According to medterms.com the definition of the Endometrium is, (8) ‘The uterine lining. A tissue which is shed monthly in response to hormonal changes of the menstrual period. The Endometrium then grows back and slowly gets thicker and thicker until the next period when it is once again sloughed off.’ (9)This plays a vital role in conception allowing the formation of the placenta, which supplies oxygen and nutrition to the fetus. As a females age increases she may experience the problem of Thin Endometrium, this can happen at any age but women in their late 40’s are more likely to experience it. (10)A Thin Endometrium means that the lining of the uterus is not thick enough (generally less than 8mm thick) to support the fertilized egg. However if the egg does get supported it can be lost in a miscarriage due to the instability of the thin tissue. It may also play a role in bad fetus development which could also result in miscarriage.
Difficulties in the sperm getting to the egg also become a greater problem as women age. (12) As women age (over 50) the estrogen levels in their bodies become lower causing a shift in mucus production, this causes the cervical glands to act differently. (11)Vaginal secretions, which are produced by the cervical glands to help maintain vaginal health, become less fluid or thick and sticky as age increases creating a hostile environment. This change in viscosity means it is much more difficult for the sperm to reach the uterus and fertilize the egg. Along with the decrease in fluidity as people age they are more likely to gain weight. This increase of lipids in the body can reduce the size of the reproductive tracts leading to the uterus. This also increases the difficulty of sperm reaching the egg. On some occasions the decay of the cervical glands or sensitivity to sperm mean that antisperm antibodies can be created which treat the sperm as foreign bodies and destroy them as part of the immune system.
Harder Deliveries
This is a great problem for first time older mothers, more so than those who have had previous children. But repeat mothers can still experience difficulties. (1)First time mothers who have passed 30 are more likely to have difficulties during labor, such as a prolonged second stage of labor and more anxiety experienced by the baby, therefore having to make use of a Caesarean section. In a study by Harvard Medical School Faculty it was found that ‘Woman aged 35-39 may have a 27.4% chance of delivering by a Caesarean section and those aged 40-49 have a 31.6% chance, higher rates than those of younger women. They’re also more likely to give birth to twins or triplets.’ (13)A Caesarean is performed by making a large incision in the lower abdomen at the end of the pubic bone, then another is made in the wall of the womb to remove the baby, there are risks associated with the procedure such as excessive bleeding, infection of the incision area and 2% of babies may be cut when the incision is made. The area is stitched back together with stitches which will naturally dissolve overt time. It is only performed when the birth is expected to produce difficulties which would put the mother or child at risk.
(13)The chances of Caesarean increase with age due to difficulties becoming increasingly likely during pregnancy. The increased likelihood of twins due to the decaying Ovarian follicles, this creates higher chances of difficulties due to an increased likelihood of the babies being in an abnormal breech position in the womb. This is when the baby is in the womb in an erratic position for example bottom or feet first. Alternatively the children may share a placenta meaning that after the first is born by vaginal birth the second may experience oxygen starvation in the womb resulting in the need for emergency caesarean.
First time older mothers are likely to have the size of their birth canal reduced due to inactivity. This means that the baby may not be able to fit through the canal. An example of this is when a baby’s head is too big to fit through the pelvis. Sometimes an artificial birth is the only safe way to remove the baby to prevent a still birth.
After a woman receives one Caesarean section then doctors will assume that any future pregnancies will also show some difficulties. Therefore older mothers who want to have more than one child are likely to experience repeated Caesareans each time, more Caesareans will increase the risk of the area reopening and the women’s birth canal will become more inactive.
Greater Risk of Genetic Disorders
As age increases there is a higher chance of there being mutation in the chromosomes. As older woman generally mate with older men the chance of having a mutated gene strain is greatly increased. The most common of these is Down’s syndrome which results in learning difficulties and certain growth problems experienced by the child. (14)It is caused by an extra 21st chromosome, in either the egg or sperm cell, resulting in a Down Syndrome child having 47 chromosomes. (1)Harvard Medical School showed in a study that the chance of having a child with Down Syndrome severely increases with age. They found that, ’At age 25, a pregnant woman has a 1 in 1,250 chance of delivering a Down syndrome baby; at age 30, it's 1 in 952; at age 35, 1 in 385; and at age 40, 1 in 106.’ This shows that between 25 and 40 your chance of having a child with Down Syndrome increases by almost 12 times.
Although some people may not see a genetic disorder as a problem a child with Down Syndrome is more likely to have an abnormal breach position or an early delivery. Caring for children with genetic disorders can also be very stressful resulting in a lot of babies being aborted due to a perceived risk of Down Syndrome, however testing for the traits in a fetus is extremely expensive and not widely available. A few hospitals offer amniocentesis tests to women who want it, which involves the extraction of amniotic fluids from the womb to test for fetus abnormalities. However this can increases the chances of miscarriage.
How to help
Although there is no definitive cure for infertility, or a way to stop birth difficulties and genetic disorders, new processes are becoming available for people to use in the UK to help with infertility and reduce the risk of the woman and the baby to be. Some of these are seen as controversial but are still considered effective, the main of course being IVF (in-vitro fertilization) to combat infertility. Two other controversial helpers are surrogate mothers and screening for genetic disorders.
