DR MAXWELL ADEYEMI

We will all grow old, and the ageing process is accompanied by a variety of changes in men and women. Generally, as women age, certain changes occur that impact their physical, physiological and reproductive health.

Fertility decline

The single most important factor influencing a woman’s fertility is her age. A woman is born with all of the eggs she will ever have in her life. Her eggs decline in quality and quantity as she ages. While good health increases the likelihood of becoming pregnant and having a healthy baby, it does not compensate for the effects of age on a woman’s fertility.

We may feel unprepared to have a baby right now while also being concerned about not being able to become pregnant later. For these reasons, it is critical to understand how ageing affects the chances of conceiving, carrying a pregnancy to term and also, the general reproductive health of a woman.

As women get older their fertility naturally declines. However, the time that that decline begins and the rate at which it progresses vary widely in women, but always begin well before menopause. Fertility generally begins to decline in your late 20s or early 30s, and it becomes more rapid after the age of 35.

Ovarian reserve

The quantity and quality of the ovarian primordial follicular reservoir is defined by ovarian reserve. In women of reproductive age, poor ovarian reserve refers to a decrease in the quantity of ovarian follicular pool. Some women in their mid to late 30s and even early 40s have no difficulty conceiving. Many other women struggle to conceive or are unable to bring a pregnancy to term. A woman is born with a finite number of eggs (about two million). Only a few hundred eggs will ovulate during a her reproductive lifespan, and the vast majority of eggs will die off due to a process known as atresia.

Quality of eggs

A chromosomally normal egg has 23 chromosomes and when fertilised by the sperm, which also has 23 chromosomes, the resulting chromosomally normal embryo will have a total of 46 chromosomes. As a woman’s ovary ages, the number of aneuploidy eggs (eggs with too few or too many chromosomes) increases. The embryo will inherit too few or too many chromosomes if it is conceived with an aneuploidy egg. The majority of aneuploidy embryos fail to implant in the uterus or result in miscarriage. Aneuploidy embryos can cause chromosomal diseases including Down syndrome and an extra copy of chromosome 21, in some cases causing developmental and intellectual delays in children if born.

Dyspareunia

Dyspareunia is the term for pain experienced during intercourse. Due to lack of oestrogen, sex is painful for more mature women. Oestrogen helps repair the vaginal lining by generating new cells and encourages the release of natural lubricants that minimises friction during intercourse. But because the body produces less oestrogen when a woman gets older, her vaginal lining thins, shrinks, and dries out and the vagina loses its elasticity. Penetration can become uncomfortable when the