Conception

How do I know if I’m still fertile?

Nowadays, for various and even valid reasons, a woman faces her first pregnancy much later than she did 20 or 30 years ago. If the age of the first child has risen, the biological clock of the woman has not undergone any particular changes.

Therefore, when a woman decides to have her first child, her fertility is often no longer optimal. Research conducted at the University of Edinburgh has highlighted the harsh reality of the facts: at the age of 30, 95% of the women examined have only 12% of the initial number of ovarian follicles that can develop into egg cells. And at 40, only 3% remain. In short, a somewhat demoralizing panorama even for me who am reading this since I am 37 years old: it makes me feel on the path of decline. But fortunately there is the flip side: the same research points out that females have about 600,000 potential egg cells at birth and therefore, even if we lose 88% of them in the first 20 years, we still have 72,000 available. And they are not few.

After the age of 35, however, egg cells can lose their initial quality, anovulatory cycles appear more frequently even if menstruation is regular. According to the American Society for Reproductive Medicine, while a 30-year-old woman has a 20% chance per cycle of getting pregnant with targeted intercourse, a 40-year-old woman has only a 5% chance per month.

If you are in your thirties and want to know more about your fertility, there are some tests that must be performed and which can give useful indications. They should be repeated annually for those who want to monitor the progress of their fertility in view of a future pregnancy.

Here’s what they are

  • Dosage Follicle Stimulating Hormone (FSH) in the blood: The test measures the levels of this hormone which is responsible for the maturation of the follicle and therefore has an important role in the release of the egg cell (ovulation).
  • Estradiol Dosage : Estradiol is a hormone that is part of the estrogen family. It is produced and released by the ovaries, adrenal cortex and placenta which forms during pregnancy to feed a developing baby
  • Anti Mullerian Hormone (AMH)  : AMH values ​​decrease in parallel with the reduction of ovarian follicles so  its measurement can give an idea of ​​what a woman’s ovarian reserve is .
  • 25-hydroxy vitamin D: this exam evaluates the possible calcidiol deficiency . This pre-hormone, which is then converted in our body into the biologically active form of vitamin D, decreases with age. Its deficiency can predispose the child to some complications

Obviously when time is not on our side, medicine comes to our aid . Nowadays it is possible to retrieve and freeze oocytes for example for future in vitro fertilizations.

According to research published in the New England Journal of Medicine, women aged 35 or younger who undergo up to a maximum of 6 IVF cycles have a 65-86% chance of getting pregnant and completing the pregnancy. pregnancy. Women aged 40 or more, on the other hand, have a halved probability: in this case, in fact, the success rates of in vitro fertilization range from 23 to 42%.

However, in the years preceding menopause (perimenopause) it is possible to get pregnant but there is a much greater risk of chromosomal complications. Risk that increases as the mother’s age increases. It is therefore advisable for women over 35 to talk to their gynecologist about possible tests to be carried out to evaluate the state of fetal health and the probability of chromosomal abnormalities including Down’s Syndrome.

Even men experience a decline in fertility after the age of 50,  however it is the maternal situation that has the greatest impact.

Older men have increased levels of sperm DNA instability, which is linked with a higher risk of autism and schizophrenia in children, according to Eric J. Topol, MD, professor of genomics at The Scripps Research Institute and author of the book. “The Creative Destruction of Medicine”.

Having said that, let’s be clear, a person is free to decide to have a child at the time of their life that they deem most appropriate and right, postponing this appointment to the bitter end.

The right man doesn’t necessarily meet at 20, maybe he meets at 40 or later and we can’t intervene on this.

But we women must also be aware that the more the years go by, the more not only the chances of achieving a natural pregnancy but also the chances of success of an assisted fertilization process decrease.

And as always: in the stork’s beak!

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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