Why Age Matters?
Women in western society over the last 50 years have chosen to delay childbearing. With women’s rights movement providing more opportunities to women, women have increasingly chosen to delay marriage and childbearing in exchange for higher educational and career aspirations.  In the last 20 years we have been seeing a similar trend in the Middle East and in other parts of the developing world.

More and more women are going to college and an increasing number are continuing their educations beyond college.   In the Kingdom of Saudi Arabia approximately 60% of college students are female.

Women are also pursuing careers in what was traditionally considered male careers. Many of these careers are lifetime careers; like medicine, accounting and Law.

All these positive and long sought after social changes have made women’s lives more full and rewarding. They have also bestowed on women the sense of power and control of their own destinies. With women in control of their destinies, education, and careers societies pressure to “marry and have children” has greatly diminished. With the availability of contemporary birth control pills and other birth control methods women have also taken control of their reproductive lives.

Women are also delaying childbirth until later in life because they have an exaggerated belief that fertility treatments will help. The media has also fueled this exaggerated belief. Media accounts of celebrity mothers achieving pregnancy at an older age using IVF and other fertility treatments has given women a sense that it is “OK” to delay childbearing.

Fertility clinics and physicians often encounter women who have read or seen on TV a celebrity in there 40’s or 50’s “who just got pregnant”. These women wonder if the same can be done for them.

Medical professionals often share many of the misconceptions of the effectiveness of infertility treatment. It is not uncommon to find patients at fertility clinics that were given misguided advice by their physicians.

The American College of Obstetricians and Gynecologists put out a committee opinion stating, “Age is a significant factor influencing a woman’s ability to conceive. Social trends have led to deferred childbearing, and an increasing number of women are experiencing age-related infertility and pregnancy loss. Women older then 35 years should receive expedited evaluation and treatment after 6 months of failed attempts to conceive, or earlier if clinically indicated”

Why Does Age Impact Reproduction:
There are several ways in which age affects fertility.

Quantity: Women are born with one million oogonia (oogonia are the cells that mature into eggs), and by onset of puberty the number of oogonia declines to 300,000. The oogonia number continue to decline as women age, by age 37-38 the oogonia decline to approximately 25,000.

Quality: Since the eggs are present from birth, women cannot produce new eggs as they age. The existing eggs that women are born with diminish over time. This dwindling of eggs called atresia. The eggs also start to diminish in quality over time. It is also noted that DNA fragmentation increase as women age, as well as an increase chromosomal degeneration.

Recently research has shown that the structures that separate the chromosomes during cell division may also be affected by age. These structures are called Microtubules. These tube like structures are similar to anchors and they pull one chromosome to each side of the dividing cell. When these Microtubules function improperly or are damaged then the cells division of chromosomes is compromised. This is likely to be the cause of increased chromosomal abnormalities in children born to older mothers.

Some new studies also show that a group of proteins called Cohesins are responsible in holding Chromosomes together. These studies indicate that these Cohesins may be reduced as women age.

Whats Next?
As we now know fertility declines for women as they get older. The decline in fertility declines at different rates for different women. If you are over the age of 35 and desire to have children it is important that you talk to your gynecologist, family doctor or Fertility Specialist. Obtain the information that you need to help you through the process. Ask your doctor if testing is appropriate for you. Remain
realistic about your goals and your chances for success.

Simple Steps:

• Talk to your Gynecologist, Family doctor or fertility specialist.
• Simple tests can be helpful (see below)
• Be your own advocate
• Talk to your Husband openly
• Keep a record of your menstrual cycles.
• Keep a record of any symptoms
• If you have tried to conceive for over 6 months without success then seek help.

Simple Tests:
1. FSH: measuring your FSH (follicle stimulating hormone) early in your menstrual cycle [day 2,3 or 4] will evaluate your “ovarian reserve”. Perhaps one of the most simple and informative tests a woman can do to help assess her chances of getting pregnant. (blood test)

2. Semen Analysis: although a male test, it is simple to do, non-invasive and inexpensive. Male infertility accounts for 20-30% of infertility cases. (evaluates sperm under a microscope)

3. HSG: evaluates your fallopian tubes. It is a special radiologic study that will determine if your fallopian tubes are patent or if there are any blockages. Fallopian tube problems account for 20-25% of infertility cases worldwide. (uncomfortable procedure, more involved, lasts about 10 mins)

4. SIS: Saline infusion Sonogram: a specialized ultrasound test that evaluates the uterine walls, the uterine cavity and the ovaries.

With these 4 easy tests a woman can determine 80-90% of the causes for infertility.

If you are worried about your age and fertility potential and you live in the Kingdom of Saudi Arabia or anywhere in the region feel free to see any of the fertility specialists that helped write this article.

Written by:
Dr. Mazin Abdullah:
American Board Certified OB/GYNE.
American Fellowship trained in Infertility.
Currently working at Sulaiman Al Habib Hospital (Arrayan)
Drmazinabdullah@gmail.com
+966-11-490-9793 / +966-11-490-9935 / +966-56-897-8531

Editor:
Dr. Majed Hudhud:
British Board Certified OB/GYNE.
British Fellowship Trained in Infertility.
Currently working at Sulaiman Al Habib Hospital (Arrayan)
Drhudhud@gmail.com
+966-11-490-9793 / +966-11-490-9935 / +966-56-897-8531

Arabic Translation:(article in arabic to be posted soon)
Dr. Dalal Suttam
Saudi Board Certified OB/GYNE.
Saudi Fellowship Trained In Infertility
Currently working at Sulaiman Al Habib Hospital (Arrayan)
Dr_dalal_kgh@hotmail.com
+966-11-490-9793 / +966-11-490-9935 / +966-56-897-8531