In short The increasing average age of women becoming pregnant for the first time is an increasingly common phenomenon in highly developed countries. Unfortunately, postponing plans for motherhood may result in fertility problems. This is because the number and quality of egg cells decrease with age, while the risks associated with maintaining a pregnancy and the proper development of the fetus also increase.
A woman’s period of peak fertility occurs between the ages of 20 and 25, after which her fertility potential gradually declines. Women in their twenties have the highest chances of becoming pregnant, reaching approximately 20–25% in each menstrual cycle. For women in their thirties, these chances are already lower, at approximately 15–20%, and after the age of 35, female fertility declines even further. Postponing plans for parenthood is largely determined by the modern lifestyle, including personal, professional, and financial circumstances. As a result, women are not always willing or able to become pregnant during the period that is potentially the most favorable from a biological perspective.
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When considering female fertility and age, ovarian reserve cannot be overlooked. So, what exactly does this term mean? Ovarian reserve, in simple terms, refers to the reproductive potential of the ovaries that a woman is born with, namely the number of follicles capable of growing and developing into a mature egg cell. Unlike men, the female body does not produce new gametes but instead stores a finite number of them from birth. This number continuously decreases at varying rates depending on age and other factors:
Throughout a woman’s entire reproductive period, between 400 and 500 egg cells mature. The remaining primordial follicles undergo apoptosis, which is the natural process of cell death. The point at which the ovarian reserve is depleted depends on overall health, genetic factors, lifestyle, and numerous environmental factors, but it cannot be completely avoided.
– With age and the decline in ovarian reserve, the quality of oocytes also deteriorates. The most significant abnormalities involve the chromosomes in the cell nuclei. The older the egg cell, the greater the likelihood that the embryo developing from it will have an abnormal amount of genetic material, which usually prevents the pregnancy from progressing safely – explains Izabela Nowak, MD, PhD, an obstetrician-gynecologist and fertility treatment specialist at Klinika Bocian in Szczecin.
In women over the age of 30, the luteal phase of the menstrual cycle may become shorter, and so-called anovulatory cycles, during which fertilization cannot occur, become more frequent. The processes associated with the aging of the body also have a negative impact on ovarian tissue, which may result, among other things, in cell degeneration and fibrosis.
A decline in ovarian reserve and deterioration in egg quality are not the only obstacles faced by women trying to conceive at a later age. The risk of reproductive system disorders and diseases also increases, including:
These conditions may make successful fertilization and a safe course of pregnancy more difficult.
With age, the risk of pregnancy loss also increases – it is approximately 10% for women in their twenties, around 25% for women in their thirties, and more than 50% at the age of 45. After the period of peak fertility has passed, the risk of serious pregnancy complications also increases. These include:
Women who would like to become mothers in the future are advised to undergo routine basic gynecological examinations, including ultrasound, and to have their hormone levels checked. Such monitoring makes it possible to detect potential abnormalities in the functioning of the reproductive system and premature ovarian insufficiency, as well as to assess ovarian reserve.
AFC – an ultrasound examination that helps determine the number of antral follicles, i.e. follicles ready for further development. During the ultrasound examination, the doctor also assesses the structure of the ovaries, fallopian tubes, and uterus, as well as the thickness of the endometrium (the lining of the uterus). The examination can also detect possible anatomical abnormalities and abnormal changes within the female reproductive organs.
Hormonal tests – to assess the functioning of the reproductive system, it is important to measure LH, the luteinizing hormone that stimulates the body to ovulate, and FSH, the follicle-stimulating hormone. An excessively high FSH level may indicate premature ovarian insufficiency. Measuring this hormone helps determine whether a woman has fertility disorders associated, for example, with the premature onset of menopause. Measuring LH levels, on the other hand, is helpful in diagnosing PCOS and other hormonal disorders. In addition, the doctor may order tests for other hormones that affect fertility, including prolactin, progesterone, estradiol, testosterone, and thyroid hormones. Measuring AMH (anti-Müllerian hormone) also provides valuable information about ovarian reserve.
– Fertility and reproductive health disorders diagnosed sufficiently early make it possible to take measures that may help protect a woman from infertility. Testing should be considered especially by women with irregular and painful menstrual cycles, as well as women over the age of 30 who have not yet had children but are planning motherhood, and those who are unable to become pregnant despite prolonged attempts to conceive – explains Izabela Nowak, MD, PhD, a fertility treatment specialist at Klinika Bocian in Szczecin.
Depending on the type of disorder causing infertility, appropriate treatment methods are introduced. Pharmacological treatment is used, including hormonal stimulation, as well as various procedures; however, in some cases, assisted reproductive methods, such as insemination or in vitro fertilization (IVF), may be necessary. If a woman no longer has her own egg cells capable of being fertilized, she may also consider using anonymously donated oocytes.
