Women’s Month Focus: Advanced Maternal Age Driving Infertility Among Women

As more women delay conception into their 30s, increasing numbers are struggling to conceive. This is often due to what is called ‘advanced maternal age’ – a global trend and a significant driving force of infertility among women today.

During this Women’s Month, our team at Medfem Fertility Clinic would like to contribute to raising awareness of advanced maternal age and its consequences for growing numbers of modern women, and to make available information about the options and fertility treatments available.

August is Women’s Month in South Africa, and is centred around the Women’s Day celebrations on 9 August – a public holiday commemorating the more than 20,000 women who marched to the Union Buildings on 9 August 1956 in protest against the extension of Pass Laws to women – and changed the course of history.

Women’s Day is an opportunity to pay tribute to these women and to all women, recognising their unique and extensive contribution to the world, which encompasses bringing the next generation of humans into the world. Having been part of welcoming more than 18,000 babies into the world, our team at Medfem Fertility Clinic have a deep understanding of just how valuable women and their unique contributions are.

Women’s Day is also an opportunity to raise awareness of issues that affect women, and at Medfem, we are passionate about contributing to raising awareness of issues that affect women’s fertility.

Certainly one of the most pressing issues affect women’s fertility in today’s modern world is advanced maternal age.

What is advanced maternal age?

Advanced maternal age refers to age 27 and older in women, and the fact that women who are older than 27 are at higher risk to encounter delay and/or disappointment due to decreased fertility.

The reason is that women’s fertility rates naturally begin to decrease significantly from as early as around the middle of the third decade or approximately age 27. This has long been known from demographic and epidemiological studies.

As more women today delay conception beyond age 27 and into their 30s, increasing numbers are struggling to conceive. Consequently, fertility clinics are seeing growing numbers of female patients with an average age of 35 and up.

This delay in conception among women is a clear global trend. The average age at which women became mothers during the 1960s and 70s was around 26, but today, the average age at which women become mothers has risen to 30.

Fifty years ago, women had generally already birthed their children by age 35. Today, however, increasing numbers of women are only having their first – or maybe second – baby at age 35.

This is a significant change and one that is very important from a female fertility point of view, because it is a major driving force of rapidly increasing cases of infertility among women today.

Women’s fertility decline with age

The decline in a woman’s fertility over time happens in a number of ways, including a reduction in quantity and a drop in quality.

In terms of quantity, women are born with a certain number of eggs and these cannot be replenished. Each woman starts out with millions of eggs, but thousands of eggs are lost every month – starting even from pre-puberty, and even if women are taking contraceptives.

Different women also have different numbers of eggs, and women go through perimenopause and menopause at greatly varying ages, from the age of 20 right up to age 50.

In addition, as a woman ages, the chromosomal quality of the remaining eggs also diminishes. This is a crucial issue, because a normal egg is an absolute necessity for a normal baby.

Intercourse frequency also declines on average with age. This also plays a big role.

All these factors contribute to the fact that fertility specialists are seeing increasing numbers of women who already have a poor prognosis in terms of their egg reserves and the number of normal eggs they have.

It is in large part due to an incorrect but general perception among people that a woman’s eggs are suitable for conception at any age. Unfortunately, this is not true. From as early as age 27, the decline in the number and quality of eggs is significant and rapid.

This has been shown scientifically and is referred to as ovarian aging.

Ovarian aging explained

The main component of an ovarian aging is that the number of eggs declines.

Certain indicators can be used determine the number of remaining eggs or ‘ovarian reserve’ as it is called, and four of these are mentioned below.

1. Ovarian volume – using an ultrasound, fertility specialists check the size of the ovaries and measure the ovarian volume.

2. Antral Follicle Count (AFC) – done on day two or three of a woman’s cycle using transvaginal ultrasound to count the number of early little follicles.

3. Antimullerian Hormone (AMH) – reflects the number of eggs remaining and is the most useful marker of ovarian reserve.

4. FSH (Follicle Stimulating Hormone) – one of the best ways to evaluate fertility potential by measuring the concentration of FSH on the second or third day of the menstrual cycle. As egg numbers or reserves decline, the FSH level increases.

These indicators help fertility specialists predict how many eggs there are and thus what the egg reserve is like. They also predict in a certain way the time remaining to ovarian failure – when menopause starts. These indicators also provide an indication of how well a patient might respond to fertility medications used during fertility treatments.

However, none of these measurements directly reflect the quality of the eggs, in which the genetic composition of the eggs plays a significant role.

The ovarian reserve indicators may reveal that you have fewer eggs, but it does not reveal the quality of the eggs. It is generally assumed that the quantity and quality of the eggs are related, but this is not the truth.

The reality is that the older a woman becomes, the higher number of abnormal eggs she will have. And lower fertility is more a function of egg quality than it is a function of egg numbers.

As a result, women who are already aged 45 or older have very little chance of achieving a pregnancy, irrespective of their egg reserve.

Options and treatments for fertility at advanced maternal age

If you are concerned about your fertility, or if you are already 27 or older and postponing conception, don’t delay in getting specialist advice.

There are treatments and options that can help protect and improve your chances of having a child, now and in the future.

These include, for example, fertility preservation options for those who want to postpone conception, such as egg freezing, embryo freezing with pre genetic testing, and ovarian tissue preservation. These are also options for the many women who face medical treatments that can negatively affect their fertility in future, such as radiation treatment or chemotherapy.

For women who want to conceive now, there are possible treatment and options, ranging from lifestyle modifications to IVF or In Vitro Fertilization with donor eggs.

If you would like to know more, meet one of our fertility specialists at Medfem Fertility Clinic, by simply clicking here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

Our Fertility Specialists can also meet with you during a virtual consultation via Zoom or Skype. Click here to book a virtual consultation now.

We look forward to meeting you!


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