Fertility

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Time and tide wait for no man, and this is true especially of your biological clock.
By Huang Rui Lin


It ’s a scenario that is all too common. A couple, busy with their careers, put off marriage and babies till they are in their thirties. By the time they feel they are ready to become parents, the goal of parenthood proves to be more elusive than anticipated. Age plays an important part in fertility, yet many couples feel that they can outrun the pace of time. Dr Peter Chew, senior consultant obstetrician and gynaecologist at Gleneagles Hospital, has seen such couples far more often than he would like to. “Many couples forget that by the time they finally decide to start trying for a baby, their chances of conception may have decreased tremendously due to age,” he notes.“Although medical technology has assisted women over 40 to conceive, they should not put off having children until their mid to late 30s. The optimal window for women to conceive is between the ages of 22 and 26.” When it comes to baby-making, there are many reasons why earlier is better than later. Here are the facts:

 

Lower Chances of Conception
Generally speaking, the older a woman, the lesser her chances of conception. This is because the quality of the egg declines significantly with age. According to Dr Chew, the statistics are stark.The percentage of women who achieve pregnancy within the first year of trying corresponds directly with their age:
• Early 20s: 90 per cent
• Late 20s and early 30s: 70-80 per cent
• Late 30s: 60-70 per cent
According to the UK-based Human Fertilisation and Embryology Authority, “At 35, you’re half as fertile as when you were at 25; at 40, you’re half as fertile as when you were 35.” This means that it may suddenly take much longer to get pregnant when you hit your late thirties or early forties and you may have problems conceiving at all. But contrary to popular belief, the age of the woman is not the only factor. The age of the man is also pivotal. Older men have significantly lower fertility than younger men. “For men, fertility decreases when they reach 40. That’s when the quality and quantity of the sperm drop,” says Dr Chew. There may also be a decline in sexual drive and a difficulty in achieving and maintaining an erection.

 

Higher Risks
A woman aged 35 and above at the time of delivery is classified as being of “advanced maternal age”. Besides
lower chances of conception, there is a higher risk of miscarriage. A UK study found that the risk of miscarriage increased drastically with age. For a woman under 30, the miscarriage risk is 10 per cent. This rises to 25 per cent for women above 35, and to 50 per cent for women above 40, and 90 per cent for women above 45.
Older mothers also risk having a child with chromosomal abnormalities such as Down’s Syndrome. A woman aged 25 has a 1 in 1500 risk, but for a mother aged 45 and above, the risk is 1 in 30. Risks of miscarriage and genetic abnormalities in the babies also increase with the age of the father. Late pregnancies also carry higher risks of placental problems, having a premature baby or a baby of low birth weight, and having twins or triplets.
There is an increased chance of developing pregnancy-related or gestational diabetes and pregnancy-induced hypertension.

 

Artificial Conception: Age matters too!
For couples who fail to conceive naturally, there are artificial methods such as invitro fertilization (IVF) and intrauterine insemination (IUI). However, IVF treatment is emotionally and physically draining, and should only be considered as a last resort. It is also very costly. One IVF cycle costs between $7,000 and $14,000 — and some couples will need more than one try, while others may not succeed at all. Since September 2008, the government has introduced an assisted reproduction treatment subsidy that co-funds half of IVF treatment at public hospitals, capped at $3,000 per fresh cycle and up to a maximum of three fresh cycles. You can also use Medisave to pay for part of the treatment. This subsidy is only for women below the age of 40, as the success rate of IVF drops drastically with age. So even with IVF and IUI, it is still not a good idea to wait. At the KK Women’s and Children’s Hospital IVF Centre, nearly 33 per cent of women below 40 achieved pregnancy, but this fell to about 12 per cent for those over 40. Women less than 40 years of age also reported a lower miscarriage and cancellation rate. Clearly, the chances of pregnancy decrease with increasing age. When it comes to baby-making, it is not a matter of “hitting the jackpot” on the very first try. Hence couples should give ample time and allow for unexpected delays. Watch that clock! Besides age, there are other issues that affect a couple’s fertility.

 

Fertility Issues
“Generally, 20 per cent of married couples will suffer from fertility problems, which results in a delay in conceiving a baby,” notes Dr Chew. “I advise couples to start planning earlier, as this would give them ample time to detect any fertility problems and seek treatment before it’s too late.” If you have been trying for more than a year to 18 months without success, consult your gynaecologist.

 

Lifestyle & Environmental Factors
• Stress: The frequency of sexual intimacy is likely to dwindle when one or both parties are under stress. As the egg only lasts 24 to 36 hours, the couple may miss the ovulation period for the month if the frequency of intimacy is limited. Stress can also cause menstruation to become irregular or even cease. In men, stress can cause erectile dysfunction, as well as reduced sperm count and quality.
• Smoking and drinking: It is advisable for both parties to kick the habit. Women smokers not only have a higher rate of infertility or take a much longer time to conceive. In a study published in the journal Fertility and Sterility, doctors found that men who stopped smoking experienced a dramatic rise in sperm count of up to 800 per cent.
• Weight: Couples who want to start a family should also pay attention to their weight. “Being under- or overweight can affect your chances of conception,” advises Dr Chew. Obesity can cause irregular menstruation in women and sperm abnormalities in men.
• Nutrition: Eating well and taking enough nutrients will ensure that you get regular periods, making it easier for you to predict your fertility window. Prenatal vitamins are also helpful in preparing the body for conception. “It is advisable for women to take folic acid three months before trying for a baby,” says Dr Chew. “Taking iron and zinc supplements are also helpful. The men can take vitamin E which is also present in most foods.”

 

Sexual Issues
About five per cent of married couples experience sexual dysfunction in their first year of marriage, such as painful intercourse or erectile dysfunction, thus making conception difficult. Seek professional help from doctors or organisations such as aLife, a non-profit organization that specializes in fertility and pregnancy (www.alife.org.sg). Don’t delay, as the clock is ticking away.

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