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Advanced Maternal Age

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Advanced Maternal Age
Does fertility age? Unfortunately, yes. And it ages faster for women than for men.

Swati, a high-flying executive in a bank, got married to colleague and friend Vinayak when she was 28. Extremely good at her work and identified by her bank as one for greater responsibilities, Swati found herself moving up the ladder fast. As career took precedence, motherhood had to be put on hold for a while, and Vinayak stood by her decision. When just past 35, a friend advised Swati not to delay her pregnancy any more. But, when she did not conceive even after a year of trying, she began getting worried and approached an infertility specialist.

Advanced maternal age refers to pregnancy in a woman above 35 years of age. A woman is born with a set number of eggs that grow lesser with age. At ovulation during each menstrual cycle one egg is released by the ovary. A woman is at her most fertile between 20 and 30 years of age. Post 35, with both the number and quality of eggs deteriorating, chances of a normal pregnancy also reduce, while the risk factors associated with pregnancy increase.

Why does normal pregnancy become difficult for a woman post 35?

A number of factors can be responsible for this.

  • Declining number of eggs. With less eggs, fertility also begins to decrease rapidly.
  • The eggs you have are more likely to have chromosomal defects. This decreases chances of fertilization and increases risk of miscarriage and birth defects.
  • With age myriad other health conditions can become factors to be concerned about – diabetes, hypertension, etc.

What are the risks associated with Advanced Maternal Age?

An older mother-to-be is more likely to have health risks associated with pregnancy, which may include:

  • Gestational diabetes: A temporary condition where the sugar levels of the mother go up. This needs to be tightly monitored and the sugar level kept under control as high levels can lead to a larger baby and birth complications.
  • High blood pressure: The risk of hypertension increases with advanced age pregnancy. This, again, needs regular monitoring as it increases risk of premature birth
  • Greater risk of premature birth with low weight baby: Which increases risk of complications in the baby
  • Risk of chromosomal conditions is higher in the baby: Conditions like Down’s Syndrome are seen more in children born to older mothers
  • Chances of miscarriage are more

Be aware, stay healthy

This does not mean that a woman cannot get pregnant post 35. A large number of women do conceive naturally and have healthy pregnancies, but it is important to understand the risks and take the necessary precautions to avoid complications. Talk to your doctor and understand the precautions you need to take. If you are over 35, remember to:

  • Go for a preconception consultation to understand the risks and the precautions you need to take
  • Take diet counselling to understand what will be most beneficial for you
  • Seek help of a physiotherapist to both pre and post pregnancy tips
  • Avoid smoking and drinking
  • It may be advisable to go for genetic testing

If you are unable to conceive even after trying naturally for six months, it is recommended to visit an infertility specialist. The doctor will run you through tests to understand your medical condition. She may give you some medications to help your ovulation process. If you are unable to conceive naturally even after this, in-vitro fertilization is a safe and effective technique that can help you achieve your dream of parenthood.

Fertility treatment

Osteoporosis and Fertility – Is there a connection?

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Osteoporosis

Osteoporosis and osteopenia are conditions where the bone structure is impacted by low bone mass or density, leading to brittle bones and a heightened risk of fractures.

Does osteoporosis affect fertility?

# Broadly speaking, osteoporosis doesn’t directly lead to infertility. However, there could be some indirect linkages. Pregnant women often experience increased calcium mobilization and bone resorption towards the later stages of pregnancy, which could sometimes lead to osteoporosis and fractures, more so among young women.

# Also, nearly all women with premature ovarian failure triggered by the inadequacy of estrogen, are impacted by osteoporosis. Still, pregnancy-linked osteoporosis remains a rare condition.

# In men, osteoporosis is often associated with low levels of testosterone, which affects sex drive and can lead to erectile dysfunction as well as low sperm count, rendering conception difficult.

# The process of decrease in bone mass density begins earlier among women than men, which is often attributed to vitamin deficiencies, lack of exposure to the sun, multiple pregnancies, less exercise, etc. Also, women who run the risk of early menopause due to some genetic reasons or otherwise, are more prone to osteoporosis.

# Although osteoporosis in itself doesn’t impact fertility, a severe condition can sometimes lead to spine or hip fractures during pregnancy.

# Sometimes, the doctor might advise a C-section to avert pelvic fractures during delivery.

# Women having a low reserve of eggs in early life are also more susceptible to osteoporosis. Vitamin D deficiency can affect fertility too by affecting egg quality.

Are infertile men more at risk of osteoporosis?

# Doctors opine male infertility is responsible for around 60% of infertility cases, and the problems could be precipitated by diseases like osteoporosis and diabetes. 

# Male infertility is often linked to low testosterone levels, which doesn’t only impact fertility, but metabolism, bone density and energy levels as well.

# Endocrinologists have found that around one-third of men who find it difficult to conceive have an elevated risk of diabetes and osteoporosis.

# Low levels of testosterone might hasten bone breakdown, leading to a lower bone density.

How can you keep your bones strong to keep osteoporosis at bay?

# Have a calcium-rich diet including milk, curd and other milk products, fish, egg yolk, etc.

# Take a calcium supplement during pregnancy and after childbirth

# Stick to a mild exercise regimen like walking and mild lifting to improve bone quality and balance

# Your doctor might prescribe medication including hormonal treatment to prevent osteoporosis

# Check your vitamin D levels and bone mass density, more so if you have a history of injuries

# Quit smoking now

# Address vitamin and mineral deficiencies

# Practice yoga to improve bone health and posture

While it should be safe to plan a pregnancy even with osteoporosis, if the condition is really severe, it’s wiser to seek a specialist’s advice, and at times, surrogacy or adoption might be suggested. More often than not though, the prognosis is positive and the issue can be resolved in consultation with your doctor.

