How age affects your fertility?


Quick Bites

  • Age is known to reduce the chances of getting pregnant and a healthy baby in women
  • By age 40 the chances of conceiving in a monthly cycle is only about 5%
  • Egg freezing is a good option if you want to delay your pregnancy
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Introduction

How age affects infertility

In this modern world, age is not a barrier to achieve a lot of things, be it a new carrier or a hobby. But unfortunately, increasing age can reduce your chances of natural conception drastically. Many pieces of research suggest that fertility decreases for both men and women with age.

The current societal shift, triggered by a greater focus on career and education, has resulted in a trend of delay in pregnancy and childbirth. Statistics show that between 1990 and 2010, the percentage of women giving birth after the age of 30 has increased six-fold. There are many cases where the couple struggles to get pregnant after avoiding it for long as the probability of conception decreases with age due to natural reasons. Not only the chances of pregnancy but also the risk to the unborn child during pregnancy increases with age.

The fertility of both men and women declines with age but identifying the exact time of fertility decline is difficult to predict as it varies from one individual to another. The best reproductive years for women are the early to late twenties, the ability to bear children gradually declines after they reach the 30s, particularly after the age of 35. By the age of 40, a woman's chances of conception are less than 5% per cycle, meaning fewer than 5 out of every 100 women can conceive successfully every month. Whereas, sperm quality also starts to decline after the age of 40 years in male.

In this article

 

How does age affect female fertility?

As mentioned earlier, fertility in women declines with age, especially after the age of 35, as both the quality and number of eggs decreases. The percentage of women who conceive approximately within a year according to their age is given in the table below:[1]

Age of the Women (in years)

Annual Fertility Rate (in %)

20 - 24 Years

47 %

25 - 29 Years

45%

30 - 34 Years

41%

35 - 39 Years

34%

40 - 44 Years

20%

Over 45 Years

4%

It is a well-known fact that women can not bear children after menopause, but pregnancy also becomes difficult five to ten years before menopause. Hence, the best age to conceive for a woman is before 35 years. This decline in female fertility with age is due to various factors, briefly discussed below:

Age affects ovulation and menstruation in women

Unlike men who can produce sperms throughout their life, women are born with all the egg-containing follicles that they will ever have. At puberty, these follicles will start maturing, and the egg is released every month. This process of egg release is called ovulation. Once released, if the egg gets fertilized with the male sperm and implanted into the uterus wall, pregnancy is confirmed. If the pregnancy does not happen, the uterus lining (endometrium) is shed, along with the blood during menstrual flow (also known as periods).

The menstruation cycle differs from woman to woman and usually lasts for about 28 days. During the age of 35-40 (perimenopause), the length of the menstrual cycle shortens from about 28 days to around 24-26 days and eventually stops when the women reach menopause. It happens because the ovaries start to lose their ability to produce mature follicles.

The woman is born with about one million egg follicles, by puberty, the number of egg follicles declines to about 300,000. And during a lifetime, women release about 400 to 500 eggs only. With age, the number and quality of egg follicles start to decrease. This decline in egg quantity (known as atresia) is a natural event and happens to every woman. However, this is faster in women smokers. Women don't always remain fertile until menopause. The average age for menopause is 51, but most women start facing difficulty in conception in their mid-30s.

Egg quantity declines with age

As discussed above, a woman is born with all the eggs. This collection of eggs from birth is known as ovarian reserve. Ovarian reserve starts decreasing and degenerating as the woman ages leading to inability to conceive soon or naturally. Even though the diminished ovarian reserve is mostly related to age, young women may also have a reduced ovarian reserve.[2] It may be due to various reasons like a family history of premature menopause, prior ovarian surgery, or smoking.

Egg quality decreases with age

Women are less likely to become pregnant and more likely to have miscarriages with age due to a drop in egg quality. The quality of women's eggs is highest during the mid-twenties and starts to decline after the age of 35.

