The Health | may, 2019
Ageing and fertility
omen in today’s modern
society should count their
blessing due to the increased
opportunities we have been
given to further pursue suc-
cess in our education and
high flying careers. However, this also means that
women are having to choose between pursuing
their career or motherhood.
Most women are found to choose the former
and defer marriage and motherhood. This has
led to a trend seen globally where the age of 1st
time mothers have increased. Although more
women are getting better education and career
is definitely a good thing, it may cost them the
opportunity to conceive once they get to their
‘right time’. Dr Natasha Ain Mohd Nor, Fertility
Specialist at KL Fertility Centre explains how age
affects our fertility.
nn (not real name) was married to
her husband for 14 years when they
realised that delaying having a child
have costed them.
She tells that during her early years of
marriage, both of them were busy with
each other’s careers. They would shrug off
questions from friends and family regarding
conceiving a child, saying that the baby
would come soon.
As time flies, they realised that they have
been trying to conceive naturally for six years
to no avail. The couple then decided to go
for a fertility check-up, but the doctors found
that they had no underlying condition for the
trouble to conceive.
Unfortunate health condition
The pursuit to conceive took a sudden halt
for the couple when Ann’s husband was
diagnosed with nasopharyngeal cancer.
Ann was devastated, and she focused on
getting her husband better from there.
Ann’s husband was lucky however, as
the cancer went into remission after a year
of chemotherapy and radiotherapy. But
the couple was cautious, and it took them
another five years to make sure that the
husband returned to good health.
Dr Natasha, stresses the importance of not delaying
your opportunity to conceive as it becomes harder as
Inspired by her sister
At the time when Ann’s husband was in
recovery, Ann was also supporting her
sister through an IVF treatment. Her sister
was successful in her IVF cycle, and
actually gave birth to twins.
The thoughts of having a baby of their
own slowly crept back into their minds,
and the couple decided to try again – with
assistance this time.
Biological clock ticking
“Fertility drops as we age due to our ‘biological
clock’. Each woman has all her eggs even when
she is still in her mother’s womb, amounting to
around one to two million eggs in her ovaries. As
she ages, the natural process of ‘atresia’ occurs,
whereby the eggs are released and absorbed by
the body in a continuous fashion,” Dr Natasha
“At puberty, the number of eggs in the ovaries
usually decreases to around 400,000, and only
around 400 eggs out of the total will undergo the
process of maturity.”
In addition, the quality of the eggs decreases
as well as women age, according to Dr Natasha.
Therefore the ageing process not only reduces
the quantity of eggs, it reduces the quality of it
Risk of miscarriage with
increased in a woman’s age
As the quality of eggs declines, the chance for
Ann went to a fertility centre to start her
consultation in 2013. She pursued with her
IVF treatment despite finding out that she
actually have Polycystic Ovary Syndrome
She managed to retrieve 12 eggs and
eight embryos. The first embryo transfer
failed, and Ann tried once more two months
later with a frozen embryo transfer. Second
one was also a bust.
Ann felt the need to rest after the first
two tries. Her doctor said that even though
they could retrieve a promising number of
embryos, the quality of it was lesser because
of her advanced age.
She took a break from trying for three
months, but went for acupuncture as
suggested by her doctor.
he ovarian reserve in women will
continuously decline as they age,
and there is no way to increase its
We now know that as we age, our
chances of having a baby will decline
significantly – be it for women as well as men.
But for women specifically, Dr Paul Tay Yee Siang,
Fertility Specialist in KL Fertility Centre spoke
to The Health about the dangers of women not
knowing about their finite egg reserve.
Third time’s the charm
Ann went for her third attempt, which was
the second time trying with a frozen embryo
transfer. She was successful! Although it
did took her a urine test and a blood test to
fully be sure that she was actually pregnant.
She gave birth to her son in August 2014.
Ann and her husband feels eternally grateful
for their success in conceiving, given her age
and other conditions which have deterred
“All the odds were against my husband
and I in having our child, and we almost gave
up on our hopes following the challenging
adversities of life. However, life has never
given up on us. Keep trying and don’t give
up. You never know what God has in store
for you,” says Ann.
Dr Paul advises older women to not waste time getting
help conceiving as our ovarian reserve lessens with age.
“There is a method used to define low ovarian
reserve, called the Bologna criteria, which takes
into account three main criteria. One is the
woman being above 40 years of age, second is
when she only able to retrieve three eggs after a
full stimulated cycle (IVF), and third, if she has
low Anti-Müllerian hormone, or Antral Follicle
Count,” Dr Paul starts.
“If three of this criteria is met, then the woman
is categorised as having low ovarian reserve,” he
The Anti- Müllerian hormone, or AMH, is