Pregnancy chromosome abnormalities after 40

While women are physically capable of carrying a child into their 40s, their chances of a healthy pregnancy decrease around age 35 with a much faster decline after 40. Elective Egg Freezing should be a consideration for women who want to preserve their best chances of a health pregnancy but are not yet ready for children. A recent study in the medical journal Fertility and Sterility found that 40-year-old women treated for infertility had a 25% chance of achieving pregnancy using their own eggs. The risk of chromosomal abnormalities also increases as women age with Down’s syndrome being the most common outcome.
At IVF New England, we specialize in helping women over 35 become pregnant with their own egg or with donor egg, if appropriate, using a treatment plan that best suits their individual needs. Using donor egg boosts the odds of getting pregnant considerably, and, that’s how most of the older celebrity moms are doing it — whether they admit it or not. Given the range of assisted reproductive technology treatment options (ART) available to protect fertility and help older women try to get pregnant, now is the time to be proactive and take control of your fertility potential. The increased rate of chromosomal abnormalities in women of advanced reproductive age has been well documented in research studies.
We do not know exactly why there is an increase in chromosomal abnormalities in the eggs of women as they age.

The meiotic spindle is a critical component of eggs that is involved in organizing the chromosome pairs so that a proper division of the pairs can occur as the egg is developing. This study gives insight into how chromosomally abnormal eggs (and therefore, embryos) are more common in older women.
17% of the eggs studied from women 20-25 years old were found to have an abnormal spindle appearance and at least one chromosome displaced from proper alignment. 79% of the eggs studied from women 40-45 years old were found to have an abnormal spindle appearance and at least one chromosome displaced from proper alignment. When the chromosomes line up properly in a straight line on the spindle apparatus in the egg, the division process would be expected to proceed normally so that the egg would end up with its proper complement of 23 chromosomes.
However, with a disordered arrangement on an abnormal spindle, the division process may be uneven - resulting in an unbalanced chromosomal situation in the egg. Older eggs are significantly more likely to have abnormally functioning spindles - which causes an increased rate of chromosomal problems in the mature eggs. In August 2009 a study was published (article by Lelanda referenced below) showing that mice that had a mutation in a specific gene had significantly higher rate of chromosomal abnormalities than normal. In the future we could possibly have a blood test (genetic testing) that could predict risks for chromosomal problems in a woman's eggs and embryos.

The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin #77, "Screening for Fetal Chromosomal Abnormalities. Yet the downside of delaying pregnancy is declining ovarian reserve, which makes it harder to get pregnant and increases the risks, especially for miscarriage and chromosome abnormalities. This condition is characterized by a low number of eggs in a woman’s ovaries and a greater likelihood that the remaining eggs will have chromosomal abnormalities that increase the risk for miscarriage and birth defects. After age 35, there is an increased likelihood of high blood pressure, diabetes, placental problems, low birth weight and preterm delivery, multiple births and still births. EmbryoSelectâ„¢ Aneuploidy Screening is available for genetic testing to identify chromosomal abnormalities of this type. The chances of a woman using her own eggs to achieve pregnancy are greater the earlier there is an assessment of her ovarian reserve. Among women who did get pregnant, the miscarriage rate was 24% for 40-year-olds, 38% for 43-year-olds, and 54% for 44-year-olds.

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