Ma'am, How Old Are You?

Women are blessed with a special ability – child bearing. In current times, men and women are considered equal in many ways. This gender equality spans through education, social status, job equality and even politics. Awareness about gender equality is fast catching up and women are getting better education and better economic equality. Thus, today we see many more working woman than 50 years ago.

Isn’t this an achievement for women? We should be celebrating it, shouldn’t we? Yes, we should indeed. Women are now better educated and less likely to be a victim of social and domestic injustice.

However, this phenomenon brought about a change in modern family lifestyles which is many more women, especially urban women, delaying their first childbirth. It is a very logical thing to do for them. They are better educated and equal in job market. At a younger age, they would pay more attention at self-development, personally and professionally, as a man would do. Many women would be in a relationship or even married but choose to delay having their first child. This phenomenon is happening worldwide with any developing and developed nations. We in Malaysia are not spared!

Do you often hear our old ladies, aunties and ‘makciks’ say, “In our times, a family have at least four to five children. Nowadays, there’s only one child per family, if any at all”. Sounds familiar?

We the modern generation can’t deny what they say. Some of our grandparents have more children than five modern families combined. There are some good valid reasons for to delay first childbearing. The woman and the man as well, may be more stable economically. They can provide better care for their future new member of the family. Furthermore, the couple may be more matured to handle a family on their own.

You may say, “Hold on a second, so what’s the problem with having a child at a later age?”

Don’t you see it? There is a BIG problem. The answer lies in your question you just asked.

You asked, “Hold a sec, what’s the problem with having a child at a later age?” To have your own genetic child at later age, YOU MUST FIRST BE PREGNANT AT LATER AGE!

Problem of infertility are on the rise. According to American Society Of Reproductive Medicine (ASRM) and World Health Organisation (WHO), infertility is defined as ‘inability to achieve pregnancy after one year of unprotected sexual intercourse’. Couples with infertility are increasing in number. According to World Health Organization (WHO), about 34 million women are suffering from infertility worldwide. Infertility is the 5th highest global disease in the world. Well, it’s happening in Western countries, we are fine. You think so?

In the last 15 to 20 years, there is an increase in the number of new clinics and hospital offering treatment for infertile couples in Malaysia and many more will come in future. As for any business, it’s always supply versus demand. You do the math. This is not a fiction or ‘cerita dongeng’ (folks story) to scare any woman. Maybe we should talk facts instead of ‘cerita dongeng’.

Biology of Infertility

A woman is born with all the eggs, medically called oocyte that she will ever have in her lifetime. An egg or oocyte is the female sex cells produced by the ovaries, when fertilised by male’s sperm, produce embryo, the early form of human life.

At birth, a woman has about one million eggs in her. By puberty, it drops to about 300 000, of this only about 300 will be ovulated in her lifetime until menopause. Many of the eggs are not ovulated and they die (called atresia). A woman is most fertile in her 20s’. Fertility gradually declines in her 30s’, especially after the age of 35 years. Each month, a healthy 30-year-old woman tries to get pregnant, one  out  of five may get pregnant (20% chance). By the age of 40, a woman’s chance of getting pregnant is about  five in 100 (5% chance).

Unlike men, women do not remain fertile until menopause. Generally, they are unable to have a successful pregnancy by mid-40s’. This is true for natural conception as well as conception via Artificial Reproductive Techniques (ART) such as test-tube baby (IVF). Age-related loss of female fertility happens because of gradual decline in quality and quantity of the female egg. This loss in quality of the eggs further leads to increase in spontaneous miscarriage rates.

Therefore, a woman’s age is an important test of female egg quality. An important change in egg quality is the increase in genetic abnormalities. As the woman becomes older, her eggs may have too few or too many chromosomes (chromosome are the basic building blocks of human. Each of us has 23 pairs of chromosomes. More or less number will produce abnormal baby).

So, can you see the problem now? There is another myth that needs clarification.

Test-tube baby (IVF) cannot reverse age-related decline in egg quality. Even with test-tube baby (IVF), the success rate drops tremendously as the woman ages. Women younger than 35 years of age have a success rate between 30 to 45%. Women over 40 years of age will have a success rate of less than 5%

So next time when someone asked you “Ma’am, how old are you?”, maybe you should not get angry at that person. Maybe it’s a sign for you not to delay having your first child or at least give a thought to it.