The number of children born to women over 40 has quadrupled in the last three decades according to new figures from the Office of National Statistics
Almost half of new babies were born in the last year were to women aged 30 and over.
How can we ensure that, if we want to leave it a bit later to have kids, our bodies will be ready?
Dr Geetha Venkat, Medical Director of Harley Street Fertility Clinic on exactly what you need to know – and do – to stay fertile longer.
At what age has fertility been shown to decline in women?
There was a general belief that women’s fertility declines over the age of 40. Slowly people came to realise that the decline started at the earlier age of 35 years.
Now, studies have shown that a women’s fertility declines much earlier than that: from their late 20s. A study (Human Reproduction, Vol 17, p 1399) involving 782 healthy couples in USA and Italy showed that female fertility starts to fall off gradually from around the age of 27 before dropping more dramatically after age 35.
They found that women between the ages of 19 and 26 with partners of similar age had an approximately 50 per cent chance of becoming pregnant during any one menstrual cycle if they had intercourse two days prior to ovulation.
This chance dropped to 40 per cent for women aged between 27 and 34, and for women over the age of 35 years it dropped to 30 per cent.
The age of fertility decline differs among different ethnic groups. Hispanic and African-American women reach menopause a little earlier and Chinese and Japanese women a little later than the average Caucasian women, who reaches menopause at about 52.
Why this decline?
Women are born with eggs. At birth the egg count is approximately 4 million. By the time girls reach puberty, the egg count drops to roughly 400,000.
Women continue to lose eggs until they reach menopause. As the egg count or ovarian reserve drops, fertility declines.
It starts from their late 20s and becomes significant over the age of 35. For women over 40, the decline is even more drastic.
What affects my fertility that I can’t control?
The age at which fertility declines varies from person to person; this is affected by many factors.
The first one is the hereditary or familial reason. If your mother had an early menopause (premature ovarian failure) you are likely to have an early ovarian failure and researchers in Denmark have directly linked the age at which a mother reaches menopause to the level of eggs found in their daughter’s reserve.
If your mother was unlucky enough to suffer from early menopause, this will result in lower levels of eggs being available to you, however, ladies who experienced this later in life will in turn, pass on the ability to possess a larger egg reserve and a longer fertile life.
There are also genetic causes such as Fragile X syndrome, which is associated with early menopause. Other non-hereditary causes include autoimmune disorders where women produce ovarian antibodies which interfere with the function of the ovaries leading to decline in fertility.
There are some cases where the cause is simply unknown along with others such as ovarian surgery and chemotherapy but doctors may talk to you about egg-freezing options if this happens to you.
What’s influencing my fertility that I can control?
Alcohol and smoking are two important life style factors that affect your fertility. Women should limit the alcohol consumption to occasional social drinks while trying to conceive and stop drinking completely as soon as they are pregnant.
Women who smoke cigarettes deplete their eggs more rapidly than women who don’t and smoking also affects the quality of the eggs.
Furthermore, oestrogen production in women is affected by smoking. Oestrogen plays an essential role in the production of cervical mucus and nicotine in cervical mucus of women, who smoke, also kills sperm, making pregnancy less likely.
Smokers are more likely to be infertile than non-smokers and smoking also reduces the chances of pregnancy by IVF.
Drinking lots of caffeine everyday has been shown to reduce your chances of conceiving. I would recommend consuming no more than about two cups of coffee, four cups of tea or 15 oz. of dark chocolate (about two squares) per day while trying to conceive.
12 per cent of all infertility cases are as a result of a woman either being underweight or overweight. Too much body fat causes production of too much oestrogen which leads to hormone imbalance and interference with ovulation.
Too little fat, on the other hand, produces insufficient oestrogen and causes anovulation. Women should aim to achieve a body mass of index between 20 and 27 for optimum fertility.
Eating a healthy, balanced diet with lots of fruits and vegetables helps. A balanced diet includes a high protein, low fat and high fibre diet.
Equally important is having regular and adequate exercise (aerobic and / or resistance exercise for 30 minutes three times a week). This, not only helps to maintain weight, but also relieves stress and anxiety, and releases endorphins, which are the happy hormones.
