By Sola Ogundipe

GETTING pregnant and giving birth is one of those things a woman often takes for granted until the day rolls around when you decide to have children and experience trouble conceiving. But while some causes of infertility are hereditary or due to health problems beyond your control, there are actually a few steps that can be taken to preserve and enhance a woman’s ability to have children. The truth is that a healthy lifestyle alone won’t necessarily protect you from infertility, but it may help especially as it is known that people who are very unhealthy have a much higher incidence of infertility.

You need to know that as a woman, your fertility starts to measurably decline around age 27, due to the depletion and ageing of your eggs. If you are under 30, it’s estimated that the chance of getting pregnant in any one cycle is 20 – 30 per cent. By age 40, it falls to 5 per cent. But it’s not just you the woman who needs to pay attention to the ticking of the clock.

Men over 35 are twice as likely to be infertile as those under 25. Studies also are showing that, as with older women, older men are more likely to have children with birth defects due to the decreased genetic quality of their sperm. Since every cell in the body ages, why would anyone want to think the sperm or testicles don’t age?

Beyond the age at which you choose to have children, there are other lifestyle factors within your control that can affect your fertility. Lifestyle is important for everything; of course it’s important to fertility. You should quit smoking and, if you’re obese or have a Body Mass Index (BMI) of 30 or more, losing weight. Why, you may ask. Obesity creates hormonal imbalances, preventing a woman from ovulating normally and affecting men’s sperm production.

Research also has shown that when both partners in a couple are overweight or obese, they’re more likely to have to wait longer before successfully conceiving a child. Men trying to conceive might want to stay away from hot baths and hot tubs. Findings show that weekly exposure to wet heat for 30 minutes or more for at least three months could impair sperm production and movement.

Couples trying for pregnancy also shouldn’t overlook the possibility that a prescription drug they are taking could play a role. Medications, such as one class of high blood pressure drugs, can be potentially toxic to sperm while antidepressants also may cause irregular menstrual cycles. Also pay attention to what you eat. It’s like if you’re running a marathon, you’ve got to train for it.

Same thing applies if you want to have a baby;  you’ve got to train for that too. As more women are seeking advanced reproductive techniques, such as IVF to assist in achieving a pregnancy, the ceiling of reproduction has been lifted such that almost any healthy women in her forties and fifties can successfully mother a child. Indeed as an older woman wishing to have children, there is no longer need to delay consulting fertility experts.

A recent study reviewed the pregnancies of post menopausal women with an average age of 53 years who underwent an in-vitro fertilization procedure with the assistance of egg donation. Currently, this is one of the largest series in the world’s scientific literature of reported pregnancy outcomes among women in their sixth decade of life and the database will likely serve as a counselling tool to guide physicians and patients to know what to expect in their fifties.

Although outcomes have been extremely favourable, there are medical conditions that can evolve pregnancy and it has become imperative to understand the physiological changes and be prepared and watchful of possible complications. We know that there is a proportion of women in their early forties who are successful in becoming pregnant with their own eggs spontaneously, while many others are able to conceive in cooperation with an egg donor.

Although the likelihood of becoming pregnant is significantly higher when enrolled in an egg donor programme, pregnancy course and birth outcomes are extremely similar whether you are able to conceive with your own eggs or with an egg donor.

What this translates into is that whether or not the pregnancy is a result of a natural conception, a conception with your own eggs and assistance from advanced reproductive techniques like IVF or with the assistance of egg donation, you are likely to have similar risks and outcomes throughout the duration of the pregnancy. The most notable risk factor is not how the pregnancy was conceived but perhaps the age in which a woman achieves a pregnancy.

One point to note is that pressing the boundaries of reproduction in women of advanced age can be complicated by undiagnosed underlying medical conditions. Such factors, like a decrease in the reserve of the cardiovascular system and the diminished ability to adapt to physical stress both may accompany advancing age and may combine to increase risks to the mother and the baby.

This is an issue because it has variously been suggested that advanced maternal age, defined as greater than 35 years is often associated with an increased risk of poor pregnancy outcome and these reports may be confounded by inconsistencies in prenatal care, preexisting medical conditions and access to appropriate health care. Women of advanced maternal age are to be followed and delivered in sophisticated, high risk care medical centres, but all in all, if you are in your forties or fifties, you should expect to have some mild increase in pregnancy related issues.

However, carefully selected and monitored women should anticipate a successful result. It is recommended that you seek advice of a reproductive endocrinologist for a medical history and physical examination. You would also undergo various tests as part of your pre-conceptional evaluation. When the assessment is completed, you’ll be counselled suitably as to what your potential risks may be.

As an older patient, you are approximately three times more likely to deliver by Caesarean Section, three to ten times more likely to experience pregnancy induced hypertension and two to five times more likely to encounter diabetes compared to younger women. However, appropriately screened, you as a healthy woman in your fifties, carrying a singleton pregnancy, can expect your gestation to go practically full term and deliver babies that are approximately the same weight as counterparts half your age.

Although there does not appear to be any medical reason for excluding you from attempting to become pregnant on the basis of age alone, it is recommended you seek the attention of a reproductive endocrinologist who is aware of these complexities, in order that you may be thoroughly screened and deemed as an appropriate candidate to experience a favourable outcome.