Health: Having children beyond age 40

Anu married in 2019 at the age of 37. The hidden pressure to have a family began on the first day. My biological clock was ticking, therefore, I was eager to establish a family too,” the Gurugram-based service worker reminisces. “Aside from the natural approach, I experimented with everything, including recording my days and conception cycle, ancient wives’ tales, and Vaastu.

Despite my extreme desperation, nothing worked out. Then everything was put on hold when the epidemic hit. I was forty years old in 2021 when we finally made the decision to pursue assisted reproductive technology (ART) and have a child via in-vitro fertilization (IVF). I feel fortunate to have been successful on my first try. I now have beautiful twins.

According to Anu’s obstetrician, Chetna Jain, head of obstetrics and gynecology at Cloud-9 Hospital in Gurugram, an increasing number of women are choosing to become mothers at or beyond the age of forty. “Anu has no health problems and is in good physical condition. According to Dr.

Jain, the average age of first pregnancies among metropolitan women has increased due to delayed marriages, with second pregnancies occurring in the late thirties. She continues, “At least 8 to 10 percent of urban moms are having babies after 40.” Even in the middle of the thirty years, fertility is somewhat higher. Even older women may now conceive via IVF using donated eggs, thanks to developments in ART. The stigma associated with reproductive treatments is fading. In society, there is more acceptance, claims Dr. Jain.

For women who marry later in life, she suggests seeing a specialist as soon as possible to assess their chances of becoming pregnant and how long they have before they become infertile. In order to ensure a safe pregnancy, she advises scheduling a pre-conception visit, making lifestyle changes, and, if you haven’t already, being immunized against diseases like chickenpox and rubella.

She also makes a warning sound. “Although ART methods like IVF have made parenthood possible for many women over 40, there are hazards involved. Dr. Jain continues, “In general, women over 40 take longer to conceive (with IVF), sometimes up to two years, whereas younger women take around six months.

Medical experts agree that the optimal age to have children is 35 since, regardless of an IVF or natural delivery, dangers and issues arise after 40. This is according to Dr. Alka Sehgal, a former professor at the GMCH-32, Chandigarh Department of Obstetrics and Gynecology.

She continues, “Older women who choose IVF should know that there are increased risks of preterm deliveries, underweight babies, stillbirths, and chromosomal abnormalities in the offspring.”

As Dr. Jain notes, there are further problems. Egg production declines beyond the age of forty, mature/aged eggs are of lower quality, less nimble, and are less receptive to sperm. Occasionally, a fertilized egg of poor quality does not develop into an embryo. Alternatively, if the embryo is of low quality, it may not adhere to the lining of the uterus, which often thins in older women. Fertility is influenced by a wide range of factors that rise with age.

Dr. Umesh Jindal, an infertility specialist in Chandigarh, claims that nature understands that a woman’s body is not meant to carry children in her late 40s, which is why the menopause occurs. Women are more susceptible to all age-related illnesses beyond a particular age. Furthermore, their body cannot handle the additional danger of pregnancy. She continues, “After 50, rates of morbidity and mortality are also high.”

According to Dr. Jain, the dangers don’t end here. Twins and triplet pregnancies are more prevalent in older women, and this increases the danger to the mother’s health. They also have a higher risk of high blood pressure and diabetes. Their inflexible pelvic region raises the risk of caesarean deliveries. She continues, “They have a higher risk of low-lying placenta, placental abruption or separation, and increased bleeding after delivery.”

According to Dr. Jain, there is a higher chance of cardiac and gastrointestinal problems in even the infants delivered via IVF. According to a study that is accessible through PubMed Central, an archive of biomedical and life sciences journal literature at the National Library of Medicine of the US National Institutes of Health, children conceived through in vitro fertilization (IVF) have a roughly one-third higher risk of congenital malformations than do other children. These include uro-genital, genito-urinary, and heart anomalies as well as musculoskeletal abnormalities.

Dr. Sehgal notes that there is still hope since IVF has some benefits over natural childbirth. Testing is an option for parents who are genetically prone to certain medical conditions. Now that the embryo is in your possession and being developed artificially, it may be examined for a variety of diseases. Furthermore, she continues, “ART and IVF are also very helpful for people who get married later in life, get married again, lose a child, or are separated from one another in different cities or countries.”

Expense plays a significant role in both the public and private sectors. Furthermore, according to Dr. Sehgal, “the majority of government setups are not providing this service or are providing limited service.”

In its obstetrics and gynecology department, PGIMER, Chandigarh, has a dedicated facility that provides IVF; however, it does not accept cases requiring donor eggs. According to Dr. Shalini Gainder, Professor, Department of Obstetrics and Gynecology, PGI, this excludes women over 40 who often have poor results with their own eggs and may need donor oocytes. An approximate cost of Rs 1 lakh each cycle is involved, which could or might not result in a healthy pregnancy.

Prominent private sector players charge between Rs 1.75 lakh and Rs 3 lakh for each IVF cycle, which includes the cost of drugs, consulting fees, and the treatment itself. If donor sperm or eggs are required, the expenses range from Rs 4 lakh to Rs 5 lakh for donor sperm and from Rs 3 lakh to Rs 4 lakh for each egg.

Despite the hazards, the majority of doctors agree that becoming a mother beyond 40 is a realistic goal for a woman in good health and physical condition.

What age is too old?

Introduced on January 25, 2022, the Assisted Reproductive Technology (ART) (Regulation) Act, 2021 sets a 50-year-old female age restriction and a 55-year-old male age limit for having IVF or other ART procedures.