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Age 35 or Older? The Impact of Advanced Maternal Age
Adapted from “Reproduction at an advanced maternal age and maternal health” by Mark V. Sauer, M.D. in May 2015 issue of Fertility and Sterility.
Women are most fertile between the ages of 15 and 30, a time in which many are unwilling or unable to start a family. From a career perspective, the years from age 35 to 45 would make the most sense, but these years represent the final stages of decline in the female fertility potential.
The definition of advanced maternal age in the literature has been creeping upward from 35 to 40 and even to 45 years.
Remarkably, over the years, little appreciable increases in success rates of advanced reproductive treatments have been realized for women older than 40 years, unless donor oocytes are used. Graphs profiling the loss of fertility in 17th century women look remarkably similar to those for modern populations.
Advanced age is a risk factor for female infertility, pregnancy loss, fetal anomalies, stillbirth, and obstetric complications.
Older patients are more prone to develop chronic illnesses, particularly obesity, hypertension, and diabetes. However, pre-existing disease does not fully explain all the adverse events associated with age and obstetric outcomes. Even after In Vitro Fertilization treatment, in which patients are generally screened prenatally and known to be healthy, rates of complications are consistently higher with advancing age, particularly related to cardiovascular events.
Maternal mortality rates are significantly increased in women older than 35 years, and even more pronounced after age of 40 years. Deaths are mostly attributed to cardiovascular disease, diabetes, placental abruption, and complications from operative deliveries.
Reproductive medicine specialists and obstetrician/gynecologists should promote more realistic views of the evidence-based realities of advanced maternal age pregnancy, including its high-risk nature and often compromised outcomes.
Realistic characterization should not scare patients away from trying to have children but rather serve as a warning of the perils of postponement and be sobering reminders that all stages of life are fleeting and pregnancy is still best accomplished while young.
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