Advanced Maternal Age

Advanced Maternal Age

35.

Where your eggs go to die

(drama!)

When you enter "advanced maternal age"

(really?)

Or have a "geriatric pregnancy"

(a dude came up with that one)

 


Is 35 the age your fertility falls off a cliff or is it shorthand OB providers use to discuss risk?

Good News!

You can still have a baby after 35!

Surprise. If Gwen Stefani can do it, so you can you.

Here's a little nugget of truth: 

Your chronological age does not represent your reproductive age (also known as biological age).

You may be 38 years old, but your eggs can be any age.

Your personal medical history, genetics, chronological age and lifestyle all influence your reproductive age.  

Why is 35 Considered "Advanced Maternal Age"?

Determining a woman's reproductive age is not routinely done by most providers. It's usually assessed when there's a clinical indication (ex: infertility). 

To establish your reproductive age you need lab work and a transvaginal ultrasound to evaluate your ovarian volume
(aka- how many eggs you got in there?!).

Since assessing ovarian volume is not standard of care most providers use 35 as the average age for when fertility beings to decline. 

A number of studies found there to be a "snowball effect' with age and fertility around age 35; you lose more eggs at a faster rate between age 35-40. 

How Old Are My Eggs?

You are born with a fixed number of eggs in your ovaries; about 1-2 million.

Theoretically we ovulate 400 times in our life. You'd think we just lose one egg per cycle, but it's actually closer to 1000!

As your body prepares to release a mature egg a number of "understudy" eggs mature along with it. It's a bit of a race to see who will mature the fastest. Whichever egg "wins" gets released and the understudy eggs "disappear". 

The quality and quantity of your eggs decrease over time, but your overall health can affect how quickly your eggs age.

Example:

Women will reach menopause when they have approximately 1000 eggs left. Menopause doesn't just occur because of your chronological age, although it is a factor, but because of how many eggs you have left. 

While we have a national average for when menopause occurs (age 51), the range of normal is broad (age 48-55).

This means our biological age varies greatly during our reproductive years since we will all reach menopause at different ages. 

Fecundability

It's a term to describe the probability of pregnancy occurring during a specific time period. 

You reach peak fertility in your teens and 20s. Pregnancy rates are typically the same for women in their 20s and early 30s.

Here are the stats:

These statistics use women aged 30-31 as a comparison group. 

Your probability of getting pregnant decreases by:

  • 14% between age 34- 35

  • 19% between age 36-37

  • 30% between age 38-39

  • 53% between age 40-41

  • 59% between age 42-44

There is no difference in probability of getting pregnant between age 30-33.

When you actually look at statistics, controlling for other health issues like endometriosis, PCOS, high blood pressure, smoking and obesity, your probability of getting pregnant doesn't change drastically until around 38-40.

And if you have a healthy lifestyle there's a chance your reproductive age doesn't match your chronological age. 

Risk Factors For Advanced Reproductive Age:

Several factors beyond age increase the risk for advanced reproductive/biological age:
- Genetics
- Diet
- Smoking
- Obesity
- Endometriosis
- PCOS

How to Have A Healthy Pregnancy At Any Age

  • Prepare for pregnancy 3 months to 1 year before getting pregnant. If you have a male partner, this includes him too. 

  • Healthy diet: start now! Anything you've eaten and stored in your body will be distributed to your baby in pregnancy and can affect fertility.

    • Go low-glycemic

    • Eat plenty of good fats and lean animal protein

    • Take vitamin D, fish oil and B vitamins

    • Eat fermented foods

    • Take a probiotic

    • Take a prenatal vitamin

  • Exercise

  • Take control of your stress

  • Get enough sleep (7-8 hours at least!)

  • Limit environmental toxins. Go here for more information.

  • Schedule a preconception visit. If you have a risk factor for advanced reproductive age speak to your provider about the possibility of assessing ovarian volume with an ultrasound.  

  • Discuss antenatal testing with an OB provider if you are over the age of 35. Some providers require additional testing for your baby, prefer induction of labor at 39 weeks, or require weekly ultrasounds in the 3rd trimester. Find out what your provider recommends even before you get pregnant so you know what your options are and what to expect. I'm available to review this information with you as well. 

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