IVF (In-vitro fertilization)
IVF is a treatment which involves removing an egg from the ovaries of the mother and then artificially inseminating it in a lab with the sperm from the father or a sperm donor. This is then placed back into the uterus where it can develop as normal. It is a process meant for people with fertility problems related to the movement of the gametes through the reproductive system, and does not provide substantial help to those with endometrial deficiencies as once the egg is inserted it will not be able to develop.
IVF is not available to anyone though. (16)Those liable for the treatment are aged between 23 and 39 at the age of treatment and/or they have had infertility problems for at least 3 years. Anyone over 42 has such a low chance of a success that the cost is not perceived to be worthy so receiving treatment is rare, this means that unless women can find that they have fertility problems early they are likely to miss out on the treatment.
However the success of IVF treatments are low, in 2006 the NHS reviewed the effectiveness of IVF on different age ranges and found that there is never more than a 3/10 chance of success. The probability also decreases more with age. The success rates they found are as followed, 29% for women aged less than 35, 26% for women aged 35-37, 17% for women aged 38-39, 11% for women aged 40-42, 5% for women aged43-44 and less than 1% for women aged 44 and above. Although the success is low it is often an only alternative to not having a baby due to infertility.
Of course as with any medical procedure there are also risks associated with the process. There are often reactions to medication taken to aid fertility; these include hot flushes, depression and headaches. In severe cases women can contract Ovarian hyper-stimulation syndrome due to an over effectiveness of the drugs, this results in a large number of eggs being produced by the Ovarian follicles, this can result in follicle cysts and the buildup of eggs. This can cause nausea and vomiting along with severe abdominal pain. It can also cause an ectopic pregnancy where the fetus develops outside of the womb, such as in the fallopian tube, this causes vaginal bleeding and can often result in a still birth. However often there are no side effects yet the ineffectiveness of the process results in a miscarriage anyhow.
Surrogate Mothers
A surrogate mother is a woman who carries a baby for the pregnancy and then once born it is passed onto the paying client simply put people are paid to have children for others. It involves the partner of the woman to give sperm to fertilize the surrogate’s egg. (18)However although legal in the USA and UK the extreme legal guidelines surrounding surrogacy in the UK mean it is not widespread. One such regulation is that it is illegal to advertise yourself as a surrogate; this means the likelihood of finding someone is almost nil. In the USA surrogate mothers are checked for medical conditions and the births are often had with no problems, yet the cost of a surrogacy can be around (19) $70000, making it an expensive alternative.
(17)On 21st of January 2011 the Director of Human Genetics Alert Dr. David King spoke out on Radio 4’s Today program about his support of the strict regulation. He raised concerns about the exploitation of the surrogate’s in countries where it is more widely available; he suggested that many women are cohered into it by abortion clinics and then paid only a nominal fee and that most people only partake in the activity due to extreme poverty. He claimed that it was turning child birth into a manipulative and commercial process. An example of this is how women in India can be paid a fraction of the price for surrogacy compared to those in the USA due to exploitation.
If legalities were changed regarding surrogacy then it could be an impressive answer to the difficulties of elder pregnancy. However as this is not something that can be foreseen in the near future it is a process which can be used by little if not none of the population.
Genetic Screening of the Fetus
(20)On the BBC on the 19th of January, it was announced that genetic screening for Down Syndrome would become available nationwide from the NHS. Before this it was only available in Edinburgh and the Lothians costing £250 on average. This meant a lot of people could not afford the treatment and it was not widely enough available for everyone to receive it. The Nuchal Translucency screening (which involves measuring the amount of fluid behind a baby’s neck, with the assistance of ultrasound scans, and taking blood tests) increases the detection rate from 60% to 80% and will be offered to all women between 11 and 14 weeks pregnant. This means that women will be able to find out if their baby has Down syndrome before the 24 week limit of abortion. This means that women may choose to abort the pregnancy and try again for another baby. Of course the subject of abortion raises many quandaries which women will have to decide over as a lot of people do not perceive the disability of a child to be a difficulty.
Conclusion
As seen, leaving pregnancy until later in life can have detrimental effects on both the mothers and babies health. Yet without changes to how women portray childbirth and how quickly they can get stability in their lifestyle, the age of which women try to conceive will not decrease. Couples will start looking for extreme answers such as surrogacy to have the perfect life they desire and until the stability of jobs and marriage is maintained couples will not feel safe having babies at younger ages.
Evaluation of Sources
The majority of sources I used were from Medical foundations such as the NHS, these would have good reliability as it is a government funded association and they have to supply decent public information. The whole website is made by experts in each field.
Some of the help websites of pregnant people may not be as reliable but show people’s experiences so are a good area for possible outcomes to be taken from also due to the fact that pregnancy difficulties is a sensitive subject people are less likely to try to deceive people. As only facts were looked for and not opinion’s it is likely that the reliability for these sources is sound as they aim to help people who have experienced the same difficulties as them.
Wikipedia can be edited by anyone, so the information may not be as reliable as other sources. For this reason I used the website sparingly and any information I used from it I checked its reliability by comparing it to other sources on the same topic.
Bibliography (Superscript numbers before text relate to references)
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