Pregnancy And Tubal Reversal: Challenges Increase With Age
This series of articles has been created by the tubal reversal doctors of Chapel Hill Tubal Reversal Center. We have dedicated this series to women over the age of forty who may be considering having their tubes untied. The information provided should be helpful to all women considering natural conception and reversal surgery. Previous articles extensively discussed adoption, IVF, and tubal reversal surgery.
The first and subsequent articles can be viewed at Tubal Ligation Reversal After Age 40 – Introduction.
Fertility After 40: Barriers To Pregnancy
Once a woman has made the decision to proceed with tubal ligation reversal, she should be aware of several considerations when trying to achieve natural conception and pregnancy. Any woman attempting to conceive naturally could be adversely impacted by poor ovulation (not releasing eggs) and pregnancy miscarriage. These two problems are more common with advancing age and can make it difficult to bear children after age 40.
Irregular Periods And Ovulation Problems
Having irregular periods can be a physical sign of a problem with ovulation. When a woman does not have regular periods this means one of two things:
• Pregnancy has occurred
• Ovulation has not occurred
If a woman is having irregular periods and pregnancy is not occurring there can be many reasons why ovulation is not occurring.
It is very common to have irregular ovulation and irregular periods when women are in their teenage years and when they are approaching the menopause. Medical conditions like Polycystic Ovarian Syndrome (PCOS), severe stress, eating disorders, hormonal abnormalities (abnormal thyroid and prolactin levels), weight gain, and strenuous exercise can also cause some women to have irregular ovulation.
If ovulation is irregular, then menstrual periods will also be irregular. If periods and ovulation are irregular, then it can become more difficult to become pregnant. Irregular ovulation can easily be diagnosed by regular use of an ovulation predictor testing kit or by serum progesterone blood testing. Irregular ovulation can be treated with several prescription medications.
Increased Risk of Pregnancy Miscarriage
As a woman ages there is an increase in the chance pregnancy loss (miscarriage). Why?
At the time of birth, a woman has all the eggs she will ever naturally have. These eggs will age as the woman ages. As her eggs age, the eggs’ ability to grow and divide after fertilization gradually becomes impaired.
When a sperm fertilizes an egg it contributes half of the DNA (chromosomes) needed for pregnancy to occur. The egg has the other half of the DNA needed. Once the DNA of the egg and sperm combine, the fertilized egg has all the DNA need to grow and form a baby. The early fertilized egg will then begin to grow and divide.
Each time the cells divide the DNA must be duplicated and equally spread between the two cells which are dividing. Any error in this process can result in a DNA abnormality – also referred to as a genetic or chromosomal abnormality. These DNA abnormalities can result in a miscarriage.
As a woman’s eggs begin to age, the eggs’ ability to grow, divide, and equally separate the DNA becomes impaired. Medical science does not fully understand why this occurs. When cells have abnormal amounts of DNA this is termed a genetic abnormality. Very often this abnormality results in trisomy- or three sets of a particular piece of DNA. There are many different kinds of trisomy, but the most common is Trisomy 21 (Downs Syndrome).
Although a genetic abnormality cannot be prevented, early pregnancy testing can often diagnose genetic problems early in pregnancy. We will discuss the types of testing available to detect genetic abnormalities later in this series.
The next article, Tubal Reversal Pregnancies: Age And Genetic Abnormalities, will explain and discuss the risk of chromosomal abnormalities and maternal age.
Submitted by Dr. Charles Monteith
Personal Stories And Advice About Tubal Reversal
We frequently post patient related stories on our Tubal Reversal Blog.
Readers are encouraged to read the previous personal patient story about pregnancy in older women, Natural Pregnancy At 46 After Tubal Ligation Reversal. This is a very personal story of Dawne who became a new mother after having her tubes untied at the age of 46!
We have also recently published the story of Denita who became pregnant at the age of 40 after a tubal reversal and having short tubes: Tubal Reversal And Short Tubes: Pregnant!
June 30th, 2009 at 6:42 pm
[...] A previous article discusses in detail the genetic reasons behind pregnancy miscarriage: Pregnancy And Tubal Reversal: Challenges Increase With Age. [...]
May 13th, 2009 at 6:44 am
Very informative article regarding the challenges of age and pregnancy.
May 11th, 2009 at 3:46 pm
Good blog Dr. Monteith! I also get questions about the challenges of getting pregnant over the age of 40. I think many of the ladies will find this informative.
May 11th, 2009 at 1:22 pm
I think all of our patients will enjoy this series of honest and thoughtful discussion of the challenges they may face as age plays a role in their desire to have another child. Excellent.
May 11th, 2009 at 9:48 am
[...] The next article in this series discusses the impact of irregular ovulation and miscarriage upon women over the age of 40, Pregnancy and Tubal Reversal: Challenges Increase With Age. [...]
May 8th, 2009 at 6:20 am
Thank you, Dr. Monteith. I receive many inquiry calls from women over the age of 40. The risk of miscarriage is one of the questions almost always asked. This information is very helpful!