Nowadays the incidence of female infertility has increased mainly due to increased female age. Many women choose to delay pregnancy today, for professional or socioeconomic reasons. It is estimated that 20% of women usually decide to have children after the age of 35 years. In addition, the abundance of information regarding the various fertility treatments and especially IVF, give a false sense of security in their choice to delay childbearing. Although it is generally well known that fertility declines with age, women have not fully comprehended the importance of age.
The climax (peak) of a woman’s ability to have a baby is reached in her twenties and declines rapidly after the age of 35. In her 40’s a woman’s ability to conceive is decreased by 30 to 50%. The most important reason relates to the quality and quantity of the ova found in the ovaries. Unlike men, who continue to produce sperm throughout their life, women have a definite number of ova which range from 1.000.000 to 2.000.000 at birth and which decrease to 300.000 at puberty. Only around 1% of these will mature and reach ovulation, whereas all the rest will be absorbed. The loss of the ova is accelerated when the woman reaches the age of 35 onwards which results in the inability or difficulty of fertilization. Finally, the chromosome related problems in older women are responsible for the increased number of abortions or abnormalities found in their children that will eventually be born.
Causes of infertility
Apart from age there are further causes leading a woman to infertility that may be attributed to:
- ovulation dysfunction
- fallopian tubes or peritoneal factor
- uterine abnormalities (congenital or acquired)
- cervical mucus disorders
- unexplained infertility
The uterine abnormalities, in particular, may affect considerably the woman’s ability to get pregnant, whether they are present from birth (congenital) or acquired later in life after an operation or inflammation, like fibrosis or Asherman syndrome and adenomyosis.