What fertility problems do older women face?
The incidence of infertility and abortion in elderly women has increased significantly. The main reason is that the number of follicles decreases and the quality of eggs decreases. The number of oocytes in women has been decreasing continuously since the peak in the fetal period, but in the reproductive period, the number of primordial follicles decreases rapidly at the rate of 1000/month, and basically loses fertility within eight years before menopause.
In addition to the decrease in the number of eggs, the decline in the quality of eggs also has a very significant impact on the fertility of older women. The main reason for the decline of egg quality in elderly women is the abnormal spindle of oocyte meiosis, which leads to the formation of aneuploid embryos without chromosome separation, followed by implantation failure and spontaneous abortion. With the increase of age, the chromosome aneuploidy of embryos gradually increases.
How to prevent pregnancy complications?
Because of their physiological and endocrine characteristics, metabolic changes, and with the increase of age, the susceptibility of elderly women to internal and surgical diseases increases their obstetric complications and complications. Therefore, once the elderly women are diagnosed with pregnancy, they should go to the hospital as soon as possible to file a card and have a regular checkup. Because doctors are very important for pregnancy management and risk assessment of elderly pregnant women.
The five colors of "green, yellow, orange, red and purple" are divided according to the degree of risk during the prenatal examination, and the high-risk groups of elderly pregnant women are specially managed according to the corresponding risks, and the whole pregnancy is dynamically evaluated. Especially for pregnant women aged 35 and above, regardless of complications, they should be marked at least as yellow (general risk), and pregnant women aged 40 and above should be marked at least as orange (high risk) and.
Many elderly women think that it doesn't matter if they are old. Is it feasible to try IVF?
With the increase of age, older women are faced with the problem that the number of follicles decreases and the quality of eggs decreases. In the data of natural pregnancy, the pregnancy rate of 30-year-old women in each menstrual cycle is 20%, which drops to 13.2% at the age of 38, and as low as 6.6% at the age of 42. For infertile patients who need assisted reproductive technology, ovarian reserve function is the decisive factor of ART pregnancy rate. The incidence of ovarian hyporesponsiveness over 40 years old is as high as 50%. If ovulation induction fails to obtain enough eggs and embryos for transplantation, the pregnancy rate will drop significantly. The results of big data research suggest that the live birth rate of in vitro fertilization-embryo transfer for women under 40 years old is 32.3% per cycle, and the live birth rate for women over 40-42 years old is greatly reduced to 12.3%, and the live birth rate for women over 42 years old is less than 4%.
Does it affect children to have children at an advanced age?
The increase of fetal complications in elderly women is mainly due to the increase of chromosome abnormality and pregnancy loss rate. In addition, the perinatal outcome of older offspring is poor, which may be due to the increase of hemodynamics after pregnancy, the decline of placental function, and various complications leading to forced early termination of delivery. A large number of documents show that the stillbirth rate, premature delivery rate, premature delivery rate, small for gestational age rate and cesarean section rate of pregnant women over 40 years old increase. In addition, age is an independent risk factor for stillbirth, and the incidence of perinatal death, intrauterine fetal death and neonatal death all increase with age.
What risks will older women face?
With the increase of age, the maternal cardiovascular regulation and adaptability of elderly women during pregnancy decrease, which leads to the increase of the susceptibility of elderly women to age-related complications. In addition, due to the damage of decidua and microvilli structure, the invasion of trophoblast to decidua is limited, and placental hypoxia induces oxidative stress, which leads to syncytiotrophoblast cell apoptosis and more immune responses, and finally leads to an increase in the incidence of pregnancy complications. The incidence of pregnancy complications such as gestational diabetes mellitus, hypertensive disorder complicating pregnancy and placenta previa in elderly women increased significantly.
In addition, the incidence of chronic diseases in elderly women is also high, especially obesity, hypertension, diabetes, cardiovascular and cerebrovascular diseases, chronic kidney disease and so on. Chronic complications aggravate the risk of pregnancy and delivery, and the physiological changes after pregnancy will also be a great test for organs that are normally aging before pregnancy. Especially for cardiovascular diseases, the maternal mortality rate increases significantly after 35 years old, and the risk is higher after 40 years old.
How to care during perinatal period?
Do it early in pregnancy:
1. Determination of embryo vitality: Because the abortion rate of women over 45 years old is extremely high, it is necessary to determine whether the embryo is alive in the first three months of pregnancy. It is recommended to do B-ultrasound to confirm the embryo vitality in the 6-8 weeks of pregnancy. In addition, for pregnant women with a history of cesarean section, it is very important to screen scar pregnancy after cesarean section.
2. Screening of chronic diseases: chronic diseases such as hypertension, heart disease and diabetes should be screened for the first time in the first trimester, and the damage of diseases to various systems of the body should be further examined and evaluated as a baseline indicator in the third trimester.
3. Chromosome abnormality: Chromosome abnormality screening should be carried out in early pregnancy, and Down syndrome and amniocentesis chromosome examination should be combined with serological indicators. In particular, women with a history of spontaneous abortion and adverse pregnancy should be screened for chromosome correlation.
In the second trimester, you should do:
/kloc-ultrasound screening from 0/8 to 22 weeks of pregnancy, screening for large organ abnormalities, and timely treatment if abnormalities are found. The position of placenta should also be observed to predict the possibility of placenta previa.
Things to do in the late pregnancy:
"Healthy Wisdom House" was jointly broadcast by Songjiang Media Center, Songjiang Health and Wellness Committee and Ivy's Office, and was co-organized by Songjiang Central Hospital, Songjiang Maternal and Child Health Hospital, Shanghai Jiaotong University First People's Hospital (South), Shanghai Fifth Rehabilitation Hospital, Songjiang Fangta Chinese Medicine Hospital, Songjiang Mental Health Center, Songjiang Jiuting Hospital and Songjiang Sijing Hospital.
Text and audio: Liu Wei and Yu Xu.