One such genetic abnormality which significantly decreases the egg quality is known as aneuploidy. Aneuploidy is an abnormal number of chromosomes in a cell due to problems during division (such as 45 or 47 instead of the usual 46 chromosomes). In normal cases during fertilization, an egg must have 23 chromosomes, when fertilized by a sperm (also containing 23 chromosomes) produces an embryo with 46 chromosomes.[3]

Even though aneuploidy is common in all ages, the rate of aneuploidy is lowest from mid-twenties to the early '30s (indicating best quality eggs). Hence, doctors consider it to be the best time to get pregnant. Embryos with aneuploidy (abnormal chromosome) increase significantly in pregnant women above 35 years of age and is about 33% to 50% at the age above 40 years. Such cases mostly do not lead to pregnancy, and if they do, it results in miscarriage. It explains fewer chances of pregnancy and more chances of miscarriage in older women.

We have learned that both egg quality and quantity declines with age in women and they are not able to conceive naturally after the menopause. Now let's see if the age also affects the fertility in males.

 

How age affects male fertility?

Even though the men can produce sperms throughout their life, the quality of sperms (sperm motility and mortality) decreases with age. Sperm motility is the ability of male sperm to swim and reach the egg. Research suggests that sperm motility decreases at a rate of 0.8% per year. As men age, they produce fewer motile sperm, which are able to travel less along a linear path, thus covering less forward distance per unit time. [4] Hence, the sperms are not able to reach the egg in time, causing the delay in pregnancy. Apart from this, studies also show abnormal sperms and decreased seminal volume (semen) affecting the chances of fatherhood.

 

Lifestyle and dietary changes that will help you maintain good sperm and egg health

Even though the age-related factors can not be fixed and as you grow the egg and sperm quality will decline naturally. However, by maintaining a healthy lifestyle and proper diet you can delay the natural decline in egg and sperm quality. Few of the lifestyle changes and dietary habits that can help you achieve the same is given below,

Lifestyle changes

These are a few steps for both men and women to preserve their fertility for longer and increase their ability to conceive,

Maintain a healthy weight

Nowadays, the diet of most people is full of sugary drinks and snacks, processed foods, and trans fat. This form of diet not only causes insulin resistance and risk to chronic diseases but also decreases your chances of natural conception. The number one thing you can do to preserve your fertility is to lose the extra kgs. Start doing regular moderate exercise to maintain a healthy BMI. Stick to the diet of ample protein from plants, lean meats, whole grains, lots of fresh vegetables and fruits, and avoid sugar. You can consume dairy products like full-fat milk and yogurt instead of fat-free or low-fat versions.

Stop smoking and cut back on caffeine

Smoking can negatively impact fertility in both males and females. It is known to add ten years to your fertility age, meaning if you are a 25-year-old, you will have the fertility of a 35-year-old. The same is also true for caffeine, drinking more than 200 mg of caffeine a day has shown to decrease the sperm and egg quality. So, stop smoking and cut back your daily caffeine amount. Also, steer clear of energy drinks because they are mostly high in caffeine.

Reduce stress and toxins

Even though trying for pregnancy can be stressful, staying away from stress is the best thing you can do to improve your chances of pregnancy. You must take some time for yourself every day to relax. You can do so by going for a walk or taking a long bath, or by incorporating meditation or yoga in your daily routine, or whichever way suits you. Along with this, stay away from toxins present in the environment. Include organic fruits and vegetables. Also, read the product labels to stay clear of known pesticides.

Talk to your doctor about your plan for pregnancy. If you are taking any medication regularly, your doctor will adjust the dose or prescribe you the other medicine that does not interfere with your fertility.

Dietary changes

In general, everything that you do to improve your overall health will lead to good sperm and egg health. Here are a few tips on what to eat and what to avoid for healthy eggs,

Include eggs and green leafy vegetables

Green leafy vegetables like spinach, kale, lettuce, and eggs improve general health and fertility. Green leafy vegetables are rich in folate / folic acid (a type of vitamin B ), and eggs are rich in choline. Both these ingredients not only improve fertility in both male and female but also prevents congenital birth defects in newborns. Other foods that contain choline are shrimp, cauliflower, scallops, and pork products like bacon. Also, citrus fruits like oranges and grapefruit are good sources of folic acid.

