Why fertility problems are more likely from mid-thirties onwards?

Almost one in six couples will seek help of fertility specialist. Majority of these will require some form of fertility treatment to help conceive. More couples are delaying starting family into early to mid-thirties’. The golden age/period for women to conceive in their third decade of life (in their twenties). As more women are delaying getting pregnant, it is even more important that they try and maintain healthy life style to maintain optimum fertility.

The Role Age Plays in Fertility

It is well known that women’s age plays an important role in their fertility. Generally speaking, women are born with around 4-5 million eggs which remain in a quiet stage until they reach puberty. From puberty onwards, there is a slow and steady loss of the follicles and only 400,000 – 500,000 follicles remain.

The process of the drop in quality and quantity of eggs gathers pace around the mid-thirties’. It gains even more pace in late thirties and later as women enter into their 40’s. The chances of getting pregnant for women in their 40’s can be as low as 5% when compared to 25% in their twenties. This does not mean that women cannot get pregnant. However, it does imply that those women trying to conceive in late thirties’ onwards may take longer to conceive. Or, they are more likely to need fertility treatment.

It is important that women understand how their age might be affecting fertility. As women grow older, the process of division of the genetic material inside the egg cell becomes faulty. This may result in unequal split of the genetic material. This results in some eggs having too few or too many copies of chromosomes. When such eggs fertilise with sperms, they create a chromosomally abnormal embryo. This may lead to either failure to conceive when trying naturally or failed IVF treatment or miscarriage.

Thinking About Fertility Early

With this current understanding about the effect of age on your fertility, most women should think about their fertility almost from their twenties. When thinking of delaying starting family to later age, all women should at least ensure that they maintain optimum fertility potential. This should include addressing the various life style factors that may have negative effect on their fertility. These include smoking, excess alcohol, use of recreational drugs, excess caffeine intake, maintaining healthy weight or body mass index and ensuring intake of healthy balanced diet.

Diet and Fertility

It is well known that heavy smoking or even mild to moderate smoking over many years may damage the ovarian reserve. This means that it can affect the quality and quantity of the eggs. Hence, can affect your chances of conceiving. Some of the effect on ovarian reserve is reversible, but many years of heavy smoking can hasten ovarian aging. So, it may be worthwhile to think of giving up smoking or at least consider alternative options for nicotine intake such as nicotine vapour (vapping), gums or patches. If switching over to vapping or nicotine gums and patches, it is important that you use these in moderation too. The ideal situation is to give up smoking or use of any recreational drugs completely. This will not only help fertility, but will be good for health overall in long term.

Similarly, excess alcohol consumption or binge drinking may have negative effect on your fertility. It is commonly recommended that women limit alcohol intake to 1-3 units a week, especially when trying to conceive. Those not trying actively, may consider consuming in moderation. Like alcohol, it is best to consume caffeinated drinks in moderation.

Whilst looking into some of these life style factors, it is also recommended that you ensure intake of healthy balanced diet. Your diet should provide you with the daily recommended intake of the essential nutrients, vitamins, mineral, trace elements and antioxidants. Whilst there is no prescribed fertility diet, but minimising the intake of fast foods or tinned foods or ready to eat meals or foods high in trans fats may minimise any potential effect on your fertility over years.

Besides the intake of healthy diet, both very low and high body mass index (BMI) can affect fertility. Hence, women should manage their weight such that the BMI is ideally between 20 – 27. The ideal BMI range may vary in different ethnic population. Women with BMI less than 19 may experience problems with ovulation resulting in irregular periods. Whereas obese and morbidly obese women may suffer from problems with ovulation and lower implantation rates. Both may influence your chances of getting pregnant.

Stress & Fertility

Stress is a common occurrence nowadays. There is evidence that suggests that couples who are stressed may take longer to conceive. So, even if you are not trying to conceive managing general stress will not only maintain optimal fertility, but will also help in better general health.

Some medical illnesses or taking certain long term prescription drugs may also affect your chances of getting pregnant when trying to conceive. It is important that women discuss this with their specialist. If there is an effect, then consider alternative medications or ways to minimise potential adverse effect on fertility. Where appropriate fertility checks may help in knowing about the current fertility potential.

Besides these, there are certain gynaecological conditions such as endometriosis that may affect fertility. It is important that it is optimally managed to avoid any long term effect on fertility. Repeated pelvic surgery in such patients may affect ovarian reserve or lead to blockage of fallopian tubes. So, keeping it suppressed using hormonal pills may help avoid repeated strategy whilst providing symptom relief. Hence, it is important that patients discuss this with their gynaecologist or fertility specialist. Also, early detection and treatment of pelvic infection may help avoid any long term consequences such as blocked fallopian tubes. So, if women experience any symptoms suggesting pelvic infection, then they should consider seeing their Doctor or specialist for further advice.

Nowadays, there is lot of emphasis on general wellbeing. If women are anxious about their fertility, then one may consider going for fertility tests or fertility MOT. A normal assessment will be reassuring. On the other hand, if the tests indicate any compromise to their fertility, then women may think of intervening earlier rather than later.