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The clock is ticking: how old can motherhood be delayed



What age is optimal for having a baby, why is “postponed motherhood” becoming more popular and why every woman needs to know her ovarian reserve, says reproductologist Dmitry Kholodov.

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After 40 years, chances of pregnancy fall sharply

From the point of view of biology, everything is quite unambiguous: the age from 23 to 35 years is considered the optimal age for the birth of a child. At this time, the highest chances of independent conception and at the same time the lowest likelihood of any chromosomal pathology in the fetus. After thirty-five years, the chance to conceive a baby yourself decreases by 15-20%. At the same time, egg quality deteriorates and the likelihood of a chromosomal abnormality or miscarriage increases - up to approximately 25%, writes

Closer to forty, the situation is even more aggravated: in 42-44, the chance to get pregnant on your own with saved ovulation, regular sex life and good sperm from a partner is only 3-5% for one menstrual cycle.

And this is for a perfectly healthy woman, and on average the chances are even lower - 1,5-2%. That is, for a year a similar couple has a chance of pregnancy - 18-25%.

In 45-47 years, this chance drops to 0,5% per month and, accordingly, to 10% per year with preserved ovulation and regular menstruation.

By and large, it turns out that a woman is very desirable to realize her reproductive function before 34-35 years. This is if we are talking about natural pregnancy without the use of modern reproductive technologies.

Egg quality deteriorates with age

With age, the number of eggs that remain in the ovaries decreases. The sex cells of a woman live with her all her life, they all are laid in utero and exist from the moment of her own conception until the cessation of menstruation - that is, their number not only does not increase, but also constantly decreases.

Since new eggs are not formed in the woman’s body, it is obvious that the quality of female germ cells seriously worsens with age. This is influenced by many factors: chronic diseases, poor ecology, unhealthy lifestyle.

A man in exactly the same situation is in a better position. In about three months, all sperm is completely renewed. If he takes up his mind, forgets bad habits and goes in for sports, then in three months the quality of his cells will noticeably improve.

Of course, after a certain age, an unhealthy lifestyle can become fatal for a man. Because not only sperm cells will die, but also the epithelium that makes them. There is no system in the human body that does not have its limits.

But the woman in this regard is still in a much more vulnerable position: all the negative effects on her body, and therefore on her eggs, do not disappear, but only accumulate. This is another reason why it is so important to give birth to children while the body is young.

Why life in a metropolis affects fertility badly

In order to maximize her fertility, a woman needs to lead a healthy lifestyle. Especially important is the environment where the future mother grew up and lives. It’s one thing if she grew up in rural areas, all her life she ate food from the garden, was in the fresh air, worked physically, she has an adequate level of vitamin D, a good level of ferritin and a normal body mass index. Such a woman has a high chance of becoming pregnant and having a healthy baby.

And if a woman lives in a metropolis, then she has a much smaller chance of a healthy pregnancy in adulthood. After all, all the toxins and heavy metals that she receives in a big city affect not only her, but also directly to her ovaries. And not only affect, but also accumulate.

Drugs, alcohol and nicotine also have a very bad effect on egg quality. Particularly dangerous is smoking, as the least stigmatized and hence more popular habit. On average, a woman who smokes ten cigarettes a day for more than two years has a lower chance of getting pregnant and having a healthy baby by 30% than exactly the same non-smoker. Being overweight also negatively affects fertility.

Therefore, when preparing for pregnancy, it is so important to lead a healthy lifestyle: quit smoking at least six months, limit alcohol consumption, start eating right, do sports, walk a lot. These are seemingly banal tips, but they will help the woman eventually get a healthy pregnancy and a full baby.

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“Deferred motherhood” is a new social trend

What to do for those adult women who cannot or do not want to have a baby here and now: because of a career, lack of a reliable partner, or simply unwillingness to plunge into motherhood at this stage? At the same time, they realize that when they need to become a mother, they will already be much older than 34-37 years, and by that time an attempt to conceive a child can be a problem. Fortunately, modern reproductive technologies allow us to answer this social request and help to postpone motherhood as much as a woman needs.

