Age-related fertility decline

The fertility of women will gradually decrease over time, starting at the age of 32 will notice a marked deterioration and will decrease very quickly after the age of 37. For that reason, women who wish to get pregnant should be consulted and understand the effect of age on their fertility.

For women over the age of 35,if it is not possible to conceive despite the desire to become pregnant and do not use any contraceptives for 6 consecutive months (this period may be shorter in some cases), it should be examined, assessment, and treatment if inferable because their fertility is age-related deterioration, and there is a high risk of disorders that affect fertility as well as a high risk of miscarriage. For women over the age of 40, assessment visits and treatment interventions become even more necessary.

The number of egg cells in the two ovaries of the woman will gradually decline on its own and at a completely natural rate. The highest number of egg cells is about 6-7 million in a 20-week-old female fetus, reduced to about 1-2 million cells at birth, to puberty only 300000 – 500000, at the age of 37 only 25000, finally at 51 years old (the average menopause in the United States) is left only about 1000 egg cells.

Fertility in females declines gradually over time, a marked decrease starting at the age of 32 and a rapid decrease after the age of 37 reflects a fundamental relationship between a deterioration in egg quality with an increase in FSH hormone levels and a decrease in levels of the hormone AMH as well as inhibin B during the menstrual cycle. The mechanism of this problem is not well explained, but it seems to be related to the multi-factor specified by the X sex chroma and common chroma.

The age factor alone has had an effect on fertility. Statistical data suggest that in communities that do not use contraception, fertility in women decreases over time, but sexual activity also decreases with age, so it is difficult to separately evaluate these two factors separately.

Although difficult, a classic French study did this by studying healthy women who had husbands without sperm in semen and had to use donor semen. The results of the last study showed that the pregnancy rate decreased very sharply as the age of the woman increased. The cumulative pregnancy rate observed over a period of up to 12 menstrual cycles was 74% for women under the age of 31, reduced to 62% in women aged 31-35 years and only 54% for women over 35 years of age.

A similar trend was also observed from the analysis of data of the artificially insefined embryo transfer program in the United States. The survival rate of artificial inse fertilization reached 41.5% for women under the age of 35, 31.9% in women 35 – 37 years old, 22.1% in women 38 – 40 years old, 12.4% in women 41 – 42 years old, 5% in women 43 – 44 years old and only 1% for women over 44 years old. In another direction, women who use donated eggs from healthy young donors for artificial inseseation have a survival rate of up to 51% without depending on the age of the recipient. As women age, the higher the risk of disorders affecting fertility, they can be uterine fibroids, diseases related to the ovary, or endometriosis. Women who have undergone ovariansurgery, chemotherapy, radiotherapy, severe endometriosis, smoking, pelvic infections, or have a family history many early menopause will face the risk of reduced fertility. The decrease in female fertility over time is caused mainly by a decrease in egg quantity and quality, and the more complicated it becomes when the menstrual cycles become abnormal at the time of premenausal . Therefore, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine have made the following recommendations:

• Women who intend to become pregnant should be consulted and understand the impact of age on their fertility.
• Women over the age of 35 who wish to become pregnant, if they are unable to conceive for a period of 6 months (or earlier depending on the case) should be examined and treated if clinically in accordance with the clinically prescribed period.
• Women over the age of 40 are sure to do the evaluation and intervention of treatment.

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Article reference source: acog.org