Apart from the fact that the ovary has a finite number of follicles and as a consequence the older we get the more unlikely it is we are able to achieve pregnancy naturally, there is also an increase in the likely hood that common female genital disorders become more common and more problematic for example fibroids and endometriosis and other contributory environmental factors.
The reproductive capacity every given month is in the region of 20-30%.
If this is the case then this would equate to a 4% infertility rate in women in their 20s compared to 10-20% at age 35.
Increasingly women have to rely on assisted conception techniques in order to get pregnant, but again success rates are age related, in the absence of any overt pathology the younger you are when you attempt IVF the more likely it is to be successful.
Figures given by the human fertilization and embryology authority in the UK in 2007 put the live birth rate at 32% for women under the age of 35 years, 12% between the ages of 40-42years and 3% between 43-44years.
The number of attempts can improve these figures, but again the age related success is demonstrated by the fact that after 6 attempts the success rates for women under the age of 35 is quoted at between 65-86% falling to 23-42% after the age of 40.
Some women opt to freeze their eggs, unfortunately this is not an exact science and women may be better off freezing embryos with a higher success rates of pregnancy. This however may have legal implications if they and their partners are no longer together. In a landmark case, the stored frozen embryos were destroyed.
An investigation used to assess ovarian reserve is the AMH test (anti-mullerian hormone test). This can also be used to predict the potential success rates for women undergoing IVF.
For certain women if this is very low they may be advised to have IVF.
Other issues that women need to consider are the potential implications of having children for the first time after the age of 40, this in itself constitutes a risk, as well as the risk of multiple pregnancies, the increased risk of chromosomal abnormalities, and the older we get the more likely it is we will suffer from medical conditions they may impact the pregnancy. The older we get the heavier we become and obesity in itself may have further impact on the pregnancy. This together with diabetes and hypertension can lead to heart disease.
Increasing maternal age also increases the risk of pregnancy loss, rising from 20% at the age of 35 to up to in excess of 50% over the age of 54. This includes miscarriages and the risk of stillbirth.
The older mum also has an increased risk of being induced, instrumental delivery and caesarean section.
These factors thus need to be tied in to the management of women with gynaecological disorders to they can make the right informed decisions once they have been diagnosed.