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Screenings do not reveal all problems: PFUR professor on reproductive age limit and late childbirth

Photo by Rui Alves on Unsplash

– In Russia there are calls for the upper limit of women’s reproductive age to be set at 49 years, which is the level set by the WHO. Is it reasonable? And why exactly are we talking about the age of 49?

– In this case, we are rather talking about the age at which a woman should be assisted to treat infertility and the age at which the use of assisted reproductive technologies should be limited. It is not only in the interest of the family that wants to have a child, but also in the interest of society. The results of late fatherhood and motherhood are mixed. We clearly know that in this case there is an increased risk of abnormalities, genetic diseases and malformations in the children.

That is why a number of countries have established an age limit until which women are paid by the state for the use of assisted reproductive technologies. After that it is entirely at one’s own expense. And in some countries it is even prohibited – after a certain age the couple will be refused such services even in private clinics. In our country there are no such restrictions, but in general doctors welcome the practice of giving birth to young parents.

– In the USSR until the 1970s the most appropriate age for having a first child was 18 to 22, and those who became a mother for the first time after 24 years were called old parents. Most Soviet women had children before age 35. Why did Soviet doctors recommend giving birth at such a young age?

– Women all over the world do not give birth as recommended by doctors, but in the specific circumstances of a particular society. In the USSR, indeed, the majority of first-borns were aged 20-25 years, women from 25 to 30 years were considered elderly first-borns, and after 30 years old they were old. These notions were introduced into the diagnosis only to guide gynecologists to the fact that a woman with age increases the number of diseases and, consequently, the risk of complications during pregnancy and childbirth increases. And such patients were treated more carefully – prevention of obstetric complications was carried out.

But times have changed, and with them reproductive behavior. For example, the average number of children was replaced by a small number of children, and in order to reproduce the population there should be an average of two children per family. In Russia today there are statistically only one and a half children per married couple. This is why the government and society as a whole are so concerned about demography and reproduction. As in Soviet times, as now doctors, obstetricians and gynecologists believe that at a younger age a woman has the least risk of complications during childbirth. And, consequently, there is a greater chance of giving birth to healthy children.

– WHO now considers the age of young to 44 years, in Russia, too, recently raised the bar – though only to 35 years. On what basis, on what data are the conclusions about the increase in the age of youth – psychology and social structure change? Or is it physiology, too?

– In 1920, the average life expectancy was about 47 years. Over the past 100 years, that figure has increased by a factor of one and a half, to about 73 years. This could not but affect society’s perception of age categories such as childhood, youth, adulthood, and old age. But social standards are one thing; physiology is another. A woman at age 44 cannot be considered young, because at that age the reproductive function begins to fade and the transition to menopause begins.

It is possible to change the appearance of a woman by means of plastic surgery, but it is not possible to rejuvenate the ovaries and the follicular supply of eggs both quantitatively and qualitatively. Oocytes age with age, so pregnancy in women after 40 years is associated with a high rate of miscarriages, as well as complications during pregnancy, the birth of premature babies, as well as children with malformations. And based on this scientific evidence, recommendations have been made, according to which the age of youth, more suitable for childbearing, is up to 35 years.

– How does giving birth at an older age affect a woman’s own health? There are very contradictory opinions on this – some write about almost rejuvenation, and others about accelerated aging.

– I will immediately refute the myth of rejuvenation through childbirth. Especially against the background of a general decline in public health. Pilot studies, which were carried out including our department, showed that today 23-year-old women often have more diseases than 46-year-old, that is the generation of their mothers. And the same dynamics can be observed all over the world, not only in Russia. The incidence of cardiovascular diseases, obesity, urinary tract diseases, as well as a number of other diseases, including gynecological diseases, is increasing;

Therefore, it would be naive to hope for rejuvenation and recovery 40-year-old woman during pregnancy. Perhaps the false impression of a rejuvenating effect is due to the fact that pregnant women and young mothers visit gynecologists and pediatricians more often than other doctors, such as vascular surgeons and cardiologists.

Pregnancy is a state in which a woman gives everything to the fetus – trace elements, vitamins. Therefore, it is impossible to rejuvenate during pregnancy. However, there is no data on possible acceleration of aging due to pregnancy. Simply after the birth of a child, the woman has to recover, to restore the reserves of micronutrients. This is why women are advised to observe the intergenital interval – a pause of two years from the birth of the child until the next pregnancy. This has a positive effect: the risk of complications is reduced, and the probability of giving birth to healthy children increases.

– How accurate are the tests today in showing abnormalities in the unborn child?

– It depends on the specific abnormality – unfortunately, screenings do not detect all problems. For example, Down’s disease is predicted with 99.9% accuracy, although this requires a fairly expensive technique. But autism cannot be detected during pregnancy, it manifests itself in children closer to the age of three.

– If the age of the father also plays a role, why in this case no one talks about “old-born” fathers?

– It is the woman who carries and provides the future child with everything he needs. The egg of a young woman under the age of 35-36 years is capable of active, proper division, unlike a woman with a clearly defined menopause, when it goes extinction of reproductive functions. And in men, reproductive functions are not lost with age.

– Late fatherhood and motherhood have their own positive aspects. For example, foreign experts published a study in 2019, according to which children were less aggressive, noisy and disobedient with ageing parents. What can be said about late parenthood in general – is it worth rushing to have children or can it still be postponed, as many do now?

– The experience of obstetricians and gynecologists clearly indicates that late parenthood is a bad thing. In the child of an older parent, the chance of acquiring a congenital anomaly and a number of previously discussed diseases increases.

As for behavioral characteristics, it is clear that as parents age, their interests focus on the child. The young couple wants not only to raise the baby, but also, for example, to go on a hike, go to the theater, go to the movies, play sports, etc.

– Does the tendency to postpone having children late affect the decline in fertility? Do people often face reproductive difficulties when they want to have children closer to age 40? How have assisted reproductive technologies advanced in recent years? And about what percentage of cases do they help solve the problem?

– If a couple is planning on having children at age 40 or older, it’s likely that there won’t be more than one child in the family. As a rule, such women are not able to get pregnant on their own because of their aging bodies. So they often turn to assisted reproductive technologies, i.e. IVF techniques. Yes, such technologies are steadily developing. However, they cannot cancel the laws of nature, nor can they significantly increase the birth rate: so far the percentage of children born through IVF in Russia does not exceed two. Only about 35% of women can get pregnant at the first attempt using this method. It is not uncommon for a woman to have up to 15 IVF attempts. This is a very difficult psychological and physical ordeal that requires the help of psychologists, a partner, a doctor’s support and family.

– What reproductive technologies may appear in the future – an artificial womb to carry children, cloning, etc.?

– This question will be answered in the future. Right now, however, all doctors are in favor of women having more children at a younger reproductive age.

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