Having a baby after 35? Understand the issues and how to work on them.
Today’s interaction with one of my patients made me throw some light on the topic of pregnancy after 35, and what it takes to have a healthy pregnancy. My patient is a senior executive in one of the renowned IT companies. She came for preconception counselling at the age of 38.
It took me almost an hour to clear misconceptions, tackle fear and insecurity, and for future planning. While talking, I realized this may be the situation of many working women out there. Being a working mom I can totally understand and correlate the issues.
So let's see how age affects fertility?
At the birth of each female child number of eggs in her ovaries is fixed. As age advances the number of eggs decline. The peak reproductive years in a woman’s life are between 20-30 yrs. But as we all know by the time a girl finishes her education and starts working, it is on average 25 yrs. The age of marriage also has risen to 25-30 years in metro cities. By age 30 fertility starts declining and it becomes more rapid after 35. By 45, chances of getting pregnant naturally are unlikely for most women.
One of the important things to be aware of is Egg Quality. Along with the decrease in the number of eggs, the quality of the egg is also hampered. It is indirectly proportional to age. For example, in a woman of 25 years even if the number of eggs is less quality is still good but the same situation may not be there after 35 years. After 35 chances of eggs with abnormal chromosomes, aneuploidy, genetic abnormalities are drastically increased. So chances of getting pregnant are also reduced with advanced age. For healthy couples in their 20s and early 30s, around 1 in 4 women will get pregnant in any single menstrual cycle. By age 40, around 1 in 10 women will get pregnant per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
What are the complications older moms has to face?
There is an increase in chances of having high blood pressure( Pre-eclampsia), gestational diabetes, preterm labor. Each one of these has its own spectrum of complications. The risks of miscarriage, stillbirth, multiple pregnancies are greater in older mothers. If it is an IVF pregnancy, the incidence of multiple pregnancies, preterm birth again rises. With respect to baby, we need to give special attention, as woman ages, the risk of having a baby with missing, abnormal, or extra chromosome increases.
Down’s syndrome (trisomy 21) is the most common chromosomal anomaly in later childbearing. it is a condition in which a child is born with an extra copy of their 21st chromosome — hence its other name, trisomy 21. Down's syndrome causes a distinct facial appearance, intellectual disability, and developmental delays. It may be associated with thyroid or heart disease. It is common for parents of babies with down’s syndrome to experience shock, sadness, and fear over the unknowns of raising a child who has intellectual and developmental disabilities. Serious health problems can add to the panic; about half of all children born with Down syndrome have heart defects. It is very disheartening to know the challenges they go through.
The risk of having a pregnancy affected by Down syndrome is
1 in 1,480 at age 20
1 in 940 at age 30
1 in 353 at age 35
1 in 85 at age 40
1 in 35 at age 45
So if I am over 35 years and pregnant how do I know about the baby’s status regarding Down syndrome and other birth defects?
There are two types of tests
Screening tests - They assess the risk that pregnancy will be affected by a specific birth defect or genetic disorder.
Diagnostic test- They can detect if pregnancy is affected by birth defects or genetic disorders.
Nobody wants to discover any abnormalities like this in pregnancy. So far we have discussed what are the health concerns, now let's talk about what we can do for a healthy pregnancy. As we all know “PREVENTION IS BETTER THAN CURE”. It is always possible to act timely and prevent further deterioration.
I have come up with the idea of FERTILITY PLAN .
All women out there should think about whether they would like to have children and, if so, when to have them. This is called a fertility plan. If you would like to have children someday, your plan can be a simple statement like, “I would like to finish education and have more money saved before having children” or “I would like to have children in my 20s when my chances for a healthy pregnancy are best.” In today’s era where women are multitasking and managing roles like daughter, wife, mother, employee altogether, It becomes confusing and difficult to prioritize things. Here comes the role of a fertility plan which will ease your decision-making to become pregnant. This will also give you enough space to plan and manage things accordingly. Consulting can definitely help you develop your own individualized fertility plan. The next step is to put your plan into action.
What if I plan to get pregnant?
If you want to get pregnant soon, you should try to be as healthy as possible before pregnancy. You should definitely consider preconception counseling. During this visit, the doctor will review your medical history, your family history, any past pregnancies, and any medications you take. They will look into immunizations to be sure that you have all of the vaccines that are recommended for you. And also concentrate upon
your diet and lifestyle
how you can maintain a healthy weight before getting pregnant
recommended screening for sexually transmitted infections (STIs)
the option of carrier screening for you and, if needed, your partner
All women should consider prenatal visits and check-up before trying to get pregnant, but it’s especially important for women older than 35.
If you are not planning a pregnancy soon then it makes sense to review your fertility plan. It is a good idea to talk about your plan once a year. Ask yourself whether you would like to have children in the next year. If your answer is yes, you can take steps for a healthy pregnancy. If your answer is no, you can make sure that you are using a reliable birth control method.
Are there any ways to preserve fertility?
As we have been talking again and again about aging and fertility. The question pops up, is there something we can do to delay the regression of fertility?. There is no magic potion But knowing about your fertility potential can definitely help you to take steps to preserve fertility. A procedure called oocyte cryopreservation—“freezing your eggs”—has become more popular in recent years. In this procedure, several eggs are removed from the ovaries. The unfertilized eggs are then frozen for later use in IVF. Egg freezing may seem like a good option for women who want to delay childbearing. But egg freezing is recommended mainly for women having cancer treatment that will affect their future fertility. There is not enough research to recommend routine egg freezing for the sole purpose of putting off childbearing. We see so many celebrities opting for this. Egg freezing may sound some fancy thing but it may be the need for some women, Like in cancer patients, ovarian failure, with very low number of eggs, autoimmune disease, transplant patients, etc. Now is the time to have a vision for planning pregnancy and not to compromise on your goals, aspirations, career.
When should I consider an infertility evaluation?
If you are older than 35 and have not gotten pregnant after 6 months of having regular sexual intercourse without using birth control, opt for infertility evaluation. If you are older than 40, an evaluation is recommended before you try to get pregnant. This advice is especially true if you have a problem that could affect fertility, such as endometriosis. During an evaluation, you have physical exams and tests to try to find the cause of infertility. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found. But the chances of success with these treatments decline with age.
So There is NO absolute NO to have a baby after 35 years.BUT it is better to plan properly and avoid complications. The proper informative consultation which will formulate your plan based on your needs, current situation, and health, is the key.
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Stay Safe Stay Healthy.