Early Menopause
Fertility changes with age. In the period following puberty, women become fertile in men. For girls, the onset of fertility happens with the onset of ovulation or the menstrual period. It is a fact that women cannot become pregnant after menopause. Generally, reproductive potential decreases with age, and fertility is expected to end 5 to 10 years before menopause. In today's society, age-related infertility is becoming more and more common. For various reasons, most women wait until their 30s to start a family. Despite the fact that today's women are getting healthier and better taking care of themselves, fertility decline cannot be prevented. It is important to understand that as women age, fertility declines due to the number of eggs remaining in their ovaries. This decrease may be much earlier than women expect.
Women do not remain fertile until menopause. The average age for menopause is 51. But most women face serious difficulty getting pregnant in their 40s. The most important reason for age-related fertility loss is the gradual decrease in both the quality and quantity of eggs.
Most people are familiar with Down syndrome, a condition in which the embryo has an extra 21 chromosomes. Most embryos with fewer or more chromosomes do not result in pregnancy or end in miscarriage. This explains why the pregnancy rate in older women is low.
There are tests to detect ovarian reserves, but there is no fully proven test for getting pregnant. These tests do not determine whether a woman can become pregnant, but they can determine whether age-related changes in the ovaries have started. Women with low reserves are less likely to become pregnant than women in the same age group. No test, alone or in combination, is 100% accurate. On the third day, FSH test, antimullerian hormone and estrogen levels, blood values are checked on the second, third and fourth days of the menstrual cycle. High FSH values and estrogen values indicate low reserve values. However, some women with low reserve values have normal reserve values when looking at their FSH levels on day 3 of their menstrual cycle. Therefore, this test is not reliable for the accuracy of normal reserves. Other tests used are the test containing clomiphene citrate and the antral follicle count test, in which the number of follicles is determined by ultrasound.
However, an evaluation should also begin if the person is older than 35 and has been trying to become pregnant for 6 months. If a couple; If there are obvious medical problems for not getting pregnant due to the absence of menstruation (amenorrhoea), sexual dysfunction, history of pelvic disease, or surgery, the couple should begin an infertility assessment immediately. fertility tests; Detection of ovulation includes evaluation of the fallopian tubes, cervix, and uterus.
Sperm analysis can be done for the male partner. Most evaluations are concluded within 6 months, and an appropriate treatment can be started soon after the evaluation is over.
Women with a health-related illness such as high blood pressure or diabetes should consult their physician before trying to become pregnant. It is important to control such diseases. Because the risk for middle-aged patients is increasing, physicians may make changes to patients' medication or general health before they become pregnant.
Diseases such as high blood pressure or diabetes are more common when a person becomes pregnant after the age of 35. A special follow-up program and tests may be recommended throughout pregnancy. It may also be beneficial to go to a counselor in this regard. Children of mothers who gave birth at the age of 35 have a higher risk of experiencing chromosomal problems. Prior to becoming pregnant, patients should discuss these risks with their physician and geneticist. Some prenatal tests can be used to check for genetic birth defects. Amniocentesis and chorionic fluid samples are two methods that can be given for prenatal testing. Blood count and ultrasound are screening tests used to detect some birth defects. Many families want to get all the information they can about their pregnancy before making a final decision.
Embryos transferred to the mother's womb are selected from chromosomally normal embryos. This procedure has shown hope for higher pregnancy rates and prevention of genetic defect transfer to the embryo.
Ovulation and menstrual cycle
During their productive years, women have regular monthly menstrual cycles because they ovulate regularly each month. The eggs mature in spheres called “follicles” filled with fluid. At the beginning of each menstrual cycle, a hormone produced by the pituitary gland in the brain is produced when women menstruate. This hormone stimulates a group of follicles in both of the ovaries to grow faster. This hormone, which stimulates the ovaries, is called follicle stimulating hormone (FSH). Normally, one of these follicles will reach sufficient maturity and release the egg; the remaining follicles will stop growing and disappear. Pregnancy results in the fertilization of the formed egg and the fertilized egg implants in the uterine wall (endometrium). If pregnancy does not occur, the endometrium partially breaks down as the menstrual cycle continues its flow and the cycle begins again. During their teenage years, girls usually have irregular ovulation, but after the age of 16 they should have reached regular menstrual cycles with regular menstrual bleeding. A woman's cycle will occur regularly, every 26 to 25 days. As time passes, women will not ovulate and will not experience menstrual bleeding. A woman can be said to be in menopause when she has not had a menstrual period for 1 year. As women age, fertility normally declines due to age-related changes in the ovaries. Unlike men, who can produce sperm their entire lives, women are born with the number of all follicles containing eggs determined. There are approximately one million follicles at birth. In adolescence, this number drops to 300,000. Of the follicles remaining in puberty, only 300 will ovulate during their reproductive years. It is observed that smokers enter menopause one year earlier than non-smokers.fertility in aging women
A woman's fertility is at its best in her 20s. Fertility decreases gradually in the 30s, especially after the age of 35, a serious decrease is observed. For each month tried; A healthy, fertile 30-year-old woman has a 20% chance of getting pregnant. This means that out of every 30 fertile 100-year-old women trying to conceive, 20 will be successful and the other 80 will not be able to get pregnant again. By age 40, this rate is less than 5% per cycle. So almost 100 out of 5 women will be successful every month.Women do not remain fertile until menopause. The average age for menopause is 51. But most women face serious difficulty getting pregnant in their 40s. The most important reason for age-related fertility loss is the gradual decrease in both the quality and quantity of eggs.
