Causes Of Infertility In Women Over 40 And Treatment Options

Infertility is one of the potential health challenges faced by today’s young adults, with nearly 16.8% falling under the age bracket of 16 to 49 years being affected in India alone. Infertility affects both men and women, and the risk of fertility decline increases with age. 

Infertility is when a couple is unable to have a child despite trying for more than a year. In women, advancing age can impact egg count and quality and simultaneously impair uterine functioning, making it weak to bear the child for a complete pregnancy term. 

According to the American College of Obstetrics and Gynaecology (ACOG), the woman reaches her peak reproductive years during her 20s and early 30s. By the age of 32, her fertility can drop. And after 37, the fertility decline process aggravates. 

By the age of 45, fertility declines so much that it becomes less likely for a woman to get pregnant. This article covers many aspects of infertility in women over 40, its causes, symptoms, and treatment options. 

What does infertility in women imply?

The World Health Organisation (WHO) defines infertility as “Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” 

In women, infertility may be due to disorders or ailments of the reproductive system that impede fertility and reproduction. Hence, infertility in women is when a woman is unable to achieve pregnancy even after repeatedly trying for over a year or more. 

What are the possible causes of infertility in women over 40

A woman begins her life with a fixed number of eggs in her ovaries. The egg numbers and egg quality decreases with increasing age. Women above 40 are more likely to make eggs with chromosomal anomalies. And even likely to have issues like primary ovarian insufficiency (low ovarian reserves), fibroids, and endometriosis that lead to infertility. 

If we score the possibilities of healthy couples getting pregnant according to age, 1 in 4 women in their 20s and early 30s can get pregnant in a single menstrual cycle. By 40, 1 in 10 women will likely get pregnant in a single menstrual cycle.   

Although a woman is born with millions of eggs in her ovaries, she loses over 30 immature eggs every day. If we calculate, by the time a girl reaches puberty, the egg count decreases to about 1,00,000. And the egg count further decreases to 20,000 at the age of forty. And along with egg count, the egg quality is also affected and decreases. The chances of developing eggs with abnormal chromosome numbers increase as a woman ages. Thus, the ability to fertilise or nurture a foetus decreases.   

The other reason is the hormones that play a crucial role in reproductive functioning. With age, hormonal fluctuations become more common. Hormonal imbalances, thyroid problems, psychological health issues, stress, and other medical conditions further reduce fertility among women aged 40 and above. 

What are the Noticeable Symptoms of Infertility in women to keep an eye on?

The prime symptom of infertility in a woman above 40 is the inability to get pregnant after six months or more. Some of the noticeable symptoms include:

• Irregular menstrual cycles– If the time between menstruations prolongs for more than 35 days or too short, less than 21 days. Irregular or absence of menstruation implies no ovulation or mature egg release.
• Repeated miscarriage is another symptom indicating that the uterus may be weak and cannot hold the child for the entire term. 
• Infertility problems like fibroids also show signs of heavy bleeding that can last more than five days, severe menstrual cramps, and fatigue. 
• Hormonal imbalances lead to hair thinning, low sex drive, weight gain, mood swings, depression, anxiety, and anger. 
• Other symptoms include pain during sex,
• Irregular and painful bowel movements. 

Treatment options- A detailed discussion

The primary step of infertility treatment in a woman is determining the cause. This is achieved through physical examination and evaluation tests, such as:

• Hysterosalpingography,
• Hormonal tests,
• X-ray, 
• Laparoscopy, 
• Transvaginal ultrasound, 
• Hysteroscopy, and 
• Saline sonohysterogram (SIS).

Once the cause of infertility is determined, the line of treatment can be devised, according to the underlying condition. Some of the treatment options for infertility in women above 40 include:

• Surgery: Surgical corrections include laparoscopy or hysteroscopy for structural deformities or blocked tubes. 
• Hormonal treatments and Medications: Prescribed hormonal medications help regularise ovulation and menstruations. These fertility medications work naturally like follicle-stimulating hormones and luteinizing hormones. They include medications, such as clomiphene citrate, metformin, letrozole, gonadotropins, and others. 
• Artificial Insemination with OI: Intrauterine insemination (IUI) is an artificial insemination method. IUI can be combined with ovulation induction (OI). Once the ovaries are induced and release eggs, the processed sperms are later inseminated at the time of ovulation for fertilisation. 
• Assisted Reproduction Technology (ART): ART includes techniques like IVF, where the ovaries are stimulated to produce more follicles. The eggs are retrieved directly from the ovaries and fertilised with the retrieved sperms in the laboratory. The developed embryo can be placed in the woman’s uterus for implantation and development. ICIS is another ART procedure where sperm is directly injected into the egg. 
•  Third-Party ART: This involves using donor eggs that can be fertilised with the partner’s sperms in vitro. Even donor embryos can be placed directly in the uterus of the woman.

Conclusion

Conceiving beyond the age of 40 for a woman can indeed be challenging. Prevention and prediction of infertility at such an advanced age can be difficult. However, the other controllable risk factors in infertility like having a healthy diet, regular exercise, avoiding alcohol, and quitting smoking, can help improve fertility.  

An infertility diagnosis can help uproot the cause of infertility and find a treatment solution that ranges from fertility medications and surgeries to assisted reproduction technology. It is advised to have regular health check-ups and see a medical expert who can guide and take you through natural conception and ART procedures. 

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