The HEALTH : May 2019 - Page 24

24 24 The Health | may, 2019 Fertility journey The woes of delaying Ageing and fertility W 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. A 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 we age. 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 explains. “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 as well. Risk of miscarriage with increased in a woman’s age As the quality of eggs declines, the chance for IVF journey 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 (PCOS). 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. Our fertility’s expiry date T he ovarian reserve in women will continuously decline as they age, and there is no way to increase its numbers again 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 their chances. “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. The definition 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 says. The Anti- Müllerian hormone, or AMH, is