This article underscores the recent experiences of Dr. Lateef Akinola,
Prof. Oladapo Ashiru and their team, regarding the proportion of women
delaying childbirth until they are in their late 30s and early 40s, a
trend that is on the increase. Such women often delay childbirth for
career development and economic empowerment while searching for the
‘right’ men. Though all of these are laudable and worth the sweat, they
can lead to age-related infertility which has been coined as “voluntary
infertility”.
Infertility is defined as failure to achieve pregnancy after one year of
unprotected vaginal sexual intercourse. This affects about 10 to 15 per
cent of couples. It is spread equally among the male and female
population. Causes of infertility in males can include low sperm count,
poor sperm motility, abnormally-shaped sperm, spermatic duct blockage,
impotence and ‘undescended’ testes.
In the female, predisposing factors include having low egg reserve,
premature ovarian failure or menopause, menstrual irregularities,
polycystic ovarian syndrome, blockage of the fallopian tubes, uterine
fibroids, endometriosis and complications from sexual infections.
Female fertility declines with age and has been proved by epidemiologic
and scientific research. The decline becomes more pronounced and
accelerated in females especially in their late 30s and early 40s. Not
surprisingly, this is the time most women decide to settle down after
satisfying their career ambitions.
There is nothing wrong with being career-minded but the fact is that from
the late 30s, there has been a decline in the female egg reserves. From
research findings, the ovary contains a finite/fixed number of eggs,
which decrease exponentially with age. It is estimated that at birth the
ovary contains about two million eggs, which decline to about 200-400
thousand at menarche (10-13 years of age), and decline to about a
thousand at age 50-51 years of age when menopause likely sets in. There
is a strong correlation between the age of a woman and the
quantity/quality of her eggs.
Therefore, the older a woman becomes the lesser the number of eggs she
has in reserve and the higher the number of poor quality eggs she
possesses in her ovary. The best time for child-bearing in a woman is
around 20 to 30 years of age.
There is an exponential decline in female egg quantity and quality with
increased age-related complications of pregnancy and childbirth,
including miscarriages often due to genetic abnormalities, need for
operative vaginal birth and caesarean delivery, ante-partum/post-partum
bleeding, raised blood pressure and gestational diabetes mellitus.
For example, the pregnancy miscarriage rate, the risk of having a
chromosomal or genetically abnormal child (like a Downs-Syndrome baby)
and medical diseases like diabetes, fibroids, fallopian tubal blockages,
pelvic adhesions and consequences of endometriosis all increase with age.
Mrs. RO is the 42-year old financial director of an institution who got
married a year ago to Mr. PO, a 43-year-old company executive. Neither of
them has children. Mrs. RO, in her early teens, had vowed to complete her
ACCA in accountancy, then get a job, before considering marriage and
raising a family. She got all this accomplished, but it took some time.
Now 42 years old, she thought it was time to raise a family but
examination revealed poor ovarian reserve.
Luckily, with some days of regeneration with Mayr therapy, she succeeded
in getting two follicles at Oocyte retrieval and was transferred and she
ended up with a baby girl.
This is not always the story in all cases.
Many will end up using donor eggs, and in some cases may end up with
adoption after several failed IVF attempts.
Artificial Reproductive Techniques like IVF, egg and/or embryo freezing
during late teens or early 20s for use in older age, receiving donor eggs
to achieve pregnancies are not the answers, guarantees or panacea, and
cannot compensate for the age-related decline in egg reserve, quality and
fertility.
Besides, infertility treatment across the world is very expensive, and
largely unaffordable by many patients, especially in low-resourced areas
of the world that include Nigeria.
In the United States of America, young women now go to fertility clinics
to freeze their eggs in the event of career pursuit, waiting for the
right partner or awaiting to do IVF after cancer treatment or other
terminal illness, in which case they can even use surrogates, using their
own eggs and their partners, sperm or even donor sperm in the event Mr.
Right never shows up.
Africans, especially Nigerian women, may also take to this route. The
technique of Oocyte – freezing – has now been perfected to an advanced
stage. Luckily we have been able to establish pregnancy from frozen
Oocytes.
Lastly it is pertinent to remind the upwardly mobile, career-oriented
ladies waiting for Mr. Right, that the optimal reproductive age is
between 19 and 25 years and, in some cases, 30. So, it must be stressed
that the freezing of eggs is a recommended medical option.
So, please, as much as possible, make haste while the ‘fertility sun’ shines.
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