AGE AND FERTILITY. AGE AND PREGNANCY Kathleen M. Gotzmann, MD Department Chair Ob/Gyn Upper Chesapeake Medical Center. BACKGROUND. Women are born with all the eggs they will ever have, about 1 million Some are ovulated, but several hundred are pre-programmed to die each month
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AGE AND FERTILITY
AGE AND PREGNANCY
Kathleen M. Gotzmann, MD
Department Chair Ob/Gyn
Upper Chesapeake Medical Center
surgery, pelvic radiation, chemo agents
The trend in delaying fertility may be due to a greater emphasis on establishing a career, later marriages, and remarkable improvements in the area of contraception.
Woman’s Age (y) % Conceiving
in 12 Mo
15 - 20% of all couples will experience difficulties with conception, but this increases up to 50% at age 35 – 40.
deliveries worldwide using assisted reproduction.
15-17 yrs old 22/1,000 women
18-19 yrs 70/1,000
20-24 yrs 101.8/1,000
25-29 yrs 115.5/1,000
30-34 yrs 95.5/1,000
35-39 yrs 45.5/1,000
40-44 yrs 9.0/1,000
45-54 yrs 0.6/1,000
- conceive with ART
- have multiple gestations
- have LBW babies
Births as old as 66 yrs of age using ART have been reported.
Oldest women to conceive naturally is 57 yrs old.
The percentage of pregnancies in women over 35 yrs old in the US:
14% before WWII
5% in 1970’s
since 1980- ~ 14%
A) increased number of women aged 35-45
B) later marriages, second marriages
C) better contraceptive options available
D) more opportunities to further education
Education of women has been increasing at a greater rate than that of the general population.
1980– 43% of women aged 35-39
had >16yrs of education
1994- 52% of women
Is the strongest predictor of:
use of contraception
timing of childbearing
total # of children
College educated women typically have low birth rates in their 20s and higher in their 30s.
of adverse perinatal outcomes. (Htn, diabetes)
On average, the prevalence of maternal health problems associated with poor outcome, increase more rapidly in advancing age in African american than in caucasian women.
(~ 20% /month)
Probability of clinical pregnancy following intercourse on most fertile day of cycle:
19-26 yrs old 50%
27-34 yrs 40%
35-39 yrs 30%
- generates more eggs and sperm to be present at the optimal time of conception.
(live birth rate drop from 32% in women<35 to 10% in women 41-42 yrs)
Pregnancy rates are determined by age of donor, but pregnancy complications by age of mother.
Source: Centers for Disease Control and Prevention 2001.
In Vivo vs. In Vitro
overall rate of Abs requiring hospitalization is ~ 11%.
<30 yrs old ~12%
30-34 yrs ~15%
35-39 yrs ~25%
40-44 yrs ~51%
>45 yrs ~93%
study of over 2000 IVF pregnancies lost after seeing cardiac activity:
<30 yrs old ~ 5%
31- 34 yrs ~ 8%
35- 39 yrs ~ 13%
> 40 yrs ~ 22%
- pelvic infections
- tubal pathology
These are all structural abnormalities and not related to aneuploidy, thus not detected by karyotype analysis.
a) >100,000 abs, stillbirths, live births-
cardiac defects 4x more common in
women >40 yrs old.
b) over 1 million singleton infants born
>20wks in Atlanta 1968-2000—
**** advanced maternal age associated with all cardiac defects ****
are related to maternal age.
existing medical conditions.
(hypertension, diabetes, placental issues)
3 to 4%. 5 to 10% in women >40
DM increase 3-6 fold in women >40.
Incidence of gestational DM in general OB population is 3%.
~7-12% in women over age 40
~20% in women over age 50
nulliparous women >40 have a tenfold increased risk of placenta previa compared to women 20-29 yrs old.
Advanced maternal age is responsible for a substantial proportion of the increase in the rate of LBW babies and preterm delivery in the last several years.
Swedish study…. Nulliparous women
173,715 women compared the birth outcome of women 20-24 yrs to 35-40 yrs
Older women had higher risk of LBW
and preterm delivery
Rates were almost doubled in the older women by age 45…..
a) increased frequency of medical
b) induction of labor
c) malposition of baby
d) maternal request for C-section
(21 vs. 9/100,000 live births)
Risk for women over the age of 40 is 5x higher
There are multiple tests today to quantify a women’s risk of chromosomal abnormality:
first trimester serum screening
quad screen in 2nd trimester
invasive testing– CVS , amniocentesis
socioeconomic class….all influence outcome.