Vitamin D supplement

Since a lot of women are deficient in vitamin D, women who want to freeze their eggs should get their vitamin D levels tested. If it is low, you must take a supplement, as food is a pretty poor source of vitamin D.

Avoid trans fats and switch to healthy fats

Avoid processed and hydrogenated oils and switch to healthy alternatives like olive oil and ghee. If you are planning for pregnancy, eat almonds, walnuts, and avocado, as they are healthy sources of good fats.

 

What if you want to conceive after the age of 35?

Planning for a baby is a mutual decision, and can take some time for newly married couples. If you are one of those couples who are planning to delay the pregnancy, for now, egg freezing can be an option for you. If natural pregnancy does not happen by then, with the help of modern reproductive technologies, like IVF, you will be able to conceive with your eggs when you opt for egg freezing (if with age, your egg quality deteriorates).

Egg freezing is also known as oocyte cryopreservation, is a process of extracting, dehydrating, freezing, and storing the female eggs for later use. The best age to undergo egg freezing is the mid to late twenties as the ovarian reserve (number of viable eggs) is high, and good quality eggs can be easily extracted for storage. If you are below the age of 30 years, you can talk to your doctor about the options for egg freezing.

Once you are ready for pregnancy, the fertility expert will thaw and use your eggs for the IVF procedure. The embryo is then implanted in your uterus to grow. You can talk to your gynecologist or fertility expert about the option of egg freezing,

If you are above 30 years of age, we recommend you not to delay your pregnancy and try for natural conception for at least six months to a year. If you are not able to conceive with a year of trying, talk to your fertility expert. The fertility expert may suggest modern fertility treatments like IUI and IVF, depending on your reproductive health.

Your doctor may also suggest you undergo IVF with the use of donor eggs if your egg quality is low. The donor eggs are healthy and good quality as they are collected from other women in their 20s or early 30s. Hence, the IVF is very successful with donor eggs. The high rate of success with egg donation shows that egg quality is the primary barrier to pregnancy in older women.[5]

Talk to your doctor if you plan to delay your pregnancy for some years. After ovarian reserve testing, your doctor can guide you about your options and tell you if you can go for egg freezing or not. Ovarian reserve test, tells you about the numbers of healthy eggs and hence gives you an indication of how much time you have for either natural pregnancy, IUI, IVF or egg freezing.

The point to consider here is that the success of fertility treatment also decreases as the women ages. IVF success rate is lower in women aged 40 and older. It is generally less than 20% per cycle.[6] Hence, taking the guidance of fertility experts is the best if you are thinking of delaying the pregnancy. Looking at your reproductive and general health, your doctor will guide you to plan a safe pregnancy.

Conclusion

It is natural for fertility to decline as women get older. However, the time the fertility decline begins and the rate at which it progresses may vary widely in women. Generally, fertility begins to drop rapidly after the age of 35 years. Hence, the best option is to conceive before you reach 35 or preserve your fertility with egg freezing. You should also consult your gynecologist about the ovarian reserve test if you plan to conceive after 30. By being aware of your own needs and goals and learning about all of the options, you and your partner will be able to make the best decisions.

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references

List of ReferencesHide

1 .

www.nice.org.uk. “Fertility Problems: Assessment and Treatment”. Clinical Guidelines [CG 156], National Institute of Health and Care Excellence, 06 September 2017.

2 .

Dr. Matthew Lederman. “Ovarian Reserve: What You Need to Know About Your Egg Quality and Quantity”. progyny.com, 22 July 2020.

3 .

Yajie Chang, Jingjie Li, et al. “Egg Quality and Pregnancy Outcome in Young Infertile Women with Diminished Ovarian Reserve”. Med Sci Monit. 2018;7279-7284, PMID: 30310048.

4 .

Sloter E, Schmid TE, et al.”Quantitative effects of male age on sperm motion” Hum Reprod.2006;21(11):2868-2875. PMID: 16793993.

6 .

Abbas Aflatoonian, Maryam Eftekhar, et al. “Outcome of assisted reproductive technology in women aged 40 years and older”. Iran J Reprod Med. 2011 Autumn, PMID: 26396576.

Last updated on: : 28 Sep 2020

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