Q. Why does fertility decline with increasing age ?

• Ageing of the ovaries is the most prominent factor and is part of the normal ageing changes that effect all organs and tissues. Most women have about 300,000 eggs in their ovaries at puberty. For each egg that matures and is released [ovulated] during the menstrual cycle; at least 500 eggs do not mature and are absorbed by the body.
• By the time the woman reaches menopause which usually occurs between 50-55 years, there are only several thousands eggs remaining. As the women ages, the remaining eggs in her ovaries. Also age, making them less capable of fertilization and their embryos less capable of implantation.
• Fertilization is associated with a higher risk of genetic abnormalities eg. Chromosomal abnormalities such as down syndrome with increasing age. The risk of a chromosomal abnormality in a woman age 20 years in 1/500 while the risk in woman age 45 is 1/20.
• Gynecological problems such as Pelvic infections, tubal damage endometriosis fibroids, ovulation problems etc tends also to increase with age. As the woman gets older, she has more time to develop these conditions, which will adversely affect her fertility. Sexual function is also decreased with ageing eg. Libido frequency of intercourse etc.
• The effect of ageing in endometrial receptivity [ability of the endometrium to receive the embryo] is controversial. There is increasing evidence that the receptivity decreases with age.
  Ageing does not just affect women but also men to a much lesser degree. It affects sperms and coital frequency.
• There is no maximum age at which men are capable of conceiving a child. Advanced maternal age increases with risk of autosomal dominant diseases such as marfans syndrome, neurofibromatosis and achondroplasia.

Q. Why does fertility decline so rapidly with increasing age ?

As women gets older, there are a number of factors that can make it more difficult to conceive. In addition as we age, our general health can decline existing conditions may worsen or new illness may develop, which can impact on fertility too.
Fertility factors that changes, as we grow older include :-

• Ovarian reserve : This is the number of functioning follicles left on the ovaries. As you get older you have fewer viable eggs left, in cases of early menopause, the eggs run out much sooner than usual.
• Menstrual cycle : As women approach the menopause their menstrual cycle can become irregular and shorter.
• Lining of womb : The endometrium may become thinner and less hospitable to a fertilized egg.
• Mucus secretions : Vaginal secretions can become less fluid and more hostile to sperm. Diseases affecting the reproductive system some conditions can damage the reproductive organs as time passes or worse if not treated properly, including endometriosis PCOS and Chlamydia. Chronic illness : Some illness can have a negative impact on fertility.
• Weight problems : Being overweight or obese can make it more difficult to become pregnant.

Q. What are the treatment options in woman with age and infertility ?

When women over 40, or with evidence of early menopause [premature ovarian failure].

• Egg Donation : Eggs from a younger woman are likely to result in pregnancy and less likely to end in miscarriage even when carried by a older woman.
• Embryo Donation : If the male partner also has a sperm problem embryo donation is the right option.
• Surrogacy : A surrogate is a woman who agrees to become pregnant for a couple using the male partner’s sperm and her own egg [traditional surrogate] or using the male partner’s sperm and the female partners egg [gestational surrogate.
• Adoption and Faster care : Another option for having a family adoption. Agencies have different rules regarding age and are now more receptive to older couples. There are generally no age restrictions for private adoptions.
• Accepting Child free living : it is important that couples consider the options of remaining child free if they are unable to have their own child or if they decide to forego infertility treatment.