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Contents 9
- Advanced Maternal Age and Its Relationship to Infertility
- Reasons Why Fertility Declines with Advancing Age
- Advanced Maternal Age and Risk of Miscarriage
- Advanced Maternal Age and Pregnancy Risks
- Infertility Treatment for Advanced Maternal Age
- IVF at an Advanced Age
- IVF Treatment at an Advanced Age
- Low-Dose Medication Use
- Conclusion
Advanced Maternal Age and Its Relationship to Infertility
Advanced maternal age is an important factor affecting fertility. A woman's ovaries stop producing eggs at menopause. As a result, both the number and quality of eggs decline with age. This can make it harder to conceive and can increase 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 an important factor that determines her ovarian reserve.
Advanced Maternal Age and Chance of Pregnancy
Age is one of the most important factors affecting the chance of pregnancy. While the monthly chance of pregnancy is reported to be around 25% in women aged 20-24, this drops to around 5% in women over 40.
Reasons Why Fertility Declines with Advancing Age
Declining ovarian reserve: As a woman's age advances, the number of eggs in her ovaries gradually decreases.
Declining egg quality: As age advances, egg quality also declines. Lower-quality eggs are harder to fertilize and are less likely to result in a healthy embryo. This reduces the chance 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. When conception occurs after age 38, the risk of chromosomal abnormalities (such as Down syndrome) increases. For this reason, women who become pregnant at an advanced age are advised 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 around 10% in women aged 20-24, this risk is reported to rise to 20-30% in women over 40.
Advanced Maternal Age and Pregnancy Risks
The possibility of pregnancy continues into later years, though at a reduced rate. Women over the age of 38 are considered to have advanced-age pregnancies. Certain risks can increase in advanced-age pregnancies.
Genetic abnormalities: The risk of Down syndrome and other chromosomal abnormalities increases in advanced-age pregnancies.
The risk of early pregnancy loss and preterm birth increases in women of advanced age
Health problems such as high blood pressure and diabetes: In pregnancies after age 38, there is a higher risk of problems such as high blood pressure and gestational diabetes. The risk of preeclampsia and eclampsia also increases.
Low birth weight: In pregnancies at an advanced age, there is a risk of the baby being born with a low birth weight. This can have a negative impact on the baby's health.
Infertility Treatment for Advanced Maternal Age
Various treatment options are available for women experiencing infertility due to advanced maternal age. These include:
IVF treatment: IVF supports pregnancy by combining eggs and sperm in the laboratory.
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 enable the transfer of healthy embryos.
Egg donation: Egg donation can be an option for women of advanced age with a reduced ovarian reserve.
Hormone therapy: Hormone therapy can help increase estrogen and progesterone levels.
IVF at an Advanced Age
A woman's ovarian reserve is an important factor affecting the success of IVF treatment. If an adequate response to medication cannot be achieved due to reduced ovarian reserve, the chance of success with IVF treatment drops significantly.
Every woman is born with a fixed number of egg cells, and this number gradually decreases over time. By the time of menopause, no egg cells remain in the ovaries. As a woman's age advances, the likelihood of having a baby, whether naturally or through treatment, decreases significantly due to the declining number of eggs. The average age of patients presenting 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, there is an increase in the number of eggs carrying chromosomal abnormalities, along with a corresponding increase in the likelihood of miscarriage. Problems such as high blood pressure, gestational diabetes, and preterm birth are also more common in advanced-age pregnancies.
There are various views regarding the effect of paternal age on IVF success rates, but it is generally observed that pregnancy rates tend to be lower in the partners of older men. Research suggests that there may be a small increase in the frequency of conditions such as autism, schizophrenia, and retinoblastoma in the children of older fathers.
IVF Treatment at an Advanced Age
No treatment method has yet been found that can increase ovarian capacity. Treatments that are not evidence-based offer very limited benefit, and many of them come with significant costs. The benefit of using high-dose medication is also debated. Short protocols are generally preferred for ovarian stimulation in IVF treatment. The doses of egg-stimulating medications used in these protocols may be higher than those used for patients with a normal response, although excessive doses are not recommended. In cases where the egg count is low, the microinjection (ICSI) method is preferred.
Low-Dose Medication Use
In IVF treatment with mild stimulation, antagonist protocols are used, involving a daily combination of low-dose egg-developing medications and medications that prevent premature ovulation. Medications containing clomiphene and letrozole may sometimes be added to this treatment. Low-dose treatments are reported to potentially have positive effects on egg quality, embryo development, and the endometrium (the inner lining of the uterus).
In natural cycle IVF, the egg's natural development is monitored by ultrasound, and it is retrieved just before ovulation would occur naturally. This is not always possible. In some women, hormonal signals from the brain can trigger spontaneous ovulation before egg retrieval can take place. Natural cycle IVF is recommended as an effective treatment option only for women whose ovaries no longer respond to medication.
Conclusion
Advanced maternal age is an important factor affecting fertility. For this reason, it is important for women who wish to become pregnant at an advanced age to consult an obstetrician-gynecologist to evaluate their fertility status.