Fertility questions answered

Posted on 15 July 2014

Dr Linnie Muller from the Panorama Fetal Medicinic Centre answers some questions about fertility.

Is it true that there are an increasing number of women above 40 who want to fall pregnant?
We see an increasing number of pregnant patients age over the age of 40 at the Panorama Fetal Medicine Centre as many women concentrate on their careers while young or only find the right partner later in life. With excellent fertility treatments, such as IVF (in vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection), there’s never been a better time to try to get pregnant as an older mum. It’s also possible to increase the chances of the older mum, from 43 onward, falling pregnant, by using donor eggs (from a patient aged between 20 and 30 years) or frozen embryos.

What complications do women in their 40s face during pregnancy or when having children?
In the past myths of Down’s syndrome, miscarriages, etc, were said to be prevalent if women chose to have children after 40. But there are certainly pros and cons in having a baby in your 40s.

•    Probably the greatest advantage is that you can be emotionally and financially ready for children. Some career women, however, can find it difficult to adjust to having less freedom.
•    Being financially secure has its benefits.
•    You may be less concerned about your own needs and will be happy to focus on your child.
•    You may be in a good position to make wise parenting decisions.
•    If you conceive naturally in your 40s, you have a higher chance of having twins, much like going through IVF or ICSI.

Most older mums need more care during their pregnancy and so many of the cons are health related. We often use the term high-risk pregnancy to ensure these mums get the care they need. Older patients are twice as likely than younger mums to experience?the following:
•    Gestational diabetes (diabetes in pregnancy)
•    Pre-eclampsia (high blood pressure and protein in your urine after 20 weeks of pregnancy)
•    High blood pressure
•    Placenta praevia (low lying placenta) that causes bleeding
•    Placental abruption (detachment of the placenta from the uterine wall), that causes severe bleeding in some cases

In addition, miscarriage risk for women over 40 is almost double compared to in a woman in her 20s or early 30s. The birth experience may be more difficult, a caesarean section is more often required, the babies present in an awkward position at birth, they are born with a low weight and often premature, and the babies of older patients have a higher risk of chromosomal defects.

As women get older, their eggs don’t divide as well, which can cause genetic problems. The most common genetic disorder is Down’s syndrome – caused by an additional chromosome 21 that causes intellectual disability, and defects of the heart and other organs. Risk of Down’s syndrome goes up significantly from the age of 35 years. Up to the age of 40, five in 1 000 and over 40, 25 in 1 000 – will have a baby with Down’s syndrome.

Has modern medicine and technology reduced and/or assisted in eliminating these chances?
All women are offered screening tests for genetic conditions such as Down’s syndrome. Maternal age is factored into the results, to give the patient a calculated risk percentage of having a baby with a problem.

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Published in Pregnancy

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