Understanding Age-Related Infertility in Women: Insights and Solutions

Introduction

Infertility is defined as the inability to conceive after one year of regular unprotected intercourse, or after six months if the woman is over 35 years old. Infertility affects about 15% of couples worldwide, and about one-third of the cases are due to female factors. One of the most common and significant factors that affect female fertility is age. In this blog post, we will explain how age affects fertility in women, what are the causes and consequences of age-related infertility, and what are the possible solutions and treatments to overcome it. We will also share some tips on how to preserve and enhance your fertility as you age.

How Does Age Affect Fertility in Women?

Fertility in women is largely determined by the quantity and quality of their eggs, which are also known as oocytes. Women are born with a finite number of oocytes, which are stored in the ovaries. The number of oocytes declines gradually with age, from about 1-2 million at birth, to about 300,000 at puberty, to less than 25,000 at age 37, and to almost zero at menopause. This process is called ovarian reserve depletion, and it is irreversible and inevitable.

Not only does the number of oocytes decrease with age, but also their quality. Oocyte quality refers to the ability of the oocyte to be fertilized by a sperm, to form a healthy embryo, and to implant in the uterus. Oocyte quality is influenced by several factors, such as the genetic integrity, the mitochondrial function, and the cytoplasmic composition of the oocyte. As women age, the oocytes become more prone to chromosomal abnormalities, oxidative stress, and metabolic dysfunction, which can impair their quality and reduce their chances of resulting in a successful pregnancy.

The decline in both quantity and quality of oocytes leads to a decrease in the ovarian function and the reproductive potential of women as they age. The ovarian function is measured by the ovarian reserve, which is the capacity of the ovaries to produce mature and viable oocytes. The ovarian reserve can be assessed by various tests, such as the anti-Müllerian hormone (AMH) level, the antral follicle count (AFC), and the follicle-stimulating hormone (FSH) level. The ovarian reserve declines with age, and it is associated with a lower response to ovarian stimulation, a lower number of retrieved oocytes, and a lower pregnancy rate.

The reproductive potential of women is also influenced by the age of the uterus, which is the organ that hosts and nourishes the embryo. The uterus is composed of three layers: the endometrium, which is the inner lining that undergoes cyclic changes in response to hormones; the myometrium, which is the muscular layer that contracts during labor; and the perimetrium, which is the outer layer that covers the uterus. The age of the uterus can affect the endometrial receptivity, which is the ability of the endometrium to accept and support the implantation of the embryo. The endometrial receptivity can be compromised by various factors, such as endometrial thinning, inflammation, fibroids, polyps, or adhesions, which can increase with age and reduce the chances of implantation and pregnancy.

What are the Causes and Consequences of Age-Related Infertility?

Age-related infertility is a complex and multifactorial phenomenon, which can be influenced by various biological, environmental, and social factors. Some of the possible causes of age-related infertility are:

Delayed childbearing: One of the main reasons for the increase in age-related infertility is the trend of delayed childbearing, which is influenced by various factors, such as education, career, finances, personal preferences, and availability of partners. According to the World Health Organization (WHO), the average age of first-time mothers has increased from 24.7 years in 1970 to 29.3 years in 2015, and it is expected to rise further in the future. However, many women are not aware of the impact of age on their fertility and the risks of postponing parenthood, which can lead to disappointment and frustration when they face difficulties in conceiving later in life.
Lifestyle factors: Another possible cause of age-related infertility is the exposure to various lifestyle factors, such as smoking, alcohol, caffeine, obesity, stress, and environmental toxins, which can affect the ovarian function and the oocyte quality. Smoking can accelerate the ovarian reserve depletion, increase the oxidative stress and the DNA damage in the oocytes, and reduce the blood flow to the ovaries and the uterus. Alcohol can interfere with the hormonal balance and the ovulation process, and increase the risk of miscarriage and fetal abnormalities. Caffeine can affect the oocyte maturation and the implantation process, and increase the time to conception and the risk of spontaneous abortion. Obesity can alter the metabolic and endocrine function, and increase the risk of insulin resistance, polycystic ovary syndrome (PCOS), and endometrial disorders. Stress can impair the hypothalamic-pituitary-ovarian (HPO) axis, which regulates the reproductive hormones, and affect the ovarian function and the endometrial receptivity. Environmental toxins, such as pesticides, plastics, heavy metals, and endocrine disruptors, can mimic or interfere with the natural hormones, and affect the ovarian function and the oocyte quality.
Genetic factors: A third possible cause of age-related infertility is the presence of genetic factors, such as chromosomal abnormalities, gene mutations, or epigenetic modifications, which can affect the oocyte quality and the embryo development. Chromosomal abnormalities are errors in the number or structure of the chromosomes, which can occur during the meiosis, the cell division that produces the oocytes. Chromosomal abnormalities can result in aneuploidy, which is the presence of an abnormal number of chromosomes in the oocyte or the embryo, and can lead to implantation failure, miscarriage, or birth defects. Gene mutations are changes in the DNA sequence of a gene, which can affect the function or expression of the gene. Gene mutations can cause various genetic disorders, such as cystic fibrosis, thalassemia, or hemophilia, which can affect the fertility or the health of the offspring. Epigenetic modifications are changes in the chemical marks that regulate the gene expression, without altering the DNA sequence. Epigenetic modifications can be influenced by various factors, such as age, diet, stress, or environmental toxins, and can affect the oocyte quality and the embryo development.

Age-related infertility can have various consequences, not only on the reproductive outcomes, but also on the physical, psychological, and social well-being of the affected individuals and couples. Some of the possible consequences of age-related infertility are:

Decreased pregnancy rate and increased time to pregnancy: As women age, their chances of conceiving naturally or with assisted reproductive techniques (ART) decrease, and their time to achieve a pregnancy increases. According to a study by Dunson et al. (2002), the probability of conception per cycle declines from 20% at age 30, to 15% at age 35, to 10% at age 40, and to 5% at age 45. Similarly, according to a study by the European Society of Human Reproduction and Embryology (ESHRE), the live birth rate per ART cycle declines from 32.3% at age 35, to 26.6% at age 38, to 17.1% at age 40, and to 6.6% at age 43.
Increased risk of pregnancy complications and adverse perinatal outcomes: As women age, their risk of experiencing various pregnancy complications and adverse perinatal outcomes increases, which can affect their health and the health of their babies. Some of the possible complications and outcomes are: ectopic pregnancy, which is the implantation of the embryo outside the uterus; preeclampsia, which is a condition characterized by high blood pressure and proteinuria during pregnancy; gestational diabetes, which is a condition characterized by high blood sugar levels during pregnancy; placenta previa, which is a condition where the placenta covers the cervix; placental abruption, which is a condition where the placenta detaches from the uterine wall; preterm birth, which is the delivery of the baby before 37 weeks of gestation; low birth weight, which is the birth of the baby weighing less than 2500 grams; intrauterine growth restriction, which is the poor growth of the baby in the womb; stillbirth, which is the death of the baby in the womb after 20 weeks of gestation; neonatal death, which is the death of the baby within 28 days of birth; congenital anomalies, which are structural or functional defects present at birth; and chromosomal disorders, such as Down syndrome, which is caused by an extra copy of chromosome 21.
Increased psychological distress and reduced quality of life: As women age, their experience of infertility can cause various psychological distress and reduce their quality of life, which can affect their self-esteem, their relationship with their partner, their family, and their friends, and their social and professional roles. Some of the possible psychological distress are: anxiety, which is a feeling of nervousness, worry, or fear; depression, which is a feeling of sadness, hopelessness, or loss of interest; anger, which is a feeling of resentment, frustration, or hostility; guilt, which is a feeling of regret, remorse, or responsibility; shame, which is a feeling of embarrassment, humiliation, or inadequacy; grief, which is a feeling of sorrow, pain, or loss; and isolation, which is a feeling of loneliness.

What are the Possible Solutions and Treatments for Age-Related Infertility?

