Geeta Chandran (name changed) had no clue about her mother’s early menopause at the age of 38 when she was a teenager. If anything, she understood it was the only the mood swings and irritability that her mother constantly unleashed. Now, Geeta has grown and married aged 31 and ready to plan her own family, Geeta got a rude shock when her gynaecologist revealed that her blood tests shows the long absent periods due to the default in her egg reservoir. After the complete assessment of Geeta’s family history helped the doctor to diagnose that Geeta is suffering from hereditary infertility. (case study of Shantah IVF Centre)
Dr. Anubha Singh explained that: A mother’s menopausal age holds vital clues to the daughter’s fertility. Mothers who experience early menopause have daughters with compromised levels of the hormones needed for ovulation and egg reserve indication. Multiple studies have shown that the age of menopause can be inherited and a strong association has been observed in siblings, twins, mothers and daughters. Menopause seems accelerated in women whose mothers experienced early menopause or premature ovarian failure.
A woman’s natural reproductive journey progresses through puberty, fertility, reduced fertility or sub-fertility, transition towards menopause and, finally, menopause. Women who delay motherhood till the late 30s often face infertility. Diminished or rapidly depleting egg reserve is one of the causes of infertility among young females.
Young women are increasingly experiencing premature ovarian failure (POF), with the incidence of POF among women below 40 years of age at 1 per cent. This condition is characterized by early menopause or cessation of menstrual periods before the age of 40. Studies have identified a 20-year interval between the first decline in fertility and onset of menopause.
- Vaginal dryness (the vagina may also become thinner and less flexible)
- Change in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
- Hot flashes (sometimes called hot flushes), night sweats (sometimes followed by a chill)
- Mood swings, feeling crabby, crying spells (probably because of lack of sleep)
- Irregular periods
- Reduced sex drive
Tests required to diagnose infertility:
Two major tests Anti-Mullerian Hormone (AMH) test and Antral Follicle count (AFC) are used to predict the age till which a woman can conceive. A study conducted in Copenhagen identified that in mothers who experienced menopause before 40 had daughters who recorded poor ovarian test results as compared to daughters whose mothers experienced menopause at a later age (55 years or above).
Maternal menopausal age not only has a link to lower AMH and AFC values but also affects the levels of Follicular Stimulating Hormone (FSH). Increased levels of FSH are indicative of an aging ovary. Aging ovaries cannot produce mature eggs.
With such advanced technologies we now have assisted reproductive methods like In Vitro Fertilisation i.e IVF and egg freezing which have revolutionized infertility treatment. Innovations in medication patterns such as the introduction of self-applicatory hormone gels and self-injectable pens have made the traditional IVF procedure highly patient compliant. It has a success rate ranging between 35 and 40 per cent. Thus, despite the challenges of premature ovarian failure, IVF has been successful in increasing pregnancy rates.
By Dr. Anubha Singh, Gynecologist and IVF specialist from Shantah IVF Centre