Advanced Maternal Age

Many women in today’s society are delaying their choice to becoming pregnant due to many socioeconomic as well as personal reasons. This wave of women becoming pregnant in their thirties and forties versus their late teens and twenties has been the cause for the questions in regards to advanced maternal age. Whereas there is fear amongst many that becoming pregnant after 35 years of age is dangerous, the truth is that about 20% of women are now waiting to begin their families after age 35. Regardless of the progression of medicine, i.e. in vitro fertilization (IVF), advanced maternal age does play a biological role in decreasing fertility. After the age of 40 the decrease in fertility has been explained by several factors including medical conditions, changes in ovarian function, and alterations in the eggs released by the ovaries.

Decreased chance in pregnancy with advanced maternal age is affected by the normal changes in the ovaries with age. Because of the decline in fertility and the increased time to conception that occurs after the age of 35, women over 35 years of age should be referred for infertility work-up after 6 months of trying to conceive. Women over 35 should also be tested for ovarian reserve testing with risk factors such as a single ovary, previous ovarian surgery, poor response to follicle-stimulating hormone (FSH), previous exposure to chemotherapy or radiation, or unexplained infertility. Additionally, women over 40 years should consider IVF if they do not conceive within 1 to 2 cycles of controlled ovarian hyperstimulation. Also, women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age. Lastly, women should be counselled about and offered appropriate prenatal screening once pregnancy is established.

Pre-conception counselling regarding the risks of pregnancy with advanced maternal age, promotion of optimal health and weight, and screening for concurrent medical conditions such as hypertension and diabetes should be considered for women over age 40. Advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions, autism spectrum disorders, and schizophrenia. Men over age 40 and their partners should be counselled about these potential risks when they are seeking pregnancy, although the risks remain small. Advanced maternal age combined with advanced paternal age is a risk factor as well. Though science has come a long way in the recent years, the human body has its limitations.

 

 Figure 1 – Maternal age versus risk factors for pregnancy, fertility rate and rate of spontaneous abortions. The graph shows a negative correlation.

Figure 1 – Maternal age versus risk factors for pregnancy, fertility rate and rate of spontaneous abortions. The graph shows a negative correlation.

 Figure 2 – The odds increase for having a baby with chromosomal abnormalities with maternal age.

Figure 2 – The odds increase for having a baby with chromosomal abnormalities with maternal age.

The American Society for Reproductive Medicine has begun an effort to educate the public about these issues because of the fact that more and more women are delaying childbearing. Some do have strong opinions that say ages 25 to 35 years of age are ideal for women to have a child and that the decade of 35 to 45 years of age are not safe. However, it still remains that just because a woman did not get pregnant in the earlier years; her later years are a contraindication alone. Chromosomal abnormalities include, but are not limited to, Down’s (trisomy 21) or Edward’s (trisomy 18) or Patau’s (trisomy 13) syndrome. These three are the more common chromosomal abnormalities which allow for live birth. Trisomy 8, 11, and 16 are strongly associated with fetal demise in utero. With appropriate education and information, many of these pregnancy issues, i.e. chromosomal or placental abnormalities, may be avoided and allow for healthy pregnancies for women over the age of 35. All women in this category who live in Denver should visit the Denver Holistic Center for more information.