Age-related infertility can be a challenging and frustrating condition, but it is not a hopeless one. There are various solutions and treatments that can help you overcome it and achieve your parenthood goals. Some of the possible solutions and treatments are:

Fertility awareness and natural conception: One of the simplest and cheapest solutions for age-related infertility is to increase your fertility awareness and optimize your natural conception chances. Fertility awareness means knowing your fertile window, which is the period of time during each menstrual cycle when you are most likely to conceive. The fertile window is usually around the time of ovulation, which is the release of an oocyte from the ovary. You can track your ovulation and your fertile window by using various methods, such as the calendar method, the cervical mucus method, the basal body temperature method, the ovulation predictor kits, or the fertility monitors. By tracking your ovulation and your fertile window, you can time your sexual intercourse to coincide with your peak fertility days, and increase your chances of conceiving naturally. However, you should also be aware of the limitations of natural conception, as it may not work for everyone, especially if you have other factors that affect your fertility, such as tubal blockage, endometriosis, or low sperm count.
Ovarian stimulation and intrauterine insemination (IUI): Another possible solution for age-related infertility is to use ovarian stimulation and intrauterine insemination (IUI) to enhance your conception chances. Ovarian stimulation means taking medications, such as clomiphene citrate, letrozole, or gonadotropins, to stimulate your ovaries to produce more oocytes in one cycle. This can increase your chances of ovulating and having more oocytes available for fertilization. Intrauterine insemination (IUI) means placing the sperm directly into the uterus, bypassing the cervix and the vagina. This can increase the chances of the sperm reaching the oocyte and fertilizing it. Ovarian stimulation and IUI can be combined to increase the success rate, especially if you have mild male factor infertility, unexplained infertility, or cervical factor infertility. However, you should also be aware of the risks and side effects of ovarian stimulation and IUI, such as ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, ectopic pregnancy, or infection.
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): Another possible solution for age-related infertility is to use in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to achieve pregnancy. IVF means fertilizing the oocyte with the sperm outside the body, in a laboratory, and then transferring the resulting embryo into the uterus. ICSI means injecting a single sperm into the oocyte, to overcome any barriers to fertilization, such as low sperm count, poor sperm quality, or oocyte hardening. IVF and ICSI can be used to overcome various causes of infertility, such as tubal blockage, endometriosis, severe male factor infertility, or unexplained infertility. IVF and ICSI can also be combined with preimplantation genetic testing (PGT), which means screening the embryos for chromosomal abnormalities or genetic disorders, before transferring them into the uterus. This can increase the chances of implantation and pregnancy, and reduce the risk of miscarriage and birth defects. However, you should also be aware of the costs and complications of IVF and ICSI, such as high financial burden, emotional stress, invasive procedures, multiple pregnancy, ectopic pregnancy, or infection.
Oocyte donation and surrogacy: Another possible solution for age-related infertility is to use oocyte donation and surrogacy to have a child. Oocyte donation means receiving oocytes from another woman, usually a younger and healthier one, and using them for IVF and ICSI. This can bypass the problem of low quantity and quality of your own oocytes, and increase your chances of having a healthy baby. Surrogacy means having another woman, usually a younger and healthier one, carry and deliver your baby for you. This can bypass the problem of low endometrial receptivity or uterine abnormalities, and increase your chances of having a successful pregnancy. Oocyte donation and surrogacy can be used to overcome various causes of infertility, such as premature ovarian failure, menopause, or hysterectomy. However, you should also be aware of the ethical and legal issues of oocyte donation and surrogacy, such as the psychological and social implications, parental rights and responsibilities, and the legal regulations and contracts.

How to Preserve and Enhance Your Fertility as You Age?

