Age, Fertility and Menopause

Age and fertility

There are many reasons why women, both as individuals and as part of a couple, are delaying first time parenthood until their 30s or 40s. There is also a growing trend to adding a new baby to complete a blended, or step-family, later in life. However, previous pregnancy and delivery does not indicate potential pregnancy success later in life.

Unfortunately, fertility in women declines with increasing age, affecting the quality of the follicles and eggs produced by the ovaries, as well as the likelihood of successful fertilisation. In addition, chromosomal abnormalities such as Down’s syndrome and associated higher rates of miscarriage are sobering risks.

For example, the incidence of Down’s syndrome increases exponentially in women aged over 40 years, along with the risk of spontaneous miscarriage. A 40-year-old woman, for example has a 34% risk of miscarriage, and a 1 in 109 chance of delivering a child with Down’s syndrome.

There is also evidence to show increased incidence of general gynaecological conditions in women aged over 40, such as fibroids, pelvic inflammatory disease (PID) and endometriosis, some of which have been shown to permanently impair fertility.

Generally, the chances of becoming pregnant with your own eggs, decreases from around 20% per cycle to 5% per cycle, after the age of 40.

For men, there is less available evidence to suggest that semen quality is related to genetic conditions, however, it has been suggested that in men over 40, there may be a slight rise in some genetic conditions in children born.

Fertility treatments such as In Vitro Fertilisation (IVF) can help couples conceive, but they cannot reverse the effects of ageing on a woman’s fertility.

Even in IVF, ageing affects the success of treatment, particularly related to the quality and quantity of eggs, the quantity of follicles stimulated with fertility hormones, fertilisation rates. There is also a much higher risk of miscarriage with IVF pregnancies in women over the age of 40.

What is menopause?

Menopause is defined as the absence of menstruation for a year, between the ages of 40-60. Some women may refer to it as “the change”. It can occur naturally or artificially (e.g., induced by surgical removal of ovaries or by damage as a result of treatment with radio- or chemotherapy). Premature menopause occurs in some women, and occurs before the age of 40.

Perimenopause is the period of 1-5 years preceding menopause, during which the ovaries gradually reduce their production of oestrogens and progesterone. and egg productions slows and halts. When a woman has reached menopause, she will have no eggs left remaining within her ovaries. Women may experience different symptoms caused by the hormonal imbalance during this period.

Symptoms of menopause

The drop in production of oestrogens and progesterone causes noticeable changes within a woman’s body. The most common symptoms of menopause are directly related to this slowing and cessation of hormone production. However, not all women are symptomatic. It is estimated that around 20% of women will have no symptoms, 60% will have mild symptoms and 20% will have severe symptoms.

The symptoms themselves are variable and may include:

a) Vasomotor Symptoms

  • Hot flushes
  • Night sweats
  • Tiredness

b) Urogenital symptoms:

  • Decreased libido
  • Vaginal dryness
  • Painful intercourse
  • Itching
  • Urinary tract infections
  • Urinary incontinence

c) Mood and sleep disorders:

  • Insomnia
  • Irritability, depression or anxiety
  • Memory loss

d) Skin:

  • Skin dryness

e) Heart:

  • Palpitations

f) Skeletal:

  • Arthralgia and myalgia
  • Osteoporosis

g) Other:

  • Weight gain and bloating

Premature menopause

If menopause occurs before the age of 40 years, it is considered to be premature. It is often linked to the treatment of the ovaries due to disease (most commonly, cancers).

Hormone Replacement Therapy (HRT)

HRT may provide some relief for menopausal women with severe or uncomfortable symptoms of menopause. Decisions about HRT are very personal, and should be discussed with a medical professional so that benefits, risks and other alternatives can be considered.

HRT is also used in fertility treatment for the preparation of the uterus for embryo implantation, in women who are using donor eggs, those who do not menstruate (also called anovulatory), and in women with ovarian failure. This is because HRT mimics a normal menstrual cycle, so that the endometrium (i.e., lining of the uterus) thickens, ready for implantation.

In Vitro Fertilisation (IVF) and Donor Eggs

In some cases of IVF, women are unable to use their own eggs. This may be due to multiple unsuccessful attempts with their own eggs, or because they have no eggs of their own. For these women, IVF treatment with donor eggs may be their best chance to achieve a pregnancy.

City Fertility offers an active Donor Egg Program. We recruit anonymous donors, but also encourage potential recipients to recruit their own known donors. Please contact our staff for further information about egg donation, or our program.