What Women Can Do About Age-related Infertility


In an insightful opening talk at this year’s Fertility Show Africa, Dr Antonio Rodrigues – a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic in Sandton, Johannesburg, South Africa – highlighted trends that are driving an increase in the number of women who require assistance to achieve a pregnancy.

Dr Rodrigues says that there are two global fertility trends that are already clearly evident in Western countries.

Global Trends In Women’s Fertility

The first trend is that people are having fewer children. The number of live births per woman has dropped from an average of 4.5 in the 1950s to just 2 in 2017 and the numbers continue to decline. While this may sound positive in the context of overpopulation globally, the reality is that some countries are experiencing negative population growth and will in future not have enough young people to manage their older population.

The second trend that is also clearly evident globally – and very important from a fertility point of view – is that the average age at which women become mothers is now 30. From a low of around 26 during the 1960s and 70s, the average age at which women become mothers has risen to 30 today.

This is a significant change. Fifty years ago, women had generally already birthed their children by age 35, and another child after this age was often a surprise. Today, however, increasing numbers of women are only having their first – or maybe second – baby at age 35, or the first baby in a new relationship.

This has given rise to increasing cases of infertility. As more women delay conception into their 30s, increasing numbers are struggling to conceive. Women who choose to postpone conception beyond age 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. Consequently, fertility clinics are seeing increasing numbers of female patients with an average age of 35 and up.

How Women’s Fertility Decline With Age

The decline in a woman’s fertility over time happens in a number of ways.

Firstly, women are born with a certain number of eggs (called ‘oocytes’ in medical terms) and these cannot be replenished. Even though each woman starts out with millions of eggs, thousands of eggs are lost every month – starting even from pre-puberty, 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.

Secondly and importantly, 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 requirement for a normal baby.

Thirdly, 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.

Understanding Ovarian Aging

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.

The first indicator is called ovarian volume. Using an ultrasound, fertility specialists check the size of the ovary and measure the ovarian volume.

The second indicator is called an Antral Follicle Count (AFC) which is done on day two or three of a woman’s cycle using transvaginal ultrasound to count the number of early little follicles.

A third measurement is Antimullerian Hormone (AMH), which reflects the number of eggs remaining and is increasingly used as the most useful marker of ovarian reserve.

A fourth indicator is FSH (Follicle Stimulating Hormone – it is 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.

What Women Can Do About Age-related Infertility

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

Despite the fertility challenges created by advanced maternal age, 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 elective embryo freezing with pre genetic testing, and ovarian tissue preservation. These are also options for the increasing number of 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.

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

* World-Class Fertility for Everyone – we believe in making world-class fertility treatments available for everyone
* A Positive Fertility Journey – It is our joy and commitment to give you a positive outcome to your fertility journey
* Delivered With Empathy & Caring – So you may have a fond memory, of a feeling of empathy, caring and being part of the Medfem family

If you would like to meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
We look forward to meeting you at Medfem Fertility Clinic!



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