Every day it is more common to find women in our consultations who decide to have a baby at Later ages.
The word late is very relative, and we could say that today a 35-year-old woman, after finishing her degree, doing a postgraduate degree and having been married for two years, to the When you consider the desire for a baby for the first time, you will surely think that you are starting on “time”.
The above could also be said of a patient who after her divorce at the age of 38 decides to marry again and after 3 years of relationship seeks a new child in this union. The same would apply to that woman who is widowed or who, after the death of a child accidentally after the age of 40, thinks again about becoming a mother.
In short, we could give innumerable examples, but Social, work or family circumstances do not correspond to biological reality and it is in this aspect that I want to draw attention.
The number of eggs in a woman is finite and the ovary as an organ has a programmed death that averages the woman’s 45 years. If we take into account that most women menstruate for the first time between the ages of 12-15 and the average onset of menopause (end of ovulatory activity) is at 50 years, the average life of the ovary is 35 years.
In numbers, a female baby at birth has 1.2 million eggs, which by the age of onset of menstrual activity have decreased to 300,000-400,000 eggs. During the reproductive life of 35 years at an average of 12 ovulations/year, the woman in this group of eggs will spend 400-500 eggs. Conclusion the ovarian economy is an economy of selection and like everything concerning our body of excellence. This ovulatory “excellence” has its climax between the ages of 25-35 and the reason could be explained with a simple example:
Maria at the age of 12 receives as a gift a box with 100 imported apples of excellent quality, the problem is that Maria does not know how to define which of those apples is of better or lesser quality and for this reason she begins an analysis that will initially depend on trial and error. The first days she will be able to casually enjoy apples of excellent or worse quality, the truth is that after the first 20-30 apples tasted, it will be easier for Maria to define which apple is at its best and early she will start the consumption of the best quality apples of the lot reserved for her, finally the last days Maria will continue to consume apples until she runs out, but no longer of such good quality. I know the previous example sounds colloquial but I hope it has left the right message: age is an independent and definitive variable in the probability of pregnancy of a woman.
We have many figures that can expand on the previous concept, among others:
The possibility of a 20-year-old woman achieving a pregnancy is approximately 35%/month, and at 35 years of age it is 15% per month, after 40 years of age it is 3-5% per month. The chance of a pregnant woman in her 20s having an abortion is 3-4% and increases to more than 30% after the age of 40. There is much other evidence like this: high incidence of miscarriages due to chromosomal alterations, early embryonic deaths due to implantation defects, obstetric complications.
Based on the above, I would finally leave the following recommendations.
If a couple starts looking for a child and the woman is over 35 years old, they should take into account the following aspects and follow the recommendations:
1. Consult the gynecologist, if after 6 months of unprotected sexual activity you have not achieved pregnancy.
2. In case of a history such as pelvic diseases, endometriosis, menstrual disorders, pelvic surgeries, consult to be evaluated early.
3. If in previous relationships there were difficulties in conceiving.
It is important to remember that basic infertility studies do not vary depending on age and that is how the patient, regardless of her age, should undergo:
1. Baseline hormonal study (measurements between the second and fifth day of a spontaneous menstrual cycle): FSH, LH, TSH, PROLACTIN, ESTRADIOL.
2. Evaluation of the female organs involved in the reproductive process: Uterus, fallopian tubes, ovaries: the examinations can be non-invasive such as ultrasound and invasive such as
Hysterosulinography (X-ray with contrast dye of the uterus and tubes),
Hysterosonography (Ultrasound with liquid medium that draws the internal contour of the uterine cavity and the turbulence of fluid
in the tubes) and finally the
Laparoscopy that allows direct visualization of the uterus, tubes and ovaries. This last exam, being more invasive and having more precise indications, has the goodness that allows the solution of alterations such as adhesions, endometriosis, cysts, etc.
3. Evaluation of the fertilizing capacity of the couple’s semen, by means of a spermogram.
Finally, the message for this woman over 35 years of age with reproductive interest is to make an early decision and get good advice when looking for a baby.
inSer
GroupArticle for El Colombiano’s blog Let’s Talk About Fertility
