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25
April
2020

Reproduction at advance maternal age and Maternal Health

Mentor Name: Dr. Shubhdeep Bhattacharya on April 25, 2020

Introduction:
Advanced maternal age is said to be once a female gets pregnant after the age of 35 years.” Pregnancy at advanced age is not safe, so plan it timely preferably before 30 years of age” this century old advice we can easily get from our elders & senior. Many of us may not know why they advice so. Some more experienced ones may go more in depth & tell delaying conception might lead you to face age related female infertility, early pregnancy loss, recurrent pregnancy loss,, fetal anomalies , preterm births, obstetrical complications along with more maternal morbidities & mortalities.

In spite of having this age old knowledge females are delaying conception in name of achieving high career & educational goals also financial stability.

Earlier the trend was more common in developed world, in name of modernization even developing world has adopted this poor trend.

As I result being infertility specialist & obstetrician we are getting more & more patients with age related female infertility & high risk pregnancies in form of pregnancies complicated with gestational diabetes mellitus, hypertension, preeclampsia/eclampsia , IUGR ,preterm birth ,fetal anomalies & many more.

Being health care providers & fertility experts its our moral as well as ethical responsibilities to educate people whoever comes in our contact about the pros & cons of delaying conception

Spontaneous conception at advanced age

As we talk of fertility in females it is inversely proportional to their age which means as the age of female advances the fertility declines in inverse proportion & this decline is exponential after the age of 35 years. The oocytes left in both ovaries are not only less in number but they are poor in quality too. Once these oocytes are converted in pregnancy chances of early pregnancy loss, fetal anomalies are more as compared to their younger counterparts.

Those females with complicated gynaecological conditions such as multiple fibroids, endometriosis, adenomyosis are difficult lot of patients for ponta neous conception . delaying concepyion in such patiens may pushthem from spontaneous conception to artificial reproduction or theyelse they may not be able to conceive at all if they delay their childbearing.

If we talk of maternal complications, owing to decreased insulin sensitivity, poor placental perfusion & co morbidities these females are more prone to have gestational diabetes mellitus, hypertensive diseases of pregnancies, thrombophlebities, proteinuria, intrauterine growth restriction, preeclampsia/ eclampsia, preterm labour in antenatal period.

Also as the age increases the bone health declinesthus as a result preterm births & caesarean deliveries are very common in siuch females.

Not only above but both the mother & child have future health complications too.

IVF AT ADVANCED AGE WITH OVUM DONATION:

Since ageing is an independent risk factor for GDM, thrombophlebitis, proteinuria, PROM, haemorrhage, preterm birth, low birth weight, intrauterine growth restriction, as well as abnormal placentation thus in spite of higher success rates of ovum donation cycles in IVF conception , evidences suggests that a the pregnancies achieved through this have many fold increase in maternal & fetal complications as compared to those achieved through self eggs.

IVF at advanced age with self eggs:
As sited above all mentioned complications occur in patients who conceive even through IVF with self eggs.

Strategies to minimize complications:

As fertility specialist we can provide following help:
• To educate people as much as possible to not delay conception unnecessarily
• Fertility preservation is to be offered to those who need to delay conception due to unavoidable reasons.
• Planned oocyte cryopreservation can be a stategy that can be used to avoid complications related to ageing of oocytes.
• Pregenetic diagnosis for aneuploidies & single embryo transfers can be offered to those who are conceiving at advanced age through Ivf to minimize complications of early pregnancy loss, fetal anomalies & those related with multiple gestations

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