In/Fertility and Age
The changing social scenario together with economic growth and an increase in job opportunities has to a great extent reduced gender inequality and has resulted in more and more older women seeking help from infertility clinics. Fertility and aging have always been closely linked and the age of the female partner remains the single most important factor in predicting success with treatment. Although tests for the ovarian reserve are an important informative tool and are helpful in selecting treatment options, they are poor predictors of the outcome.
AGE is a very important factor with regard to fertility, and even with all the advancements in assisted reproduction, it still remains an insurmountable barrier. Public awareness of this fact is important as the age-related decline in fecundity leaves the clinician and the couple with limited treatment options. From a purely fertility aspect, delay in child bearing should be avoided. Tests for predicting the ovarian reserve are useful prognostic tools but poor predictors of the IVF outcome.
Infertility is a distressing issue to both the couple and their families. The ability to procreate is age related, more so in the female partner. In the female fetus, germ cell proliferation comes to a standstill by around 20 weeks, resulting in women being born with a set number of primordial follicles. In contrast, active sperm production in men continues throughout the adult life, with age causing mainly a decline in function. At birth, the female child is born with about 5 million primordial follicles which decrease to about 500,000 at menarche. With each subsequent menstrual cycle follicular atresia/apoptosis continues with the numbers decreasing to about 25,000 at the age of 37 and 1000 close to menopause. There is an age-related decline in fecundity, the decrease usually starting at the age of 32 with a dramatic fall after the age of 37. Spelt differently, the natural monthly fecundity rate which is about 25% between 20 and 30 years of age decreases to below 10% above the age of 35.
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