Mother's Day 2021: Concerned about motherhood after 40? It is a possibility with help: Experts

Motherhood is an experience that many women seek in their lives. It is a known fact that female fertility is a function of age – women in their 20s can have children with fewer difficulties compared to their older counterparts.
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If you’re a 40-year-old female who is planning to conceive, chances are menopause has crossed your mind, and rightly so. 

This Mother’s Day, let’s understand how women can kick off on their journey of becoming mothers even after 40, empowering them with the knowledge to make the right decision for themselves. 

What are ovarian reserves?

Women are born with limited egg reserve in their ovaries which dwindle with age. Over one million immature eggs decrease to only about 300,000 eggs by puberty which drops further with every ovulation of the menstrual cycle; some even get destroyed. In Post mid-thirties, the quantity and quality of eggs worsen with about 50% of the egg pool becoming genetically abnormal once women hit 40.

What is menopause?

Menopause is the phenomenon that marks the end of the menstrual cycle in women. It is nature’s way of indicating the decline of reproductive potential in the body. It is a gradual process that occurs between ages 45 to 55, marked by irregular menses and a significant change in hormonal levels.

How does this impact fertility and women’s chances of becoming pregnant?

A depleted pool of viable eggs is a tell-tale sign of decreasing fertility potential. Menopause induces a host of associated changes in the body, including the ability to conceiving naturally. 

During a female’s fertile age, many processes occur in the ovary including the maturation of egg-containing follicles, ovulation, and production of the ovarian hormones oestrogen and progesterone. These regular bodily changes gradually decrease and over time stop altogether. In the absence of oestrogen and progesterone, the uterine lining, the endometrium does not grow and the uterus begins to shrink. Moreover, the pituitary gland releases a significant amount of two hormones named follicle-stimulating hormone (FSH) and luteinising hormone (LH).

You don’t need to give up on your motherhood dreams after 40

While the biological clock starts to tick faster after 40, although difficult, it is possible to attain a normal pregnancy. This is dependent on the number of eggs present in the ovaries and their quality. It can also depend on the husband’s sperms. 

Women who are not able to conceive naturally but desire to become mothers can turn to assisted reproductive technology (ART) such as in-vitro fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI). Both the female and male partners are evaluated for their fertility, which is followed by putting them on the best treatment options available and. Proper and empathetic counselling from the right specialists and experts plays a key role in helping aspiring parents through this process.

Egg reserve testing

Egg reserve testing is imperative to plan and administer the right ART treatments. This test is conducted in two steps – through blood test and sonography. The blood test is taken to understand the levels of the hormones Follicle Stimulating Hormone (FSH) and Antimüllerian hormone (AMH). Ideally, the AMH levels are between 2.5 and 4 ng/mL, subject to the follicles available in the body. If AMH is less than 2 ng/mL and levels of FSH are high, the conclusion is that the egg reserve is less.

In case sonography finds follicles that are under 5mm in size (called antral or Graafian follicles) and are less than 5 in number per ovary, the reserve is considered to be small.

If the reserve is adequate, the woman is given hormonal injections for a period of 10-12 days during which the eggs would develop. These eggs are collected by a method called ‘ovum pickup’, fertilised with the sperm of the husband, and the developed embryo is transferred into the uterus later. However, if the reserve is less, or embryos fail to form, with the consent and requisite documentation the patient can choose to opt for donor eggs.

Is becoming a mother after menopause possible?

It is possible to achieve pregnancy post-menopause with the help of ART interventions, albeit it is a rare occurrence. Many countries also have an upper age limit for undergoing ART procedures. Hormonal tablets are administered for two to three months to prepare the uterus and so menstruation can take place again. Only donor eggs can be used in this scenario.

What can be the complications?

The risk of congenital genetic disorders in children is higher in pregnancies conceived at later ages; pre-implantation genetic testing (or PGT) is thus, important. An embryo biopsy is taken and the number of chromosomes and their respective sizes are checked. This helps in eliminating embryos that may have congenital diseases, also decreasing the chances of a miscarriage.

Pregnancies after 40 are considered to be at high risk because of the problems that may arise in the mother during the term. This may be severe vomiting and nausea, placenta previa, gestational diabetes, postpartum haemorrhage, and pregnancy-induced hypertension. It is imperative that aspiring mothers take care of themselves before setting on the journey of motherhood, and get checked by physicians and endocrinologists. It is only when the woman is healthy that it can lead to a healthy pregnancy and child.

About the author: Dr Kshitiz Murdia, CEO & Co-Founder, Indira IVF.

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Anonymous 1 month ago

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