Fertility treatment

Diabetes: How does it affect fertility?

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Diabetes and infertility

Scientific research has established that uncontrolled diabetes can affect fertility and reproductive health in both men and women. It is linked to hormonal disruptions, poor sperm quality and DNA damage, often resulting in irregular or absent menstrual cycles in women, while men could find it difficult to achieve and maintain erections.

What effect does diabetes have on fertility?

Diabetes can have different repercussions among women and men in terms of affecting fertility.

In women:

Infections: Women with diabetes are more prone to infections and damage to their reproductive organs, most commonly, the fallopian tubes.

Complications with pregnancy: Uncontrolled blood sugar levels can lead tomiscarriage or congenital defects in the foetus or even to ‘big baby syndrome’ or macrosomia.

Subdued libido: Most women with diabetes would suffer from fatigue, increased anxiety and depression, which could lead todecreased sexual desire. They can also feel pain and discomfort during sex because of decreased vaginal lubrication.

PCOS: Type 2 diabetes and obesity are also linked to PCOS or Polycystic Ovarian Syndrome, a metabolic disorder characterized by an excess of male hormones.

Anti-sperm antibodies: Diabetes can produce antibodies which may attack the sperms and even her eggs.

In men:

Sexual dysfunction: Men with diabetes often find it difficult to maintain an erection leading to infertility.

Decreased libido: Diabetic men also suffer from fatigue, weakness and loss of sexual drive, since certain areas of the brain don’t receive enough glucose, which is the only source of energy.

Damage to sperm DNA: Men with diabetes can experience impaired reproductive potency because of increased nuclear, mitochondrial and DNA damage.

Poor sperm quality: Type 2 diabetes is linked to poor sperm concentration in semen and also sub-par motility. Structural damage to the sperm and its DNA are also commonplace.

How is diabetes-related infertility treated?

A more holistic approach involving the couple’s respective family and medical histories is the ideal strategy. The aim is to achieve better control over the glycemic level and reproductive hormones and functions.

Some of the treatment options available are:

Medications: Treatment approach often startswith medications to stimulate ovulation in women, besides treating infections. Medications (sometimes coupled with hormonal supplements) are also used to treat issues like erectile dysfunction and premature ejaculation in men.

Surgical management: Surgical management often becomes a necessity to treat some cases of PCOS, uterine fibroids, trauma injuries, etc.

Advanced reproductive technologies (ART): For men, ART experts use procedures forsperm retrieval and intracytoplasmic sperm injection. For women, the methods generally deployed are in-vitro fertilization, intrauterine inseminationand assisted laser hatching.

However, it’s not all gloom and doom if you have diabetes and planning to start a family. It just requires early and comprehensive planning involving multiple specialties including endocrinologist, gynecologist and andrologist. The goal is to maintain your blood glucose levels at an optimum range to facilitate conception and maintain pregnancy till full-term. It’s all about cutting risks, watching your weight, eating right and meticulously following the advice of the doctors. Sometimes it will be absolutely necessary to seek help from a fertility expert as well.

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Fertility Preservation: ‘Preserving’ your dreams of Motherhood

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Fertility Preservation

Breast cancer is regarded as the most prevalent malignancy in women and usually, the incidence is higher among older women, a majority diagnosed post-menopause. However, a large number of young women too are diagnosed with breast cancer during their reproductive lifespan. A lot of these patients experience difficulty conceiving after cytotoxic chemotherapy and/or hormone therapy.

With increasing positive outcomes in breast cancer treatment thanks to rapid advances in methods and techniques in modern medicine, it is becoming more and more relevant to consider fertility preservation in these patients. Fertility preservation is “the process of saving or protecting eggs, sperm, or embryo” to enable a person to use them to conceive in future.

The key to successful fertility preservation in cancer patients is early counseling and a prompt referral to a reproductive specialist. This gives the patients and their spouses/kin adequate time to make an informed decision on an appropriate method of fertility preservation, since there are a whole host of linkages between cancer diagnosis and fertility to consider and it can be really overwhelming.

What are available options of fertility preservation for breast cancer patients?

The currently used methods include: Cryopreservation of embryos; Oocytes cryopreservation; Gonadotropin-releasing hormone agonist treatment before and during chemotherapy; Ovarian transposition.

The most suitable method of fertility preservation is usually arrived at following a threadbare discussion of all the pros and cons between patients and doctors.

The entire process of fertility preservation following a breast cancer diagnosis can be traumatizing and confusing for couples. Men can bank their sperm without much ado, but for women, it’s a little more complicated. Cryopreservation of embryos is a commonly used technique these days for preserving fertility for use in assisted reproductive technology like IVF or in-vitro fertilization.

Who else can benefit from fertility preservation?

Individuals afflicted with certain illnesses or disorders which affect fertility could also benefit from fertility preservation. These include:

  • Those who have been exposed to toxic chemicals
  • Those suffering from endometriosis
  • Those having uterine fibroids
  • Patients needing treatment for an autoimmune disease
  • Those having a genetic disorder affecting fertility
  • Women who push back childbearing

Studies have shown that women diagnosed with breast cancer who have completed their treatment, “had no increased risk of relapse” if they delivered a baby following conception through IVF techniques. Overall, there is “no clear evidence” that ovulation induction or IVF increases the risk of breast cancer. The same studies on breast cancer patients also reveal that pregnancy and childbirth are not known to increase the risk of relapse.

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