Difficult and risky to get pregnant at 51

Q I am a 51-year-old woman.

My husband underwent a vasectomy 10 years ago after I had a miscarriage. He is also 51 years old.

I have been experiencing pre-menopausal symptoms for about five years but I still have regular monthly periods. I also have a small fibroid but it has caused no problems.

We have two children aged 20 and 18 and we would like to have another child. It is the whole family's wish.

Can we, at our age?

A A very simple answer to the question is "no".

However, as the question involves several interesting aspects of fertility and fertility treatment, it is probably worthwhile to look at them in greater detail.

After a vasectomy, the outflow tracts of sperm from the testicles are blocked. The treatment can be reversed by surgically reconnecting the blocked ends.

It can also be reversed with the surgical retrieval of sperm from the testes or epididymis and the couple can try to get pregnant with in-vitro fertilisation (IVF).

It has been reported that the success of a vasectomy reversal is lower five years after the procedure.

However, there are several urologists in Singapore who are skilled with microsurgical reversal of a vasectomy.

Meanwhile, every woman is born with a finite number of eggs.

At birth, she has about 2 million eggs. This number drops to about half a million at puberty and to near zero at menopause.

Genetic, autoimmune and environmental factors can exacerbate the decline in ovarian reserves.

Due to the decline in the quality and quantity of eggs, fertility drops with age. Based on my personal data of more than 3,000 IVF cycles carried out in five years, the pregnancy rate per IVF cycle was about 48 per cent before the age of 35. This drops to 33 per cent for women in the age bracket of 35 to 40 years old. The pregnancy rate for those who were 40 and above was only 13 per cent per cycle.

For a person who is 51 years old and with pre-menopausal symptoms, your ovarian reserves, in terms of the quality and quantity of the remaining eggs, are extremely low.

While there are treatment methods which could attempt to stem the decline in ovarian reserves, most fertility experts would agree that IVF success with your own eggs at this age is very low.

The low chance of success also means that the Ministry of Health will not allow any IVF centre here to perform the procedure for you.

On the other hand, egg donation is legal in Singapore. Patients with poor ovarian reserves and repeated IVF failures have successfully conceived with the help of donor eggs.

As it is difficult to look for egg donors in Singapore, some patients go overseas for donor egg programmes, in which the fertility centres abroad source for egg donors on behalf of the recipients.

While it is possible to seek the help of overseas centres to help you conceive with donor eggs and IVF, there are some serious considerations.

Due to your age, it is prudent to examine your general and reproductive health to assess if you are suitable to undergo pregnancy.

Pregnancy puts a significant burden and stress on the body and health. At an older age, pregnancy complications - such as diabetes and pre-eclampsia (high blood pressure in pregnancy) - are more common. There is also a higher risk of death.

DR LOH SEONG FEEI,
medical director of Thomson Fertility Centre

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