Never too late

If you are planning to conceive after 35, here is all you need to know

Career takes precedence over marriage and family for the modern-day couples. There has been a sharp increase in the number of pregnant women over 40 years of age and there has been an increase of 33% in childbirths to mothers over the age of 40 in the last five years. Delayed pregnancies come with a lot of complications such as infertility and greater chances of chromosomal abnormalities in the child.

Moreover, according to a study conducted by American College of Obstetricians & Gynaecologists (ACOG), the rate of miscarriage increases progressively as women age, from 13% in women younger than 35 to 54% in women who are 45 or older.

With ageing, there are many physiological changes that take place in a woman’s body, which can hinder the natural conceiving process, or can lead to miscarriages. Not only women, men too experience low sperm count and other impaired sperm parameters which can be associated with ageing.

Alternatives

Couples, in this case, often opt for artificial reproductive technologies such as in-vitro fertilisation (IVF). IVF is gaining popularity especially in couples who are planning their pregnancies in their late 30s.

Most embryos with an incorrect number of chromosomes fail to implant in an IVF process or miscarry during the first trimester of pregnancy. In many cases, it can also lead to multiple miscarriages. In women over 38 years old, 79% of embryos have chromosomal abnormalities. These abnormalities can be numeric, with the most common example being that of Down Syndrome (three copies of chromosome 21 instead of two), along with Edwards’ and Patau’s syndromes.

However, although the chances of getting pregnant after 35 decrease, it is not impossible.

Another practice that is gaining popularity among urban women is egg freezing. This is a solution to the age factor so that couples can conceive when they’re ready for it. In egg freezing technology, the egg is stored and is frozen, for years. When the woman is ready for pregnancy, these eggs are used to form an embryo which is then implanted in her womb through IVF.

Couples opting for a late pregnancy can rule out the possibility of a chromosomal abnormality in their baby and increase their chances of a successful pregnancy using the following reproductive genetics techniques:

• Non-Invasive prenatal testing analyses the most frequent chromosomal alterations with a simple blood extraction. It is completely safe for you and your baby. An expecting mother can opt for this in the 0th week of pregnancy.
• In case of repeated IVF failures, pre-implantation genetic screening (PGS) and Mitoscore are recommended. A study suggests that in the general population, 20% of all clinical pregnancies miscarry and about half of them are chromosomally abnormal. PGS with Mitoscore improves reproductive success by helping the specialist to select chromosomally normal embryos which have a greater possibility of resulting in a successful and healthy pregnancy through IVF.
• PGS is also recommended for couples who have experienced several miscarriages due to unknown causes, couples with several failed cycles of IVF, men with low sperm concentration and couples with a previous pregnancy with a chromosomal abnormality.
• The quality of the sperm is also important for a healthy embryo which can be implanted successfully in an IVF process. The sperm aneuploidy test (SAT) is another diagnostic test for male factor infertility. This test enables estimation of the transmission risk of chromosomal abnormalities in the child. It analyses the chromosomes mostly implicated in spontaneous miscarriages and cases of births with common chromosomal abnormalities such as Down Syndrome. It, therefore, screens the sperm sample for chromosomes abnormalities related to Trisomy13, 18 and 21 and the sex chromosomes X and Y.

Dr Rajni Khajuria

(The author is lab director at Igenomix & former researcher at AIIMS)

Lifestyle & its impact on delayed pregnancy

Recent studies have shown that almost 10% to 15% of couples in India are affected by infertility or delayed pregnancy. Experts, nutritionists and dietitians attribute this to the poor lifestyle choices made by people today.

According to a recent research in the journal Human Reproduction, following a diet which includes no fruit adds on an average two weeks to the time taken for conception, as compared to a diet which includes three or more pieces of fruits.

In a survey entitled Screening For Pregnancy Endpoints, researchers surveyed a total of 5,600 women based on their diet choices, time invested in exercising etc. Results of the study explicitly confirmed the link between delayed pregnancy and an increased consumption of junk food. Fertility experts recommend making the flowing lifestyle changes to help you get pregnant sooner:

• Exercise regularly: Women who are overweight are more prone to experiencing hormonal imbalances, which can result in a disturbed and disrupted menstrual cycle. Tip: Even if you do not get the time to exercise every day, experts recommend light exercise four to five times a week to avoid delayed pregnancy.
• Eat healthy: Dietary factors have the biggest influence on delayed pregnancy, which makes it important to mind what you put into your mouth. Tip: Folic acid is a B9 vitamin which is popularly known to boost fertility. Experts recommend increasing your intake of dried peas, lentils and spinach to increase your consumption of folic acid. Consumption of two to three portions of fruits each day has also been linked to increased fertility.
• Relax: Stress has an adverse impact on the hypothalamus, which is a gland that releases the hormones required to facilitate the production of eggs. Tip: Yoga and meditation are the best ways to calm your nerves, soothe your anxiety and help you relax.
• Track your cycle: Understanding and keeping track of your fertility cycle is the key to boosting your chances of conception. Indulging in intercourse in the highly fertile periods of the female fertility cycle can increase your chances of pregnancy exponentially. Tip: Install apps such as My Calendar, Period Tracker etc., which not only keep a track of your menstrual cycle but also provide information related to your fertility window.

Dr Sunil Eshwar

(The author is senior consultant obstetrics & gynaecology at Apollo Cradle)