What are three best things I can do to preserve my fertility?
A fertility MOT every three years should be taken much the same as a PAP smear test, from the age of 25, so any problems can be caught early and addressed.
This will leave you as prepared as possible should you run into any problems. Most fertility clinics do these.
In many cases, it is impossible to predict when you will begin trying for a baby. In light of this, it is also worth considering egg freezing in your 20s in case you experience any fertility problems later on, or find yourself not ready to start trying to conceive until your 30s.
By looking into this option, if your fertility does decrease, you will have the opportunity to use your own eggs when undertaking IVF, instead of considering egg donation.
Lifestyle can also be an issue and impact your fertility. Making sure you eat healthily and undertake regular exercise will have a positive impact on your chances of conceiving later.
I recommend eating a high protein, high fibre, low fat diet, ensuring you incorporate the appropriate vitamins such as folic acid, which is important both to current and future fertility.
What can someone having IVF do to help it work?
Acupuncture helps to restore the body’s energy balance and improves overall health. If you find it difficult to conceive, trying to get pregnant can be stressful.
Acupuncture helps to reduce the stress associated with trying for a baby. When the stress is reduced, your chances of achieving a pregnancy are higher.
However, please do not expect such changes with one session of acupuncture. A few sessions of acupuncture, while you are trying may be helpful. If you have a fear of needles, you can go for laser acupuncture, which uses a focused beam of light and does not involve needles.
This is also effective in reducing stress levels.
What about men’s fertility?
Even though men are known to father children when they are in their 60s and 70s, their fertility starts to decline from the age of 35.
Over the age of 45, the sperm quality deteriorates. The DNA damage of the sperm is found to be higher at that age. However, men do not run out of sperm (or gametes) with increasing age, as women do. This is because women are born with all their eggs, whereas men produce sperm.
A man can make some changes in his lifestyle which will lead to significant improvement in his sperm motility and quality.
First and foremost is smoking, which reduces the motility of the sperm.
Along the same lines, excessive caffeine and alcohol should be avoided. But these changes should be undertaken long-term as it takes 70-80 days for the sperm to be produced in the testicle and then brought out in the ejaculate. Therefore it takes 2-3 months before any improvement can be seen in the sperm parameters.
Heat can also reduce sperm production. Hot baths, sitting for long periods of time and tight-fitting underwear that constricts the testes can elevate temperatures long enough to suppress sperm production.
Regular exercise (five times a week for at least 45mins) and healthy diet enhance fertility by keeping body weight at normal levels and relieves stress and anxiety.
Taking vitamin supplements will help men boost male fertility. Vitamin C (1000 to 2000 milligrams daily) is an antioxidant and prevents DNA damage in the sperm.
Zinc supplements (15 to 30 mg daily) can increase the sperm count and mobility. The other supplement which is useful is Selenium (200 microgram daily); this improves the sperm function.
How long should I try for a baby naturally before thinking about IVF?
This depends on your age. If you’re under 30 you and your partner should try for two years before seeing a specialist. If you’re between 30 and 40, try for one year.
If you’re 40 or over if there is no joy after six months of trying, see the specialist. At this stage, the specialist will advise them about the possible treatment options.
What fertility tests should any woman have even before starting to try?
It is a good idea to have some key fertility tests before starting to try for a baby – both:
An ovarian reserve test gives information about the potential number of eggs in the ovaries. This test is a blood test to check the hormone Anti Mullerian Hormone (AMH).
If the level of this hormone is normal, it indicates a good ovarian reserve (a good number of eggs in the ovaries). Thereby indicating that you have many years of reproductive capability still left.
It’s not yet available on the NHS but it is available privately from gynaecologists and most fertility clinics and costs around £120-130.
The other blood test is to check the levels of the three reproductive hormones: Follicular Stimulating Hormone (FSH), Lutenising Hormone (LH) and Oestrogen (E2).
This test has to be performed between the second and fifth day of a period (day one being the first day of bleed). This gives information about the ovarian function. Your GP should be able to do this one.
It is also useful to have an internal ultrasound scan to check the uterus and ovaries for any abnormalities that could interfere with conception.
For more information please visit: hsfc.org.uk
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