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19 February, 2019 11:35:53 AM

Women’s fertility: Contributing factors

Discussions about timing of childbearing tend to focus on women but research shows one of the main reasons for later childbearing is women have trouble finding male partner willing to commit to parenthood
Mohammed Abul Kalam, PhD
Women’s fertility: Contributing factors

As every unattached woman in her twenties or thirties out there is well aware, the most important factor determining her chance of achieving pregnancy is age. In broad terms, fertility starts to decline when women are in their early 30s, the rate of decline speeds up at around age 35 and by age 40 and beyond, the chance of pregnancy is slim and the risk of miscarriage high. This is because, as women age, the quantity and quality of their eggs decrease.
Menopause marks the absolute end of the reproductive lifespan. The age of menopause varies between women but usually occurs between the ages of 45 and 55 years. Pregnancies in the ten years leading to menopause are rare.The age at which women are having their first baby is increasing in Bangladesh and elsewhere. This in turn increases the risk of age-related fertility. Women who worry about their “biological clock” ticking awaywant to know how long they can wait without jeopardizing their chance of having a baby.
It’s said that “40 is the new 30” and “50 is the new 40”. But, when it comes to female fertility, 40 are still 40, and the likelihood of successful pregnancy and childbirth has notably decreased from age 30. By the time a woman reaches 50, her capacity to conceive and give birth to her own genetic child is near to nil, even with the assistance of fertility treatment.
In vitro fertilization: Even when couples are aware of the age effects on fertility, there is often the belief that assisted reproduction treatments such as IVF will overcome any age-related fertility problems. The importance of egg-age on IVF success rate is further highlighted by the fact that the live birth rate for women aged 45 and over is much improved by using eggs donated from a younger woman. But egg donors are in short supply world-wide.IVF is not a panacea for age-related fertility problems and while living a healthy lifestyle will improve general health and fertility prospects it does not slow the effects of age.

Can women tell how long they have? Women are increasingly having the so-called “egg timer” test to get an idea of how much longer they have to achieve pregnancy. There is a recommendation that women in their late 20s have the “egg timer” test at regular intervals to monitor their fertility potential.This is a blood test that measures a woman’s level of anti-müllerian hormone (AMH) which is linked to the number of eggs remaining in her ovaries. Higher levels mean more eggs are present, which theoretically means a higher fertility potential.

But the “egg timer” test does not provide information about the quality of the eggs, which mostly depends on a woman’s age. It is also expensive and research shows it’s not a reliable measure of fertility potential and can give false low readings for women who use the contraceptive pill.

Relying on the “egg timer” test for pregnancy planning can give women with normal or high readings a false sense of security about postponing childbearing and women with low readings unnecessary worry about their ability to have children. This might lead them to pay the significant cost associated with egg freezing.

More education about age and fertility is needed: We’ve known for over 50 years that reproductive ageing results in a gradual loss of fertility until about age 37, when the rate of decline accelerates dramatically. The loss of fertility is accompanied by increased risks of miscarriage and of conceiving babies with Down syndrome. But we have not been clear on the precise mechanism by which this occurs – until now.

All of a woman’s eggs are produced before she is born and remain in a preserved state within structures called primordial follicles for several decades. Follicles are gradually recruited to grow; this process begins soon after they are formed and continues throughout the woman’s reproductive life. Once a follicle is triggered to re-initiate development, it enters into the pool of growing follicles, most of which will disintegrate along the way. Hundreds of thousands of follicles are lost before puberty but once puberty occurs, follicles go through an extra phase of maturation so that each month, one follicle (usually) is ovulated and a single egg released. The majority of follicles are still lost along the way.The last three months of growth and maturation of recruited follicles are critical for normal development and this is when the ageing environment causes problems. Strangely enough, having a low number of remaining follicles causes the problem. Such a lot of follicles have been wasted during the woman’s life that as she ages there just isn’t the critical mass remaining to give out the correct hormonal signals.

The size of the pool can be measured by the AMH (anti-muellarian hormone) test or slightly less accurately by the FSH (follicle stimulating hormone) test. A low AMH or a high FSH result is a sign that the pool is near or at a critically low level.Some younger women have a condition known as reduced ovarian reserve, which has similar outcomes to ageing. This is caused by several different genes, the best known of which is the fragile X gene, which causes learning difficulties in affected males. Women carrying this gene have low ovarian reserves and higher risks of having Down syndrome babies, as well as of sons with fragile X.

Men need to step up:Discussions about timing of childbearing tend to focus on women but research shows one of the main reasons for later childbearing is women have trouble finding male partner willing to commit to parenthood.While men almost universally value parenthood, want and expect to become fathers, and aspire to have at least two children, most have inadequate knowledge about the limitations of female and male fertility and overestimate the chance of spontaneous and assisted conception. Since childbearing and parenthood are shared endeavors, men who want children and have a partner need to be active participants in childbearing decision-making and avoid deferring the decision to have children to a time when the chance of achieving a pregnancy is diminished.

While most people might think age only affects female fertility, there is growing evidence that sperm quality decreases as men age, starting at around 45. Women with male partners aged 45 or older are almost five times more likely to take more than a year to conceive compared to those with partners aged in their twenties.

There is also research that shows that older fatherhood increases the risk of miscarriage and birth defects and of their children developing schizophrenia and autism spectrum disorders. Age-related fertility decline is a cause of involuntary childlessness or having fewer children than planned. To overcome age-related infertility, people often turn to assisted reproductive technologies such as IVF for help. But unfortunately, as with spontaneous conception, the chance of having a baby with assisted reproductive technologies decreases with increasing parental age..

Existing research – and public discourse – relating to childbearing focus almost exclusively on women. Declining fertility rates are often portrayed as being the result of women delaying childbearing to pursue other life goals such as a career and travel.But we know that it’s the lack of a partner or having a partner who is unwilling to commit to parenthood that is the main reasons for later childbearing and involuntary childlessness. We also know, contrary to the common stereotype that parenthood is more important for women than for men, that men desire parenthood as much as women do. So how do men influence the age of childbearing and fertility rates?

Childbearing and parenting are shared endeavours, and men’s lack of knowledge about fertility and attitudes towards acceptable ages for parenthood might put them at risk of missing out on ever having kids, or having fewer children than they wanted to have. Attempts to increase men’s knowledge about the limitations of fertility may increase the likelihood that men (and women) achieve their parenthood goals. The bottom line is, for men who have a partner and want to have children; the “right” time to become a father is sooner rather than later.

The writer is Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR).




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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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