You can freeze your eggs while the body is young and the quality of these eggs is as good as possible. And then, when the time comes, take advantage of this material and give birth to a healthy and biologically native child.

This method is called vitrification, or egg cell cryopreservation. The procedure can be recommended when planning a “delayed pregnancy” or before treating diseases that may affect the reproductive system.

Eggs frozen at a young age, for example, before 30 years, have a higher chance of becoming a healthy embryo than those that will mature after 40 years without any stimulation.

The modern method, when freezing is carried out in an ultrafast mode, so that ice crystals that can damage oocytes do not have time to form, was developed by the Japanese scientist Masashige Kuwayama. After vitrification, 99% of eggs are thawed successfully. Since 2013, this method has been officially recognized not only as scientific, but also as a clinical technique, and has been introduced into widespread practice.

With age, the number of cells in the ovaries decreases and their quality deteriorates. And at the same time, more and more germ cells are needed to freeze and produce one normal embryo.

When we offer a woman delayed motherhood, we must honestly inform her and take the number of eggs that is necessary in terms of her age. To avoid this, when an 35-year-old woman takes five eggs and promises her a healthy child in the future.

This is not true: in order for her child to be born in 40, she would have to freeze at least eight eggs, and if she wants two, then at least sixteen. Only in this case could we guarantee the birth of one child and with a probability of 60% the birth of two.

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Who needs to determine the ovarian reserve?

By and large, ovarian reserve, or the remaining number of eggs located in the ovaries, must be routinely determined for all the girls who, in principle, plan a pregnancy. That is, they come to the antenatal clinic and say: “I want to give birth to a child in three / five / ten years.” It is necessary to determine the ovarian reserve of this woman and say: “Yes, excellent, you have enough eggs, you will manage to do everything”.

It happens that in some patients, for some reason, the ovarian reserve is initially reduced. They can get pregnant without problems, for example, only until 28 years, and then their chances are sharply reduced. If a woman contacted a gynecologist in advance and he was able to identify this problem, then in the future it will be easier for her to plan motherhood.

There are situations when it is critically important for a woman and doctors to know how many eggs she has left.

For example, if a girl is diagnosed with a benign tumor of the ovary (cyst), and she has surgery. Before putting the patient on the operating table, the doctor must find out when she is planning the child and whether she plans in principle. Because such an intervention, like any other operation on the ovaries, carries the risk of losing part of the ovarian tissue and, consequently, losing part of the eggs.

For one woman, such a loss will not be significant, she will have enough eggs, and for another it can be fatal. Therefore, before any surgical intervention in the ovaries, it is necessary to determine the ovarian reserve and, if necessary, freeze the eggs. So the girl will have a certain guarantee that she will be able to have her child biologically in the future. And the surgeon will be more comfortable with the operation, especially if something goes wrong. For example, bleeding will occur and he will be forced to remove one of the ovaries. If a woman has frozen cells, then even removing the ovary will not be a crippling procedure.

Ovarian reserve is also definitely watched if a woman has been unable to get pregnant for a long time or before an IVF procedure.

In general, the egg reserve should be determined before any medical interventions that in one way or another can affect the woman’s reproductive system. For example, this should be done before chemotherapy begins, so that later, in remission, the woman has the opportunity to become a mother.

Determination of ovarian reserve is a comprehensive method that includes ultrasound and blood tests for antimullers hormone, AMH. It can’t be that your AMG level is the same, low, for example, but you have a lot of follicles. If the follicles are few, then the AGM will be low, and vice versa. Modern ultrasound devices are able to scan the ovary in three-dimensional mode, build its model and automatically count all the follicles that are there. That is, these are not some complex studies and they are available in almost all medical institutions.

The number of remaining eggs is an individual thing and if you see in time that their stocks are small, then you can manage to take some action in order to eventually become a mother. Fortunately, at the present stage of development of reproductive technologies, this is quite possible.

The material is published for informational purposes only, does not constitute medical advice and does not replace medical advice. ForumDaily Woman is not responsible for any diagnosis made by the reader based on the site's materials, as well as for the consequences of self-medication, and may not share the point of view of the author or expert.

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