Fertility And The Pursuit Of 5 Cs

Husband: Errr…Darling, we’ve all the 5Cs, but I feel we have another C missing!
Wife: Let’s go through the directory and make an appointment with a doctor…

Conventionally, society chooses the five Cs of life, namely, Cash, Car, Credit Card, Condominium and Country Club membership. If you have those 5Cs, you are most likely to be considered as successful and in a prestigious status. However, it is time for us to redefine success and to look into an equally important C, which is – Child. The proportion of woman who delays childbearing beyond the age of 35 years has greatly increased in recent decades. Additional factors include women are now more independent, change in lifestyle and search for freedom. Occasionally, they are still waiting for Mr. Right.

The consequences of advancing maternal age are not only relevant to the risk of natural and medical assisted conception, but also for the outcome of pregnancy and reason of not ovulating. In a woman, there are 1–2 million oocytes at the time of birth, about 250,000 oocytes at menarche, 25,000 oocytes at 37 years of age, and only a few hundred or thousand at the end of their reproductive life.

A substantial amount of eggs are lost before puberty and at every menstrual cycle. The progressive loss of eggs is a normal process, and the loss of eggs is accelerated after the age of 35. The decrease in fertility or causes of infertility with female ageing is mainly due to a decrease of quantity and quality of eggs.

The eggs, embryos and occasionally the sperms are stored and freeze inside liquid nitrogen tank at sub-zero temperature ( -160°C) for future use.

When the eggs, embryos and sperms are needed, they are thawed and fertilized or used during future fertility treatment.

Due to the ageing process, the quality of eggs is affected whereby there is an increased risk of genetic abnormalities called aneuploidy. Aneuploidy refers to an abnormal number of chromosomes in the fertilized egg, resulting in the condition such as Down Syndrome. Thus, as women age, they become less likely to conceive easily, more likely to have miscarriages and also higher risk of having children born with chromosomal problem. Not to mention, complications associated with pregnancy in ageing mothers.

Fibroids, Endometriosis, Endometrial Polyps and Ovarian cysts are acquired gynaecological diseases, which are more common when women age and in women who have not given birth before. These diseases might affect your chance to conceive or causes of infertility in future.

Advancement of Assisted Reproductive Technology (ART) has allowed and helped many couples to fulfil their dreams to conceive. ART is used to treat infertility, which could be due to various reasons. Types of Assisted Reproductive Treatment include Intra-Uterine Insemination (IUI), In-Vitro Fertilization (IVF/ TEST TUBE BABY), Intracytoplasmic Sperm Injection (ICSI) and Preimplantation Genetic Screening (PGS), among others. A suitable treatment plan is chosen based on the cause(s) of infertility and the couple’s preference after a thorough counselling with a gynaecologist or fertility specialist.

The picture shows a genetic makeup of Down Syndrome (Trisomy 21) Embryo through Preimplantation Genetic Testing.

Do take note that there are three chromosomes (extra genetic material) on Chromosome 21.

Thanks to advancement in women healthcare and fertility services, women who choose to delay pregnancy for whether medical or social reasons, can opt for oocytes cryopreservation (eggs freezing). It is a procedure to preserve a woman’s eggs for later use. Egg freezing enables women to protect the current health of their eggs and increase the chances of conception through IVF in the future. Can you imagine: You are 40 years old when you opt to have a baby, you can use the eggs which you have preserved earlier to have a better success rate in IVF.

Eggs freezing may be the way out but there is some decrease in overall success rate in IVF as age increases because we cannot deny our body from physiological and physical changes in ageing. Nevertheless, eggs freezing outcome is much better than those individual without eggs freezing.

For a relatively healthy woman, it is crucial to have scheduled health checks with your gynaecologist because early diagnosis and prompt treatment can reduce the impact of gynaecological diseases on your fertility journey.

The conventional 5Cs should be changed to 6Cs, with a child(ren) in the picture. A child should not be a hinder for you to pursue the 5Cs. Starting a family and gaining economic stability should go hand in hand.

DR. Tan CH

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