With age libido or longing for sexual relations declines. Moreover, the male partner also advances in age and in older men, the sperm quality declines.
Risks associated with advanced maternal age
When a woman has reached advanced maternal age and is thinking to start a family, then the key to a healthy pregnancy, will be to consult a doctor and have a thorough medical check-up, mainly if she has some underlying health conditions (hypertension, diabetes, thyroid problems), because conceiving with health issues will have a direct effect on the developing baby. If one is overweight, then it is time to follow a strict healthy diet and an exercise regime before planning a pregnancy.
Getting pregnant at 40 risks - There are some risks associated when a woman plans her pregnancy at an advanced age, which she needs to be aware of and consider minimising the risk factors. A female is born with a fixed number of eggs, and as she ages the quality and quantity of eggs available significantly decreases, thus reducing fertility. The incidence of medical conditions like diabetes and hypertension also increases, and this, in turn, increases pregnancy complications. The risks associated are:
Chromosomal abnormalities -There is an increased risk of having babies with genetic abnormalities like Down syndrome in advanced age because an older woman faces a high risk of having eggs with structural problems. Which means that the eggs have a defect in the way they are formed. These eggs may not fertilise easily. If even they do fertilise, the survival rate will be low and would result in a miscarriage. If the fertilised egg develops into a baby, then there is a risk of the baby suffering from some congenital disabilities which could be developmental, physical or mental.
Spontaneous abortion/miscarriage -The risk of miscarriage increases as a woman ages, because of the presence of chromosomal abnormalities in the egg. Poor-quality eggs and chronic health conditions together like hypertension, diabetes increases the risk of miscarriage.
Pregnancy complications -With advanced age, the risk for pregnancy complications increases like:
- Ectopic pregnancy – Maternal age increases the risk of developing an ectopic pregnancy.
- Preeclampsia – High blood pressure during pregnancy can lead to a pregnancy complication called preeclampsia, which if not controlled, can lead to multi-organ failure.
- Gestational diabetes – This kind of diabetes only happens during pregnancy. And is characterised by the presence of high blood sugar during pregnancy, and results in the birth of larger than average size babies. After delivery, this condition usually goes on its own.
Stillbirth -Due to pre-existing health conditions and pregnancy complications the risk of stillborn or loss of pregnancy increases in an older woman.
Pre-term delivery -The risk of premature delivery increases in women of older age group. Because with age pregnancy complications increase like high blood pressure, and reduced blood supply to the uterus, thus restricting the growth of the baby. Therefore, early delivery may be required.
Conceiving twins/triplets -The risk of multiple pregnancies increases with age. As the ovarian reserve starts to decrease with age, the body signals the ovaries to release more eggs, so the chances to conceive with twins or more increases.
What can be done to increase the chances of pregnancy in older women?
Advanced maternal age group women find it difficult to conceive or may take a longer time to get pregnant. So, there should be an advanced maternal age pregnancy guideline, where a woman is explained the do’s and don’ts before planning a pregnancy.
Fertility starts declining after the mid-’30s and plummets when a woman reaches 40 years. To increase the chances of pregnancy in older women, we recommend them:
- To lead a healthy lifestyle, reduce stress and start with prenatal vitamins like folic acid and DHEA supplements. DHEA ((Dehydroepiandrosterone) is a hormone that is known to improve the quantity and quality of eggs, thus reducing the chances of miscarriage.
- Counselling the patient on the awareness of the effect of age on fertility is essential.
- A woman who is older than 35 years should receive evaluation and treatment after six months of failed attempts to conceive.
- And in women older than 40 years, immediate evaluation and treatment are needed.
- A pre-conceptioncheck-up is necessary, and during the consultation, a detailed family history of the couple is taken. If during investigations chronic health conditions are found, they should be managed well medically as these can lead to a high-risk pregnancy.
- A woman above the age of 35 should have a genetic counselling to know the risk of having a baby with genetic abnormalities. With advanced maternal age, Down syndrome is the most common birth defect, and a woman’s chance of having a baby with Down syndrome increases with age. At age 35 the risk is 1:350, at age 40 it is 1:100, and at age 45 it is 1:25. So in advanced maternal age mothers, genetic testing should be done to find out the odds of having a pregnancy with any genetic abnormality.
What are the treatment options for advanced maternal age?
Conceiving naturally - Fertility declines with age, but the rate at which it declines increases with age. So, a woman under 30 years have 25% chance of getting pregnant naturally in each cycle, above 30 years the chances come down to 20%, and by 40 years, the possibility of getting pregnant naturally each month comes down to 5%. The only drawback of trying to get pregnant naturally after 40 is that it can take a while, or not happen at all as fertility starts declining at a steady pace. So, if you have been trying for a while and have not been successful, it is advisable to visit a fertility consultant. Because with age, the ovarian reserve reduces, and the quality of eggs also becomes poor, which can lead to infertility.
Conceiving with ART (Assisted Reproductive Techniques) - At an advanced age, each day matters. So, resorting to assisted reproductive techniques may increase the chances of pregnancy. After a brief period of ovulation induction, IVF can make the optimal use of the limited eggs left in the ovary. Provided the matured egg retrieved in that specific cycle is of good quality. And for women for whom ovarian stimulation to retrieve good quality eggs have failed, then IVF with donor egg should be considered. A donor of younger age with a matching profile of the woman is selected. Donor egg/Donor embryo IVF treatment can also be helpful for women who have had their menopause to conceive successfully. If associated with medical comorbidity, Surrogacy can also be an option for advanced age group mothers.
How can medicover fertility help women to conceive in their advanced age?
Medicover Fertility clinics are among the top fertility clinics in Europe now in India. With state-of-the-art technology and technical expertise of doctors, we have been helping older women in planning a pregnancy.
The concept of delayed parenthood is slowly increasing. Careers get preference and accumulation of assets is a priority. Family planning takes a back seat. The theory that most people follow now is about securing themselves financially before they have a child. That way, they can give the child all the comforts and necessities of life. So, this has resulted in couples to plan a pregnancy at an advanced age.
So, the cases of infertility are on the rise due to work-related stress, irregular eating habits, reduced ovarian reserve and ageing eggs. But motherhood now does not have to be limited to the younger women only. Advances in fertility treatments have helped many older women to conceive successfully.
Related questions on advanced maternal age:
Q1) What is Geriatric Pregnancy?
A) In the past, doctors used to define geriatric pregnancy for women who used to conceive at an advanced age of 35 years and above. Now it is termed as Advanced Maternal Age.
Q2) What age is high risk to have a baby with genetic problem?
A) The risk of having a baby with Down syndrome or any other genetic anomalies increases with age. When a woman is in her mid-30’s, the risk becomes more. At age 35, the risk of having a baby with Down syndrome is 1:350, at age 40 it is 1:100, and at age 45 it is 1:25.
Q3) Is advanced maternal age high risk?
A) If the woman has some underlying chronic health conditions like hypertension, diabetes, thyroid problems, then conceiving at an advanced age can be of high risk and can cause pregnancy complications.