Make haste while your fertility sun shines

Written by Oladapo Ashiru - Nigeria.

Oladapo Ashiru

This article underscores the recent experiences of Dr. Lateef Akinola, Prof. Oladapo Ashiru and their team, regarding the proportion of women delaying childbirth until they are in their late 30s and early 40s, a trend that is on the increase. Such women often delay childbirth for career development and economic empowerment while searching for the ‘right’ men. 

Though all of these are laudable and worth the sweat, they can lead to age-related infertility which has been coined as “voluntary infertility”.

Infertility is defined as failure to achieve pregnancy after one year of unprotected vaginal sexual intercourse. This affects about 10 to 15 per cent of couples. It is spread equally among the male and female population. Causes of infertility in males can include low sperm count, poor sperm motility, abnormally-shaped sperm, spermatic duct blockage, impotence and ‘undescended’ testes.

In the female, predisposing factors include having low egg reserve, premature ovarian failure or menopause, menstrual irregularities, polycystic ovarian syndrome, blockage of the fallopian tubes, uterine fibroids, endometriosis and complications from sexual infections.

Female fertility declines with age and has been proved by epidemiologic and scientific research. The decline becomes more pronounced and accelerated in females especially in their late 30s and early 40s. Not surprisingly, this is the time most women decide to settle down after satisfying their career ambitions.

There is nothing wrong with being career-minded but the fact is that from the late 30s, there has been a decline in the female egg reserves. From research findings, the ovary contains a finite/fixed number of eggs, which decrease exponentially with age. It is estimated that at birth the ovary contains about two million eggs, which decline to about 200-400 thousand at menarche (10-13 years of age), and decline to about a thousand at age 50-51 years of age when menopause likely sets in. There is a strong correlation between the age of a woman and the quantity/quality of her eggs.

Therefore, the older a woman becomes the lesser the number of eggs she has in reserve and the higher the number of poor quality eggs she possesses in her ovary. The best time for child-bearing in a woman is around 20 to 30 years of age.

There is an exponential decline in female egg quantity and quality with increased age-related complications of pregnancy and childbirth, including miscarriages often due to genetic abnormalities, need for operative vaginal birth and caesarean delivery, ante-partum/post-partum bleeding, raised blood pressure and gestational diabetes mellitus.

For example, the pregnancy miscarriage rate, the risk of having a chromosomal or genetically abnormal child (like a Downs-Syndrome baby) and medical diseases like diabetes, fibroids, fallopian tubal blockages, pelvic adhesions and consequences of endometriosis all increase with age.

Mrs. RO is the 42-year old financial director of an institution who got married a year ago to Mr. PO, a 43-year-old company executive. Neither of them has children. Mrs. RO, in her early teens, had vowed to complete her ACCA in accountancy, then get a job, before considering marriage and raising a family. She got all this accomplished, but it took some time. Now 42 years old, she thought it was time to raise a family but examination revealed poor ovarian reserve.

Luckily, with some days of regeneration with Mayr therapy, she succeeded in getting two follicles at Oocyte retrieval and was transferred and she ended up with a baby girl. This is not always the story in all cases. Many will end up using donor eggs, and in some cases may end up with adoption after several failed IVF attempts.

Artificial Reproductive Techniques like IVF, egg and/or embryo freezing during late teens or early 20s for use in older age, receiving donor eggs to achieve pregnancies are not the answers, guarantees or panacea, and cannot compensate for the age-related decline in egg reserve, quality and fertility. Besides, infertility treatment across the world is very expensive, and largely unaffordable by many patients, especially in low-resourced areas of the world that include Nigeria.

In the United States of America, young women now go to fertility clinics to freeze their eggs in the event of career pursuit, waiting for the right partner or awaiting to do IVF after cancer treatment or other terminal illness, in which case they can even use surrogates, using their own eggs and their partners, sperm or even donor sperm in the event Mr. Right never shows up.

Africans, especially Nigerian women, may also take to this route. The technique of Oocyte – freezing – has now been perfected to an advanced stage. Luckily we have been able to establish pregnancy from frozen Oocytes.

Lastly it is pertinent to remind the upwardly mobile, career-oriented ladies waiting for Mr. Right, that the optimal reproductive age is between 19 and 25 years and, in some cases, 30. So, it must be stressed that the freezing of eggs is a recommended medical option.

So, please, as much as possible, make haste while the ‘fertility sun’ shines.