Women decide to have children later and later. We also hear more and more often about those who give birth to children in their 40s or even later. Does this mean that medicine can do anything today? Is there a limit beyond which a woman can no longer become a mother? We talked to a gynecologist, Dr. n. med. Marcin Mika.
- Gynecologist: if we assume that the average fertility of a woman 20+ is approx. 85-90%, then in a woman aged 35 it drops to approx. 60%, and in a woman aged 40+ to 10-15%. The decline in fertility is therefore 75-80 percent.
- We cannot “rigidly” establish the upper limit of a woman’s natural fertility. Physician: It is very diverse and interdependent
- The indicator that gives credibility in this matter is the anti-Mullerian hormone – AMH. Thanks to it, we know to what extent the ovaries are capable of producing eggs
- Infertility is a civilization disease. In Poland, one and a half million couples struggle with this problem
- You can find more such stories on the Onet homepage.
obstetrician and gynecologist dealing with, among others diagnosis and treatment of infertility at the Superior Medical Center in Krakow.
Karolina Świdrak / Medonet: We hear more and more often about women who became pregnant very late and gave birth to a child. For some people, this may be a signal that conceiving and giving birth to a child is possible at any age, and that modern medicine has overcome this limitation. How is it really? When are the chances of natural conception greatest for a woman, and how does it change with age?
Dr. n. with Marcin Mika: A woman’s age is the most important issue in the fertility treatment process. This is a factor that cannot be modified. After all, it is not possible to rejuvenate a woman by 5 or 10 years … When you look at the curve of the number of pregnancies depending on the age, you can see that there is a point at which fertility drops significantly. This is the 35th year of a woman’s life.
In our busy times, it is by no means late. Today, many women only start considering motherhood in their thirties. There is more and more talk about freezing oocytes, i.e. eggs. One and a half or two years ago, Google and Apple even informed that they had made such an opportunity available to their employees. So it is clear that women are increasingly postponing the time of procreation.
How a woman’s fertility changes with age. How is it in a twenty-year-old woman and in a woman of 40+?
If we assume that the average fertility in a woman aged 20+ is around 85-90%, then in a woman aged 35 it drops to around 60%. When it comes to women 40+ trying to have a child, it is estimated that only 10-15 percent. of them become pregnant. The decline in fertility is therefore 75-80 percent. In the case of older women – over 45 years of age, it is assumed that they very rarely manage to get pregnant. It’s about 5 percent.
Of course, we can’t reduce everything to statistics. After all, genetics also influence fertility. This is a very important factor. All women are born with roughly the same number of eggs. With age, their number decreases by thousands, by hundreds of thousands. And it’s not that there’s another ovulation and we’re losing another egg. The problem is that our body is programmed, fertility is also programmed for a certain period of time.
According to the recommendation of infertility treatment, if a 40+ couple who has been trying for a child for some time comes, they should be offered treatment with assisted reproductive techniques, i.e. in vitro fertilization. Of course, after checking whether such an option is possible.
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Can we say that there is an upper limit to natural female fertility?
We cannot set such a limit because it is very fluid and very arbitrary. Some women, even as young as their 30s, may develop what was once known as premature menopause. Today it is referred to as primary ovarian insufficiency (POI). The fertility of such women is already minimal and even the methods of in vitro fertilization are very limited. When it comes to assisted reproduction, embryo adoption issues have to be considered in these situations.
Sometimes there are reports that a fifty-year-old woman became pregnant thanks to IVF. One woman will menstruate until age 55, another will stop when she is 40. In my experience, there are women whose fertility will be very limited at the age of 35 and the only way to become mothers is assisted reproduction, i.e. in vitro fertilization. There are also women in whom, at the age of 40, the analysis of hormone levels can show that the chances of conceiving a child are good. Generally, however, we can say that planned pregnancies are rare above the age of 40, and more often they are accidental pregnancies.
It is also true that IVF technology is, in general, the possibility of extending the chances of parenthood.
Yes, IVF is a science achievement in the 2010st century, not only to extend the chances of parenthood (in XNUMX, the creator of the in vitro fertilization technique was awarded the Nobel Prize). The possibility of freezing sperm, ova, and also embryos is often the only way to motherhood for couples with diagnosed idiopathic infertility, i.e. with undetermined cause.
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What conditions must a woman or a couple meet for the IVF procedure to be successful?
The chances of successful IVF depend primarily on the age of potential parents. We go back to what I said at the beginning: the most important factor influencing fertility and the decline in fertility is age. Though the boundaries are fluid.
