Advanced Maternal Age – What Are My Options?

The term “advanced maternal age” is generally used to refer to the age of women who are older than 35 years. The reason for this is that a woman’s ovarian reserve diminishes with age and rapidly after age 35 – which is considered an ‘advanced’ age for women trying to fall pregnant.

Advanced maternal age can affect fertility in three ways: making it more difficult to fall pregnant; increasing the risk of miscarriage and chromosomal abnormalities such as Down syndrome in the embryo; and increasing the risks of the pregnancy to the mother’s health. Fortunately, advanced maternal age does not mean that you are unable to have a baby – it simply means that you will need medical assistance to achieve and successfully carry a pregnancy.

In this article, we look at the extent to which advanced maternal age affects fertility and pregnancy, and some of the treatment options that are available to address these challenges.

The impact of advanced maternal age

The effect of advanced maternal age on your chances of getting pregnant is sobering.

Research shows how dramatically your chances of falling pregnant declines with age, as detailed in the table below.

Age – Chance of Pregnancy (per month)
20 – 35 = 25%
35 – 39 = 18%
40 – 44 = 5%
45+ = 1%

The reason for this is that women experience a decline in fertility with increasing age, as both their egg numbers and egg quality diminish. The decline is gradual until the early 30s but accelerates quickly after age 35.

Even if you do fall pregnant, advanced maternal age also poses a risk of miscarriage and of genetic abnormalities.

Advanced maternal age and pregnancy

Age – Chances of a genetic abnormality
20 – 35 = 1 in 1200
35 – 39 = 1 in 350
40 – 44 = 1 in 38
45+ = 1 in 12

Advanced maternal age and miscarriage

Age – Chances of miscarriage
20 – 35 = 20%
35 – 39 = 25%
40 – 44 = 35%
45+ = 50% +
Furthermore, women who become pregnant at an older age have a higher risk of complications during the pregnancy, such as gestational diabetes and preeclampsia.

What are the treatment options?

However, there are a number of ways in which the effects of advanced maternal age can be overcome.

Lifestyle changes

While it is not possible to slow down or reverse reproductive aging, making certain lifestyle changes will improve your overall health and therefor also your fertility.

Studies suggest that smoking, poor diet and stress may have an impact on the quality of eggs of a woman’s eggs and may accelerate menopause.

Eating well, exercising regularly, getting enough sleep, avoiding smoking and alcohol, and adopting a lifestyle that reduces stress will improve your overall health and also your fertility.

However, improved health will not offset the natural age-related decline in female fertility, which can take place much sooner than many women expect.

Testing ovarian reserve

A woman is born with all her eggs, so there are no methods/treatments to grow more or new eggs, or to preserve the quality of those eggs still in reserve.

However, your ovarian reserve – which is the number and the quality of your eggs – can be estimated using blood tests for follicle-stimulating hormone (FSH) or antimüllerian hormone (AMH) levels. An ultrasound is sometimes used to count the number of follicles, called an antral follicle count (AFC).

Egg donation

Another option is to use donated eggs. Egg donations are made by young, healthy women, and as a result, the pregnancy rate, the rate of miscarriage and chances of genetic abnormalities are also those of the younger woman.

For this reason, many women in their 40s choose to use donor eggs to become pregnant, with success rates of about 80% per IVF cycle.

Because of the increased risks of miscarriages and genetic abnormalities, the vast majority of women over 45 also choose to use donor eggs.

Medical treatments

Whether using donor eggs or your own, there are several medical strategies that can maximise the chances of conceiving.

These procedures focus on bringing the egg and sperm together at the optimal time for conception to occur. These can include intrauterine insemination (IUI), in vitro fertilization (IVF) or taking fertility medications, such as those used for ovarian stimulation.

In brief, ovarian stimulation involves a course of hormone therapy taken through daily hormone injections to stimulate the ovaries to produce more eggs than usual. IUI involves inserting large amounts of sperm directly into a woman’s uterus, significantly increasing the chance of egg fertilisation.

During IVF, an egg (from the female partner or from a donor) is fertilised with sperm in a laboratory to create several embryos (fertilised eggs). After three to five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation hopefully occurs and pregnancy begins.

Fertility preservation

Women who want to delay starting a family, or who face medical treatments that can negatively affect their fertility in future (such as radiation treatment or chemotherapy), can consider methods to preserve their fertility.

Egg freezing and storage is a realistic option today thanks to a revolutionary technology called vitrification – a new freezing technique. Vitrification freezes the eggs at a very fast rate, with significantly improved survival rates for eggs than previously used slow-cooling techniques.

Freezing embryos (fertilised eggs) – or embryo cryopreservation as it is also called – is used in fertility programs to freeze and store embryos from an assisted reproductive cycle, such as IVF, for future use. In many cases, there are spare good quality embryos that are suitable to be cryopreserved for use at a later stage, for example, if a couple’s first attempt at IVF fails, or if they would like to have more children in the future.

Embryo freezing allows for the storage of unused embryos for an indefinite amount of time. At a future time, a Frozen Embryo Transfer (FET) can be performed in a simple, short procedure.

Embryo Genetic Testing

Studies have shown that as many as 50% of embryos are chromosomally abnormal. If transferred, these embryos are likely to fail to implant or may result in a miscarriage.

Today advanced techniques of genetic analysis allow for egg and embryo screening for genetic and chromosomal information and for specific abnormalities. The most common embryo testing techniques are preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS).

PGD enables embryos to be tested where the parents carry a known genetic marker for a specific inherited disorder. Used for more than 20 years, PGD is of great benefit to women of an older maternal age, and those with a history of miscarriage or failed IVF cycles, and is known to improve IVF pregnancy rates.

PGS involves the detection of chromosomally abnormal embryos that result in IVF failure, miscarriages or babies born with Down’s syndrome or Edward’s Syndrome. It is used in cases of advanced maternal age, repeated IVF failures, recurring miscarriages, or previous pregnancies that were genetically abnormal.

Which treatment option is right for me?

If you are already of advanced maternal age, or if you are delaying starting your family beyond your 30s, or if you have any reason to be concerned about your fertility, we invite you to meet one of our fertility specialists at Medfem Fertility Clinic.

At Medfem, we believe in helping you reach your family dream through:

* World-Class Fertility for Everyone
* A Positive Fertility Journey
* Delivered With Empathy & Caring

We make world-class fertility treatments available for everyone and it is our joy and commitment to give you a positive outcome to your fertility journey, so you will have a fond memory of feeling empathy, caring and being part of the Medfem Fertility Clinic family.

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244, and we will be able to assist you to identify the optimal treatment for your fertility challenge.

We look forward to meeting you!



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