Advanced maternal age (AMA) and fertility outcomes – patients’ stories

In this webinar, Dr Emma Maria Adsuar, Gynaecologist at UR Vistahermosa, Alicante, Spain, has discussed advanced maternal age and has explained all the things that need to be done before embarking on the IVF journey to get to the final outcome – a healthy baby.

Advanced maternal age (AMA)

Dr Adsuar started by explaining that the age of maternity is increasing worldwide. Historically, it has been defined as more than 35 years old, but in recent years it has changed. Nowadays, advanced maternal age is defined as more than 35-38 years old. Extreme advanced maternal age means more than 48 years old. As of now, there is an egg donation technique available for a 48-year-old woman who can get pregnant. It’s really difficult to define a specific threshold as age affects the quality and quantity and is defined as a continuum, and we don’t exactly know when it starts.

Mean age at childbearing

• in industrialized countries, it was 26.5-year-old in 1985 to 29.4 years old (2015)
• in the 1970s, the first delivery was in the early 20s, nowadays, the first delivery is at around 27-29 in 2017
• first delivery in women over 35 represents 9% of all the deliveries
• age 45 to 49 rose from 0.39/1000 okay to 1.79 in 2010

Age & its effect on fertility

• the continuous decline in the number and quality of oocytes
• this dropping is faster from the age of 30
• chances of pregnancy in every cycle when 30 y is 20%
• when 40, less than 5%
• above the age of 45, the possibility of pregnancy is almost 0
• male fertility declines at around 60 y

Infertility

• one year after regular intercourse with no protection or 6 months if you are more than 35 years old
• 15% of the couples in industrialized countries suffer from this condition
• multiple factors: around 30% female factor, around 25-30% male factor, 30% of the cases are a combination of both, 10% remain unknown
• The age of the woman is the most important factor

Advanced maternal age – possible complications

There is an increase in miscarriages, there is like 5% of probability of having a miscarriage when you are below 30, and there is a 22% of probability when you are more than 40-41 years old. If we are talking about 43-44, the risk increases. The most common causes are chromosomal and genetic disorders, it’s around 80% when you are more than 40 years old and it’s because of the low quality of the eggs.

Other complications of advanced age include:

• high blood pressure/ preeclampsia
  • below 30 years old is 4%
  • over 40, it’s 5-10%
  • more than 50 years old, 35%
• gestational diabetes
• placental abnormalities
• increases the probability of C-section
• low birth weight and preterm delivery
• the psychological impact increases the rates of depression and stress

What can be done to increase your chances?

• lifestyle
  • dietary quality
  • the chronic administration of oral antioxidant
  • melatonin
  • caloric restriction
  • increased of Omega-3 (fatty acids)
  • folic acid
  • Coenzyme Q10
  • Inositol in PCOS

What can be done when you are approaching that age and you don’t want to be a mother or you cannot because you don’t have a stable partner or you don’t have a proper job. There is an option called oocyte cryopreservation. The best moment is to do it if you are below 30, most patients come to the clinic when they are between 30-34 as the fertility declines over the age of 35. Therefore, if we could freeze our eggs before 35 years old, we would gain a lot.

It’s important to highlight that it’s not the same as having 10 eggs when you are 25 years old as when you are 43 years old. When you are 43 years old, 10 eggs is not a bad result, even though we don’t expect too many eggs at 43 years old.
There are several techniques that we can offer to patients who are not able to conceive, the treatment has to be individualized, and it all depends on your particular case. For AMA patients, we can also offer artificial reproduction therapy, e.g., IVF/ IUI, egg donor/embryo donation.