The indicator that gives credibility in this matter is the anti-Mullerian hormone, i.e. AMH. It allows you to determine the fertility of a woman, i.e. the ovarian reserve. Thanks to this, we know to what extent the ovaries are capable of producing eggs. Such a test can be performed by any woman who has problems with getting pregnant. It is one of the many basic tools in assessing the chances of successful in vitro fertilization, i.e. pregnancy.
Health is also important. The probability of success in vitro is reduced, among others, by autoimmune diseases, civilization diseases – diabetes, hypertension, obesity and others.
Sometimes the chances can be so low that IVF is not done, and it is always the couple’s decision. Of course, this estimation is based on the principle of probability and is arbitrary. There are pairs that, at very low parameters, decide to try.
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You tell the doctor that the couple ultimately decide. Can the doctor issue a recommendation, say directly that the procedure has no chance of success?
We use scientific data and base our knowledge on it. On their basis, we also evaluate the effectiveness of the method under certain conditions. In the case of a couple where the woman is diagnosed with obstruction of the fallopian tubes, it does not have the human strength to naturally become pregnant. This is only possible by in vitro fertilization.
- In vitro – indications, methods. How does IVF work? [WE EXPLAIN]
What about women going through the menopause? Is IVF possible with them?
Theoretically yes. It is, however, a very difficult, even breakneck action, though not impossible. There are cases where this has been successful. In general, however, we focus on methods that bring a higher probability of pregnancy, including the oocyte donation program, which is available in Poland. A couple who cannot produce offspring from their gametes go to the germ cell bank and embryo. In our country, this type of donation is legally regulated, incl. donors are anonymous.
The conventionality of the age limit until which it is possible to become a parent is confirmed by the cases of very late motherhood known in the media. Among them was a woman about 60 years old …
Remember, however, that in medicine we cannot rely on a single case in the country or in the world. We must rely on methods that work. If one does not work for a given couple, we suggest switching to another. Of course, the acceptable limits are set by the couple themselves. There are, for example, those who want to use different methods but do not consider IVF. These are personal decisions. And it is very important.
From your point of view, is there more opportunities for infertility treatment abroad? You spoke about methods that we do not have.
In part, yes, especially when it comes to family donation. While couples in the West take advantage of this, in Poland this solution is legally unacceptable. With us, reproductive cells or embryos can only be donated anonymously. The donor doesn’t know who they will go to. Similarly, the recipient – apart from the basic information on the blood type, eye color or height, does not have any additional information.
In some countries, the law allows for the so-called open donation. For example, one sister donates embryos to another sister who, for various reasons, cannot have children of her own. In Poland, this method is impossible. Abroad, there is also an infertility treatment option for single women.
- If you want to support your fertility, use CONCEIVE PLUS Fertility Gel.
Please explain what the embryo adoption procedure looks like in Poland?
If a couple has medical causes of infertility and it is not possible to obtain offspring from their own gametes (because, for example, a man has undergone radiation or chemotherapy, has azoospermia and the woman has a very low AMH level), she qualifies for an embryo donation program. Of course, if he agrees to it. Such a pair is reported to the embryo bank, which are then selected according to phenotype and blood groups.
Our law allows anonymous donation of embryos, but limits the possibility of fertilization to 6 eggs under 35 years of age. Despite this, Poland ranks high in the ranking compared to other EU countries in terms of the effectiveness of infertility treatment with the use of in vitro methods (IVF, ICSI).
I would also like to mention that in Poland a kind of obligatory reading for couples who treat infertility and approach assisted reproductive techniques is the 2015 Act on the treatment of infertility. All possibilities are described there.
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In your opinion, will the regulations governing IVF in Poland change in the near future? There are such voices.
It is rather a question for politicians. The current law is quite restrictive in terms of infertility treatment, which is, after all, a civilization disease and affects 10 – 20 percent. par. In Poland, this means one and a half million couples struggling with infertility. Of course, only some of them use IVF solutions, but infertility treatment involves many more different methods. Restricting access to such procedures is very disadvantageous for society.
After all, infertility does not only affect wealthy people and those who can be treated abroad. To a large extent, this problem also affects average citizens, who often refuse a lot to collect the amount needed to start treatment. Every day we meet couples who come to us from distant cities and towns. They go for a check-up every few days for a few hours, which is a great experience for them. It is regrettable that the state does not help them in this endeavor. Thousands of couples are just left to fend for themselves. And that is perhaps the saddest.
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