Fertility in the Older Woman

How does age affect fertility?

Age is the single biggest determinant of your chances of getting pregnant and having a healthy baby. Every woman is born with a fixed number of eggs. Both the number and quality of eggs decrease with age. With increasing age, there is a higher risk of error during cell division and the pregnancy ending up with an abnormal number of chromosomes e.g. Down syndrome. 

As a woman grows older, the risk of developing issues that can affect fertility also increases. These include medical conditions such as obesity, diabetes, hypertension, lupus etc, and gynaecological conditions such as ovarian cysts, uterine fibroids, adenomyosis and endometriosis etc.

There are also reasons (other than age) that can cause faster depletion of egg reserve – this includes ovarian cystectomy, history of chemo- or radiotherapy, or family history of premature menopause.

Hence, overall fertility begins to decline significantly from a woman’s mid-30s, with a corresponding increase in miscarriage and other pregnancy complications.

A man’s age has a much lesser impact on fertility compared to a woman’s; however, after the age of 45, there is an association with higher fertility complications.

I’m 35 years old and am trying to conceive. What should I take note of?

• Pre-conception care
  This is important as it can increase your chances of becoming pregnant and having a healthy baby. The major things you and your partner should look into include:

• • Taking folic acid (for women)
  • Maintaining a healthy weight
  • Avoid alcohol/smoking 
  • Optimising control of your medical conditions 
  • Adjusting your long-term medications (if any) to be pregnancy safe
  • Ensure your vaccinations are up-to-date
  • Ensure your environment, stress levels and mental health are conducive 

• Regular sex
  Set aside time for regular sex throughout the month and not just during your fertile period. Although there are ovulation kits that are available over-the-counter, they may not be fully accurate and you should maximise your chances of conceiving through regular sex. 

• Pre-conception checks
  If you have been having regular unprotected sex for 6 months and have not gotten pregnant, you should consider getting a pre-conception check. Depending on your risk factors, this may include:

Female

• Ultrasound scan: to check for uterus and ovarian abnormalities
• Vaginal swabs: to check for sexually transmitted infections (STIs) 
• Blood tests: To check your ovarian reserve, blood count, thalassemia, communicable diseases e.g. Hepatitis B/syphilis/HIV, immunity to chickenpox/rubella (to see if you require pre-pregnancy vaccinations)
• Hysterosalpingogram: check the patency of your fallopian tubes 
• Pap smear/HPV test: if it is not up-to-date

Male

• Semen analysis: to check for sperm count, motility and morphology

Assisted conception

Not being able to fall pregnant naturally is not the end of the road in today’s world of modern technology. Speak to your gynaecologist about your options – this may include ovulation induction, artificial insemination and in-vitro fertilisation.