Fertility in the aging man
Contrary to early fertility decline in women, sperm characteristics change later in men. Sperm quality decreases as men age, but this is usually not a problem before men reach 60 years of age. Despite these changes, there is no maximum age at which men cannot become fathers, as evidenced by men who can become fathers at 60 or 70 with their young partners. As men age; testicles tend to soften and shrink, and sperm morphology (shape) and motility decrease. In addition, there is a slightly higher risk of genetic defects in their sperm. Aging men may have certain medical conditions that can adversely affect their sex lives. As they get older, not all men will experience these experiences that can affect their sex life, especially men who are aging well. If a man has trouble with libido or erections, he should seek treatment with his urologist or physician. Decreased libido may be due to low testosterone levels.Egg Quality
As the number of remaining eggs gradually decreases, women are more likely to become pregnant or miscarry, due to poor egg quality. These changes are more noticeable for women after their 30s. Therefore, a woman's age gives the most accurate test result for egg quality. One of the most important changes in egg quality is the frequency of genetic anomalies called aneuploidy (too many or too few chromosomes in the egg). It has 23 chromosomes. As women age, the eggs gradually have either more or fewer chromosomes. This means that if fertilization occurs, the embryo will have fewer or more chromosomes.Most people are familiar with Down syndrome, a condition in which the embryo has an extra 21 chromosomes. Most embryos with fewer or more chromosomes do not result in pregnancy or end in miscarriage. This explains why the pregnancy rate in older women is low.
Number of eggs
The decrease in the number of follicles containing eggs in the ovaries is called "ovarian reserve loss". Before women become infertile and their regular menstrual bleeding stops, they begin to lose their ovarian reserves. Since women are born with all the follicles they can have when they are born, they are increasingly used in waiting follicles. As ovarian reserves begin to decline, follicles become increasingly less sensitive to FSH signals, so more stimulus is required for an egg to mature and ovulate. Initially, the menstrual cycles become shorter by getting closer to each other in shorter cycles, with the cycles being 21 to 25 days apart. Eventually, the follicles become unable to respond well to ovulation, resulting in longer and irregular cycles. Destroyed ovarian reserves are usually age-related and result from natural egg loss and reduced quality of the remaining eggs. However, young women may also have low ovarian reserves due to smoking, a family history of early menopause, or ovarian operations. Low reserves can also be seen in young women who do not have risk factors.There are tests to detect ovarian reserves, but there is no fully proven test for getting pregnant. These tests do not determine whether a woman can become pregnant, but they can determine whether age-related changes in the ovaries have started. Women with low reserves are less likely to become pregnant than women in the same age group. No test, alone or in combination, is 100% accurate. On the third day, FSH test, antimullerian hormone and estrogen levels, blood values are checked on the second, third and fourth days of the menstrual cycle. High FSH values and estrogen values indicate low reserve values. However, some women with low reserve values have normal reserve values when looking at their FSH levels on day 3 of their menstrual cycle. Therefore, this test is not reliable for the accuracy of normal reserves. Other tests used are the test containing clomiphene citrate and the antral follicle count test, in which the number of follicles is determined by ultrasound.
Infertility assessment and advancing maternal age
Infertility is usually diagnosed if the person does not become pregnant after 1 year of unprotected sexual intercourse (without using any contraception).However, an evaluation should also begin if the person is older than 35 and has been trying to become pregnant for 6 months. If a couple; If there are obvious medical problems for not getting pregnant due to the absence of menstruation (amenorrhoea), sexual dysfunction, history of pelvic disease, or surgery, the couple should begin an infertility assessment immediately. fertility tests; Detection of ovulation includes evaluation of the fallopian tubes, cervix, and uterus.
Sperm analysis can be done for the male partner. Most evaluations are concluded within 6 months, and an appropriate treatment can be started soon after the evaluation is over.
Women with a health-related illness such as high blood pressure or diabetes should consult their physician before trying to become pregnant. It is important to control such diseases. Because the risk for middle-aged patients is increasing, physicians may make changes to patients' medication or general health before they become pregnant.
Diseases such as high blood pressure or diabetes are more common when a person becomes pregnant after the age of 35. A special follow-up program and tests may be recommended throughout pregnancy. It may also be beneficial to go to a counselor in this regard. Children of mothers who gave birth at the age of 35 have a higher risk of experiencing chromosomal problems. Prior to becoming pregnant, patients should discuss these risks with their physician and geneticist. Some prenatal tests can be used to check for genetic birth defects. Amniocentesis and chorionic fluid samples are two methods that can be given for prenatal testing. Blood count and ultrasound are screening tests used to detect some birth defects. Many families want to get all the information they can about their pregnancy before making a final decision.
Treatment options and alternatives
If the cause of infertility has been determined, physicians may recommend specific treatment. Sometimes, though, no definitive cause can be found and infertility is referred to as "unexplained". For unexplained infertility, or when conventional treatments fail, advanced infertility therapies such as super-ovulation (IUI) or in vitro fertilization (IVF) may be recommended. In an IUI cycle, when infertility drugs are administered, they initiate the growth of more than one egg in the ovaries. When these eggs are ready to ovulate, the partner's sperm is inserted directly into the woman's uterus. This procedure is called "vaccination" (IUI) and they can cause some discomfort. The IVF method, on the other hand, results in the fertilization of the eggs with the partner's sperm in the laboratory environment, and then the transfer of the resulting embryo to the uterus.Preimplantation genetic screening
Thanks to new technologies, methods of detecting the presence of chromosomal anomalies are being investigated. This technology is applied to embryos created in in vitro fertilization methods. This may be more appropriate for older women. By preimplantation (PGD), they are evaluated by making genetic determinations by removing a small number of cells from each of the embryos.Embryos transferred to the mother's womb are selected from chromosomally normal embryos. This procedure has shown hope for higher pregnancy rates and prevention of genetic defect transfer to the embryo.
