Advanced Maternal Age and the Relationship with Infertility
Advanced maternal age is an important factor affecting fertility. Women’s ovaries stop producing eggs during menopause. Therefore, as age increases, both the number and quality of eggs decrease. This can make it more difficult to conceive and increases the risk of miscarriage.
Advanced Maternal Age and Ovarian Reserve
Ovarian reserve is a measure of the number and quality of eggs present in the ovaries. A woman’s age is one of the most important factors determining ovarian reserve.
Advanced Maternal Age and Chances of Pregnancy
Age is one of the most important factors affecting the chance of pregnancy. While the monthly chance of pregnancy is approximately 25% in women aged 20–24, this rate decreases to about 5% in women over the age of 40.
Reasons for Decreased Fertility with Advancing Age
Decreased ovarian reserve: As women age, the number of eggs in the ovaries gradually decreases.
Decreased egg quality: With advancing age, egg quality also declines. Lower-quality eggs are more difficult to fertilize and have a lower chance of developing into healthy embryos. This reduces the likelihood of pregnancy and increases the risk of miscarriage.
Increased risk of genetic abnormalities: Becoming pregnant at an advanced age increases the likelihood of genetic abnormalities. In pregnancies over the age of 38, the risk of chromosomal abnormalities (such as Down syndrome) increases. Therefore, women who conceive at an advanced age are recommended to undergo genetic testing.
Advanced Maternal Age and Risk of Miscarriage
Age is also a factor that increases the risk of miscarriage. While the risk of miscarriage is about 10% in women aged 20–24, this risk rises to 20–30% in women over the age of 40.
Advanced Maternal Age and Pregnancy Risks
Although the possibility of pregnancy continues at advanced ages, it is reduced. Women over the age of 38 are considered to have advanced-age pregnancies. Certain risks may increase in these pregnancies.
Genetic abnormalities: The risk of Down syndrome and other chromosomal abnormalities increases in advanced-age pregnancies.
Risk of early pregnancy loss and preterm birth: The risk of miscarriage and preterm birth increases in women of advanced age.
Health problems such as high blood pressure and diabetes: In pregnancies over the age of 38, the risk of conditions such as hypertension and gestational diabetes increases. The risk of preeclampsia and eclampsia is also higher.
Low birth weight: In pregnancies occurring at an advanced age, there is an increased risk of the baby being born with low birth weight. This may negatively affect the baby’s health.
Infertility Treatment at Advanced Maternal Age
There are various treatment options for women experiencing infertility due to advanced maternal age. These include:
In vitro fertilization (IVF): IVF is a treatment that supports pregnancy by combining eggs and sperm in a laboratory setting.
Genetic testing (PGT): Women considering IVF treatment at an advanced age may undergo genetic testing. These tests aim to examine embryos for genetic abnormalities and to transfer healthy embryos.
Egg donation: Egg donation may be an option for women with diminished ovarian reserve and advanced age.
Hormone therapy: Hormone therapy may help increase estrogen and progesterone levels.
IVF at Advanced Ages
Ovarian reserve is an important factor affecting the success of IVF treatments. If an adequate response cannot be obtained with medications due to decreased ovarian reserve, the chance of success in IVF treatment decreases significantly.
Every woman is born with a certain number of egg cells, and this number gradually decreases over time. During menopause, there are no egg cells left in the ovaries. As a woman’s age increases, the probability of having a baby naturally or with treatment decreases significantly due to the reduction in egg number. The average age of patients applying to IVF clinics has increased over time. Aging negatively affects both the quality and quantity of eggs, thereby reducing the chance of pregnancy.
With advancing age, the number of eggs carrying chromosomal abnormalities increases, leading to a higher risk of miscarriage. In advanced-age pregnancies, problems such as hypertension, gestational diabetes, and preterm birth are also more common.
There are various opinions regarding the impact of male age on IVF success rates; however, it is generally observed that pregnancy rates are lower in partners of older men. Studies suggest a slight increase in the frequency of conditions such as autism, schizophrenia, and retinoblastoma in children of older fathers.
IVF Treatment at Advanced Ages
There is currently no treatment method that can increase ovarian capacity. The benefits of non–evidence-based treatments are very limited, and many of them involve significant costs. The benefit of using high-dose medications is also controversial. In IVF treatment, short protocols are generally preferred to stimulate the ovaries. In these protocols, the doses of ovarian stimulation drugs may be higher than those used in normal responders, but excessive doses are not recommended. In cases where the number of eggs is low, the microinjection (ICSI) method is preferred.
Low-dose medication use
In IVF treatment with mild stimulation, antagonist protocols are applied, which include a combination of low-dose ovarian stimulation drugs and medications that prevent premature ovulation. Medications containing clomiphene and letrozole may also be added to this treatment. It has been reported that low-dose treatments may have positive effects on egg quality, embryo development, and the endometrium (the inner lining of the uterus).
Conclusion
Advanced maternal age is an important factor affecting fertility. Therefore, it is important for women who wish to become pregnant at an advanced age to consult an obstetrician and gynecologist to evaluate their fertility status.