This is defined as pregnancy intention above the age of 35 by some protocols and above age 40 by other criterias . Still , the consensus is that pregnancy above the age of 35 is considered to bear risks and this becomes pronounced with more advanced ages .As women become more empowered and busy with careers , this is becoming a norm in a majority of our Kenyan setting; especially the urban population .
I personally got my first child at mid-30s
and my second 20months later and this was contributed by a variety of reasons amongst them delay in settling down due to socio-cultural issues . In the waiting time, I immersed myself in career progression. I still consider this time a reasonable age with the many rapid changes in current times.I still have room for more children but I have to weigh and balance with rapidly advancing age ; do I want a child in my 40s? I would have conceived no.3 by now but I must balance other important life needs too.
A woman's peak reproductive fertility years are between the late teens and late 20s. By age 30, fertility starts to decline. This decline happens faster from mid-30s. By 45, fertility has declined so much that getting pregnant naturally may be unlikely.
A woman is born having 1-2 million potential eggs in ovarian follicles, by the time they reach puberty there is only a store of between 300,000 and 500,000. Although a woman ovulates between 400 and 500 times in their life, and although, each time, there may be only one egg (ovum) that ovulates, hundreds of follicles are lost with each ovulation.
It is believed that there is an accelerated decline in ovarian follicles pool at the age of 37–38 years when it reaches below a critical of 25,000. Subsequently, more decline occurs. It is believed that this phenomenon is accompanied by a declining quality due to aging oocytes. It’s not uncommon to see more and more miscarriages in women past this age due to poor quality ovums.
An individual’s speed of decline in fertility after age 35 is dependable on a number of issues amongst that individual probable age of menopause , any surgeries involving the ovaries , smoking and aggressive medical treatments such as cancer treatment that may affect fertility. Unfortunately one cannot tell their exact menopause timing and this is only a retrospective backward diagnosis after it has happened . I have seen patients in menopause as early as age 43 others as late at 52.
Most common factor for diminished ovarian reserve is age .There is a more rapid decline after age 40. It may vary amongst individuals ; some women get to menopause earlier hence a more accelerated loss in quantity and quality in their pre-menopasual years (years that preceded their actual menopause time) which for them could be in their late 30s . For other women , they may still stand a good chance of a natural conception in their 40s especially if they are to have late menopauses above age 50. I have personally delivered a good number of women between ages 40 and 44. Others have had to undergo IVF with donor eggs due to critically low ovarian reserves ; this varies from client to client , and their individual test results . I know of a woman who conceived spontaneously at age 48; she thought that she had a pelvic tumor only to be met by a bouncing female fetus at 20 weeks ; baby is all grown now and in primary school ( this is an isolated rare case and should not be used a confidence bench to delay conception).
About one in one hundred (1 in 100) women experience early menopause(below age 40). Sometimes the event is genetic; other times, it results from a health condition or curative medical treatments. This is one of the reasons that fertility preservation (egg freezing)is a hot topic in the cancer field. Women facing chemotherapy or other cancer treatments may risk compromising fertility, so freezing eggs beforehand makes sense.
I will not be surprised to see more career-oriented women do egg freezing to conceive much later via IVF once their career and life goals are met. It’s already a common trend in the first world countries and may be picking up in the major towns in Kenya.
The association of pregnancy complications with advanced age appears to be on a continuum such that risks increase with increasing age at the time of the pregnancy. Likewise, studies evaluating the effect of chronic medical conditions such as diabetes, hypertension, and obesity, which may exacerbate pregnancy-related morbidity, appear to demonstrate an increasing risk with increasing age at the time of pregnancy. Therefore, recent studies have commonly divided the age of individual pregnant women at age 35 years and older into 5-year increments: 35–39 years, 40–44 years, 45–49 years, and 50 years and older, which better stratifies the possible pregnancy risks associated with advancing age.
Women who are pregnant above age 35 are managed as high risk pregnancies and prevention and early detection of key pregnancy morbidities is key . Its not uncommon to see the Gyanecologist insist on folic acid prior to conception and in the first trimester to prevent risk of congenital anomalies and thus risk of miscarriages .There be more keen scans in 1st trimester to predict possible aneuploidies (chromosomal anomalies) and more detailed follow-ups to prevent and detect any complications in these pregnancies . Countries and centres in Nairobi that offer genetic screening would be more keen on this in pregnancies especially those above age 40. I commend women who come to us for pre-conception care because they are aware that they are at advanced ages.
So yes , let us embrace this discussion. Let women be aware about dipping ovarian reserves so that they don’t delay their attempts at conceptions too much ; any Gynecological issues should be sorted in advance to give time for fertility care and treatment way before menopausal ages . If one has a Gyanecological surgery to pave way for fertility care , let this be done early. Presence of menses is not an absolute ticket to confirm fertility wellness ; this is a big misnomer in the population ; women who delay first child conception just because they get monthly menses should be educated.
Let us also educate each other about possible risks of advanced-age pregnancies . See your Gyanecologist to weigh about decisions on late conception (especially if you already have children) to walk with you safely in case you settle on an advanced age pregnancy .
Technology has come to us and has helped tons of women conceive through IVF . For women with critically low ovarian reserves , donor egg is a growing trend in our society and enables such women to conceive and carry to term their children.
We also have IVF with own eggs for women in their 40s with unexplained infertility who may not have the luxury of trying longer naturally due to rapidly advancing age and fear of impending peri-menopause . This year alone I have delivered three sets of twins of women we sent for IVF in their early to mid 40s who we thought we couldn’t waste time any longer . Oh the joy in those mother’s faces remains ached in my heart and soul forever . Did you know that currently in Kenya TSC Teachers and National Police Service are directly covered for IVF services without any delays in waiting times or complicated processes? They simply walk in , get tests done and are scheduled automatically if they qualify .
This is a very sensitive topic ; I hope I didn’t scare or offend anyone. We however must educate one another and prevent mistakes that we have seen in others . See your Gyanecologist for more personalized care . Don’t wait too long for that baby, run around and try care before it’s too late . Still don’t make irreversible mistakes and settle in a wrong union because you want babies pronto; very tough balance - being a woman can be rough. I find myself identifying more with my clients because I am a woman , who has gone through the seasons . I would gladly refer and support m a woman who say is sure she wants donor sperm conception in the meantime as they figure life ; yes I would !!
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