Age-related infertility can be a daunting and discouraging condition, but it is not a hopeless one. There are various ways that you can preserve and enhance your fertility as you age, and increase your chances of having a healthy and happy family. Some of the possible ways are:

Fertility preservation: Fertility preservation means storing your oocytes, sperm, or embryos for future use, when you are ready to have a child. Fertility preservation can be done for various reasons, such as medical, social, or personal. Medical reasons include having a condition or undergoing a treatment that can affect your fertility, such as cancer, chemotherapy, radiation, or surgery. Social reasons include postponing parenthood due to education, career, finances, or lack of partner. Personal reasons include having a personal preference or a life goal that requires delaying childbearing. Fertility preservation can be done by various methods, such as oocyte freezing, sperm freezing, or embryo freezing. Oocyte freezing means extracting and freezing your oocytes when they are still young and healthy, and using them for IVF and ICSI when you are ready to conceive. Sperm freezing means collecting and freezing your sperm when they are still viable and motile, and using them for IUI, IVF, or ICSI when you are ready to conceive. Embryo freezing means creating and freezing your embryos by combining your oocytes and sperm, or donor oocytes and sperm, and transferring them into your uterus when you are ready to conceive. Fertility preservation can help you extend your reproductive window and increase your chances of having a biological child. However, you should also be aware of the limitations and challenges of fertility preservation, such as the cost, the availability, the success rate, the ethical and legal issues, and the emotional and psychological implications.
Fertility enhancement: Fertility enhancement means improving your fertility potential and your reproductive health, by adopting various lifestyle changes, natural remedies, or complementary therapies. Fertility enhancement can be done by various ways, such as:
- Improving your diet and nutrition: Eating a balanced and nutritious diet can help you maintain a healthy weight, regulate your blood sugar and insulin levels, and provide your body with the essential vitamins, minerals, antioxidants, and omega-3 fatty acids that support hormonal health and fertility. Some of the foods that can help you enhance your fertility are: leafy greens, cruciferous vegetables, berries, nuts, seeds, legumes, whole grains, lean protein, fatty fish, and dairy products. You should also avoid or limit foods that can harm your fertility, such as: processed foods, refined sugars, trans fats, caffeine, alcohol, and soy products.
- Increasing your exercise and physical activity: Engaging in regular exercise and physical activity can help you improve your blood circulation, reduce stress, balance your hormones, and enhance your fertility. Exercise can also help you prevent or manage conditions that can affect your fertility, such as PCOS, thyroid disorders, obesity, and diabetes. However, you should not overdo it, as too much or too intense exercise can have the opposite effect and impair your fertility. Aim for at least 30 minutes of moderate exercise, such as walking, swimming, cycling, or yoga, three to five times a week.
- Reducing your stress and practicing relaxation techniques: Stress can have a negative impact on your hormonal balance and fertility, as it can trigger the release of cortisol, the stress hormone, which can interfere with the production and function of other hormones, such as estrogen, progesterone, testosterone, and LH. Stress can also affect your mood, sleep, appetite, libido, and immune system, which can further impair your fertility. Therefore, it is important to reduce your stress levels and practice some relaxation techniques, such as meditation, breathing exercises, massage, acupuncture, aromatherapy, or music therapy, to calm your mind and body and restore your hormonal harmony and fertility.
- Taking herbs and supplements: There are some herbs and supplements that can help you enhance your fertility naturally, such as: vitex, maca, ashwagandha, shatavari, dong quai, black cohosh, red clover, evening primrose oil, zinc, selenium, magnesium, vitamin B6, vitamin C, vitamin D, vitamin E, and folic acid. However, you should consult your doctor before taking any herbs or supplements, as they may interact with your medications or have some side effects or contraindications.

Conclusion

Age-related infertility is a common and complex condition that affects many women and couples who wish to have a child later in life. Age-related infertility is caused by various factors, such as delayed childbearing, lifestyle factors, genetic factors, or underlying medical conditions, and it can have various consequences, such as decreased pregnancy rate, increased risk of pregnancy complications, and increased psychological distress. Age-related infertility can be diagnosed and treated by various solutions and treatments, such as fertility awareness, ovarian stimulation, IUI, IVF, ICSI, PGT, oocyte donation, or surrogacy. Age-related infertility can also be prevented or overcome by various ways, such as fertility preservation, fertility enhancement, or adoption. By following these tips, you can improve your fertility potential and your reproductive outcomes, and achieve your parenthood dreams.