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an outrage , I don ’ t know , who could perform such a heinous act but back to the point . By the time most girls hit puberty , the egg count has dropped to less than half a million oocytes , about 400,000 .
You can see that the drop is very rapid . The average woman will have about 400 menstrual cycles meaning ovulate 400 times prior to menopause . By 50 years the egg count has dropped to less than 1000 oocytes . The human species is very interesting . Based on our genetic code in most cases only one egg of several that have been recruited for that cycle will become dominant and ovulate . We have cases of twins , triplets and quads that can occur naturally , but do not believe that a woman carrying 8 children would have been as a result of natural conception .
The other eggs that are not ovulated die off and another set is recruited for the next cycle . The issue of donating eggs should not worry people as the fertility specialist cannot extract eggs that were not recruited for that particular cycle .
The process of natural loss of oocytes will continue throughout the woman ’ s life but for some strange reason at about 35 years this rate increases exponentially . With already few eggs the process of their depletion is even faster .
A classic French study was able to separate behavioral and age effects by studying healthy women with husbands who had azoospermia and underwent donor insemination . The study found that pregnancy rates decreased progressively with increasing age of the recipient female patient . The cumulative pregnancy rate observed up to 12 insemination cycles was 74 % for women younger than 31 years and decreased to 62 % for women aged 31 – 35 years and to 54 % for women older than 35 years .
A similar trend has been observed in analyses of data derived from In Vitro Fertilization ( IVF ) embryo transfer programs in the United States . The percentage of IVF cycle starts that resulted in live births was 41.5 % in women younger than 35 years but was less than 5 % in women aged 43 – 44 years , and 1 % for women older than 44 years . In contrast , in patients who used eggs obtained from healthy , young donors , 51 % of fresh transfers resulted in a live birth , regardless of the age of the recipient .
Back to Jeanie , well when I informed her of all these facts , she had something short of a nervous breakdown . The husband was equally distraught and was engulfed in how to protect his precious Jeanie but was confounded by his lack of control in the whole situation . I did not think that they would come back for a future consult but they heeded my advice and are now proud parents to twins , a boy and a girl . Needless to say it was a donor cycle .
Don ’ t get me wrong , I have not said that a woman over 40 years of age , cannot bear children . Being a person of faith we all know Biblically the oldest mother was Sarah , who was barren for several years . God had promised Abraham that he would be a father of great nations , and that Sarah would bear him a child . She gave birth to Isaac at 90 and died at 127 years . Recognize that nothing is impossible with God .
In modern times and in the absence of miracles , Yerrammati Mayangamana from India , is the world ’ s oldest mother after delivering twins at the age of 73 years in 2019 . Notably , these were donor eggs . She is now a single mother as her husband Raja died of a heart attack in March 2021 .
We know many women who have had the “ retirement child ” and I even know of a couple who had a natural conception and the mother was in her fifties despite it being her first marriage . These are great exceptions to the norm , and as much as I would welcome and congratulate anyone who succeeds at this age , I would not intentionally encourage women to experiment . The odds are very much against them .
We must also remember that , as age increases , the risks of other disorders that may adversely affect fertility , such as fibroids , tubal disease , and endometriosis , also increases . Women with a history of prior ovarian surgery , chemotherapy , radiation therapy , severe endometriosis , smoking , pelvic infection , or a strong family history of early menopause may be at an increased risk of having a premature decrease in the size of their follicular pool and decline in fertility .
The age-related decline in fertility is accompanied by significant increases in the rates of aneuploidy ( abnormal number of chromosomes ) and spontaneous abortion . Autosomal trisomy such as
Down ’ s Syndrome ( trisomy 21 ) is the most frequent finding . Even for morphologically normal embryos selected for transfer in IVF cycles , the prevalence of aneuploidy is high in women of advanced maternal age .
The fetal loss rate also is significantly increased , even after fetal heart rate motion is detected by transvaginal ultrasonography . Although 9.9 % of women younger than 33 years who conceive during IVF with a fresh embryo transfer have a pregnancy loss after 7 weeks of gestation with fetal heart activity observed , the rates of miscarriage progressively increase from 11.4 % for women aged 33 – 34 years to 29.9 % for women aged 41 – 42 years , and 36.6 % for women older than 42 years .
The American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine make the following recommendations : education and enhanced awareness of the effect of age on fertility is essential in counseling the patient who desires pregnancy ; women older than 35 years should receive expedited evaluation and treatment after 6 months of failed attempts to conceive or earlier , if clinically indicated ; and in women older than 40 years , immediate evaluation and treatment are warranted .
I think that summarizes my conclusion and would hope I have convinced women to plan their lives in accordance with their physiology or biological clock . You can become anything you want at whatever age you want . Unless women invest in egg freezing ( usually not very feasible in women under 35 due to the prohibitive costs ), they are unlikely to attain their child bearing goals at an advanced age , with their own gametes . Some big corporates especially IT firms like Google and Microsoft offer their women employees egg banking to encourage them to join their organizations . “ Roho safi !” I think natural conception is easier and definitely more fun than artificial methods so go ahead let ’ s have kids at a more opportune time .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com .