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Reproductive aging: understanding the ticking of the Biological Clock of fertility and age

The ability to conceive and have children is a fundamental aspect of human life. However, fertility is not a timeless gift, and age plays a significant role in a person’s reproductive potential. With age the conception rates go drastically down. Both men and women experience changes in fertility as they age, but women, in particular, face a biological clock that affects their reproductive capacity leading to age related infertility. In this blog, we will explore the impact of age on fertility, the underlying biological factors, and the implications for family planning and assisted reproductive technologies.
Understanding impact of age on Female Fertility:
Female fertility is intricately linked to the menstrual cycle and the process of ovulation. Women are born with a finite number of eggs that is between 2 to 20 million, and this ovarian reserve gradually declines over time. As women approach their late 30s and 40s, the quality and quantity of eggs diminish, making it more challenging to conceive naturally and increasing the risk of chromosomal abnormalities in the embryos. 
The Decline in Fertility with Age:
  • Ovarian Function: The most significant factor influencing female fertility is the decline in ovarian function and the reduction in the quantity and quality of eggs over time. As women age, the number of eggs remaining in the ovaries decreases, and the remaining eggs are more likely to have genetic abnormalities, reducing the chances of successful conception and increasing the risk of miscarriage.
  • Menstrual Cycle Irregularities: Age-related hormonal changes can lead to irregular menstrual cycles, making it difficult to predict ovulation accurately. This irregularity can further complicate natural conception attempts. It will displace and shorten the fertility window of conception with age.
  • Increased Time to Conceive: As a woman’s ovarian reserve decreases, it often takes longer to conceive. The chances of achieving pregnancy decrease significantly after the age of 35, and by the age of 40, the decline becomes more pronounced.
  • Increased Risk of Pregnancy Complications: Advanced maternal age is associated with an increased risk of pregnancy complications such as gestational diabetes, preeclampsia, and preterm birth. Additionally, the risk of chromosomal abnormalities, particularly Down syndrome, increases with maternal age.
Male Fertility and Age:
While women have a well-defined biological clock, men also experience changes in fertility with age, although the decline is more gradual and less pronounced. However, it’s important to note that men can father children at older ages compared to women. Nevertheless, advanced paternal age has been associated with a higher risk of genetic disorders and certain health conditions in offspring.
Family Planning and Assisted Reproductive Technologies:
The declining fertility with age has significant implications for family planning. Couples who delay starting a family may face difficulties conceiving naturally or may require assisted reproductive technologies (ART) to achieve pregnancy. Here are some options to consider:
  • Timely Family Planning: It’s important for individuals who desire to have children to be aware of the impact of age on fertility and make informed decisions about the timing of family planning. Discussing reproductive goals with a healthcare professional can provide valuable insights and guidance.
  • Fertility Preservation: Women who wish to postpone childbearing or delay their motherhood may opt for fertility preservation methods, such as egg freezing or embryo cryopreservation, while they are still in their reproductive prime of 20s and 30s. This allows them to preserve their eggs or embryos for use in the future when their fertility may be compromised. This help freeze their fertility.
  • Assisted Reproductive Technologies: ART, such as in vitro fertilization (IVF), can help overcome age-related fertility challenges. IVF involves the retrieval of eggs, fertilization with sperm in a laboratory, and the transfer of resulting embryos to the uterus. The use of donor eggs or sperm may also be considered in cases where a person’s own reproductive potential is severely compromised.
  • Ovarian rejuvenation: though still a research therapy but treatments live stem cell therapy or platelet rich plasma (PRP) therapy  with other adjuvant medicines can be tried for ovarian regeneration to achieve more number of eggs in IVF.
  • Genetic Screening: As maternal age increases, the risk of chromosomal abnormalities in embryos also rises. Preimplantation genetic testing (PGT) can be performed during IVF cycles to screen embryos for specific genetic conditions, increasing the chances of selecting chromosomally normal embryos for transfer.
Age significantly impacts fertility, particularly for women due to the biological clock and the decline in ovarian function over time. Understanding the effects of age on fertility is crucial for individuals and couples planning to have children. Timely family planning, fertility preservation, and the use of assisted reproductive technologies can help mitigate some of the challenges associated with age-related fertility decline. It is important for individuals to consult with healthcare professionals and fertility specialists to discuss their options, receive personalized advice, and make informed decisions regarding their reproductive journey. But remember your biological clock is ticking so you can freeze it but can’t stop it.
Senior Consultant Gynaecologist And IVF specialist
Co Director IVF

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