In the centuries preceding the Industrial Revolution, teenage pregnancy was something to be celebrated, and the more children a woman gave birth to during her lifetime, the better. Of course, at that time life expectancy was a great deal shorter than it is today, and the risk of infant mortality was around 25%.
In
our modern era, as women have begun to seek higher education and employment
outside of the “traditional” housewife model, it is perhaps unsurprising that
women have begun to delay childbearing. It can seem easier to put having a
family on hold than finishing school, finding secure employment, or getting
that next promotion. After all, magazines and talk shows are full of stories of
women in their late 30’s or even 40’s who successfully have children. With all
of our medical advancements, haven’t we figured out a way to beat the
biological clock?
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Halle Berry (41) on the cover of InStyle, February 2008. Image from http://tinyurl.com/asuepam |
Unfortunately,
waiting that long before having children isn’t always an option. Fertility
begins to decline well before the onset of menopause (after which women cease
monthly menstruation), and many physicians consider 35 to be the tipping point,
after which pregnancy is both dangerous to the mother and unlikely to be successful.
After 45, the probability of conception through natural methods, sometimes
called “spontaneous conception”, is so low that most pregnancies are only
possible with a combination of medically assisted fertilization and the use of
either eggs frozen at a younger age or eggs from a donor in her 20’s – 30’s.
The
real-life implications of a woman’s biological clock got an unusual airing in
the public forum on an episode of Fox’s “New Girl” just after Thanksgiving.
Check out the clip below:
While
Jess’s (played by Zoe Deschanel) ignorance may seem comedic, she’s not alone.
Studies in Sweden, Israel, Canada, and the US have shown that most while most
people understand that fertility decreases as women get older, they often
underestimate the influence of maternal age on successful pregnancies,
overestimate the rate of spontaneous conception, and overestimate the success
of fertility treatments such as IVF (in
vitro fertilization) to promote conception. Many women assume that because
medical advances and better nutrition have extended life expectancy beyond the
27 years one could expect in Europe during the late 18th century,
the age at which fertility begins to decline has moved upwards as well. But
while genetic manipulations to combat the natural decline in fertility are a
possibility, at the moment they are more science fiction than scientific fact.
This
begs the question of what causes this decline in female fertility, and why we
don’t see the same magnitude of a decline in men of a similar age. Current
research points to increasing aneuploidy, the failure of chromosomes to
separate properly during meiosis, as the culprit. Aneuploidy most often results
in spontaneous abortions, in which the fetus dies prior to completing
development, and those babies that do survive are often born with severe
developmental disabilities. Meiosis is the process of cellular division that
produces eggs or sperm, depending on the sex of the individual in question. In
males, once an individual has reached puberty he continually produces new sperm
via meiosis. In females, the process of meiosis begins as the fetus develops in
her mother’s womb, and then is put on hold. After the onset of puberty, each
month one of the immature eggs, or oocytes, completes meiosis. If it is not
fertilized, the egg is discarded through menstruation and the following month,
another oocyte completes meiosis.
The
lengthy period of time an oocyte spends in the interval between the initiation
and completion of meiosis in females (also known as “prophase arrest”), is
likely a major factor underlying the high rate of aneuploidy in older women,
but the exact mechanism is not yet fully understood and likely involves multiple
factors and processes. Some studies have shown that as maternal age increases,
the integrity of proteins known as “cohesins”, which are crucial to proper
chromosome separation, decreases. Work on other organisms that exhibit similar
declines in female fertility suggests that hormones such as TGF-b and IGF, which are also
involved in regulating physical growth, may also play an important role.
But
while the exact mechanisms underlying decreased female fertility with aging are
of great interest to scientists and medical professionals, the average woman
simply wants to know what she should do about it. When should she start trying
to have kids? What medical options are available if she has trouble conceiving?
While
by no means an in-depth look at the huge variety of maternal age-related fertility
treatments available today, there are essentially two main precursors: use of a
donor egg or use of eggs frozen earlier in life (ie with a younger maternal age
than the biological mother’s age now). Modern methods of egg freezing, also
known as vitrification, address many of the issues associated with older
methods of egg freezing, such as ice crystallization that renders the oocyte
non-viable. Vitrification seems to represent a promising avenue for women to
set aside “younger” eggs and thus preserve their fertility. However, even
though vitrification is no longer considered an “experimental” treatment, there
has been a great deal of push back from the medical community, insisting that
vitrification should not be available to women without immediate medical
concerns that threaten their fertility, and many insurance companies still
refuse to cover the cost of elective egg freezing.
As
the ethical debates over techniques such as vitrification play out, I hope that
we as a society will come down on the side of hopeful parents who are
struggling to cope with a biological clock who’s timing was fixed millennia
ago, when living to 100 was pie in the sky rather than reality. And I hope that
we continue to educate ourselves about the science of infertility and the risk
of involuntary childlessness, whether by combing scientific literature, talking
with your doctor, or watching surprisingly educational television episodes.
References
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W.P. Robinson. 2010. Fertility and aging: do reproductive-aged Canadian women
know what they need to know? Fertility and Sterility 93(7):2162 – 2168.
Chiang, T., F.E. Duncan, K. Schindler, R.M. Schultz, M.A.
Lampson. 2012. Evidence that Weakened Centromere Cohesion is a Leading Cause of
Age-Related Aneuploidy in Oocytes. Current Biology 20:1522-1528.
Hasholoni-Delev, Y., A. Kaplan, S. Shkedi-Rafid. 2011. The
fertility myth: Israeli students’ knowledge regarding age-related fertility
decline and late pregnancies in an era of assisted reproduction technology.
Human Reproduction 26(11): 3045-3053.
Homburg, R., F. van der Veen, S.J. Silber. 2009. Oocyte
vitrification – Women’s emancipation set in stone. Fertility and Sterility
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Hunt, P. and T. Hassold. 2008. Female Meiosis: Coming
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Knapp, Vincent J. 1998. Infant Mortality and Malnutrition in
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– 95.
Lampic, C., A.S. Svanberg, P. Karlström, T. Tydén. 2006.
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Mac Dougall, K., Y. Beyene, R.D. Nachtigall. 2013. Age
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NPR. 2012. Egg Freezing Moves Out of Experimental Realm. http://www.npr.org/2012/10/24/163558294/egg-freezing-moves-out-of-experimental-realm
Tatar, M. 2010. Reproductive aging in invertebrate genetic
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