By Bonnie Miller Rubin, Chicago Tribune reporter
April 18, 2012
In an age of assisted reproductive technology, can you rewind the biological clock? Not as much as you think, say Yale researchers in a study published in a recent issue of "Fertility and Sterility."
Those are the findings of Dr. Pasquale Patrizio, professor of obstetrics & gynecology at the Yale School of Medicine, director of the Yale Fertility Center and one of the authors of the study. Here's what he told the Tribune about reproductive aging:
Q. What are the most important findings of the study?
A. That there is an alarming misconception about fertility among women. Since an increasing number of women are delaying motherhood well into their 30s and 40s, they are forced to face the natural limits of their own reproductive system. ... A woman's fertility begins to decline throughout her 30s, becoming more significant by 35 and accelerating after 40. It is alarming to find women "surprised" to learn of their high risk status.
Q. What's the usual response?
A. Typical reactions when they hear of the low probability of success are: "I am healthy, I exercise, I eat right and look at the various celebrities with babies in their late 40s, and I cannot have my own baby? I wish someone would have informed me!" This lack of awareness ... is important, and we as professionals have to intervene.
Q. Why have women not received the message that fertility has an end?
A. The growing popularity of Assisted Reproductive Techniques — in vitro fertilization — and the celebrity pregnancies at old age, have given women the false impression and a wrong sense of security that female fertility may be manipulated at any stage of life. It is this erroneous assumption that can result in irreversible future infertility and disillusionment.
Q. As a clinician, what do you think is the optimal window for pregnancy? Why?
A. Fertility peaks by age 30 and then begins to steadily decline. The decline starts to become steeper as a woman approaches her 38th birthday. By age 43, the chances of pregnancy and, most importantly, of live birth, are very low. In fact, even as the number of women who turn to ART at advanced ages has increased tenfold in the last few decades, the percentage of pregnancies in women older than 42 (who use Assisted Reproductive Techniques) has almost not: 9 percent in 2009, substantially lower than that for women under age 35 (47.6). When the outcome is live birth, the numbers are even smaller: only 4.2 percent of women older than 42 will give birth, compared with 41.4 percent under 35.
Q. What's the data on pregnancy loss and birth defects?
A. The risk of miscarriages is 50 percent at age 42 to 43. At ages younger than 38, the risk of miscarriage is 20-25 percent.
In addition to chromosomal disorders, pregnancies at older age are also associated with obstetrical risks. In fact, pregnancies in older mothers are associated with babies of low birth weights, preterm deliveries, pre-eclampsia, gestational diabetes ... and even a higher risk of delivering by cesarean section. These numbers are rising ... as a consequence of more older women experiencing pregnancy.
Q. If you haven't met the right person or aren't ready to raise a child — but hope to be a mom some day — what steps should you take now to head off complications?
A. Oocyte cryopreservation (egg freezing) has now become a valid option for women who do not have a partner or are focused on their career ... but want to conceive their own biological child in the future. By freezing their own oocytes while still young, they can have their "peak fertility years" suspended in time. When they're ready to conceive, their eggs can be thawed and fertilized. This option, called elective oocyte cryopreservation, can be considered an act of preventive medicine. Moreover, this gives women their reproductive autonomy and increases their chances of genetic motherhood at a more advanced age. Another option, if a woman is in a stable relationship ... is to do embryo freezing instead of egg freezing.
Q. You mention an "urgent need" to educate women that reproductive aging is irreversible. How do you hope to accomplish that goal?
A. An information campaign with colleagues that age and infertility must be an issue of discussion with their patients. ... I truly believe that preventing age-related infertility is the responsibility not only of doctors and medical practitioners but also of society at large. Even though social, economic and personal pressures cause women to delay conception to later in life, those who choose to delay motherhood are stigmatized as being selfish and unconcerned about starting a family. This stigma must be banished, and age-related infertility should be faced as a medical problem.
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