Imagine this scenario. A young couple in their late 20’s early 30’s enters the consulting room of a gynaecologist. The women is having some vaginal infection and needs a gynaecological opinion. The gynaecologist examines and gives appropriate treatment. The couple thank the doctor and before leaving the room the women asks “doctor May I ask you one more question” “sure” says the doctor. “We are both 29 yrs old and have just married a few months back, how much time can we wait more before having a baby. You see we are still financially not settled and would like to wait couple of more years but the family is insisting on having a baby. What is your opinion? ” Well this is the story of modern India. Better education opportunities, women empowerment, rising costs and high standard of living are leading to late age at marriage and prolonged career goals. Couples now want to be independent, well settled financially before they have a baby. All this perfectly make sense and therefore we find more and more women having their first child in their late 20’s and early 30’s. But unfortunately God had planned it some other way. A women’s maximum fertility potential (Ability to conceive) as per Gods planning is between 18-28 years of age. Thereafter it starts falling and beyond 35 years there is a drastic reduction in fertility potential. It has to be remembered here that this is a general rule. Some women may easily conceive even at 40 and some women have difficulty even at 22. One has to understand that before planning or postponing planning there are few factors which may be taken into account- some scientific and some practical. So this is the checklist for all those couples planning to postpone the pregnancy by a few years:
- Age of the women: As already mentioned a women’s fertility potential is at its peak between 18-28 years and it’s always better to have a baby before the age of 30. So yes if you are 30 and planning to postpone your pregnancy, give it another thought. Career and life goals can wait. Please prioritize your ambitions.
- Menstrual pattern: If you have any irregularity in your menstrual pattern, consult your gynaecologist and rule out PCOS (polycystic ovarian disease). 30% of women with subfertility have PCOS. Alternatively irregular menses could be due to POF (premature ovarian failure). In both cases women have a tendency to form cysts in their ovaries. Both these together are the leading cause of infertility. So beware of irregular menses.
- Infections: If the women has a prior history of tuberculosis whether it be of lung or intestines, there is a fair chance that the bacteria may have spread to the uterus or fallopian tubes. Genital tuberculosis may lead to infertility by either causing blockage of tubes or damaging the uterine lining or the endometrium. Even repeated pelvic pain and recurrent vaginal infections may point to something we call as PID(pelvic inflammatory disease) and lead to fallopian tubal block and infertility. 10-15% of women with subfertility have tubal factors as a cause.
- Uterine fibroid or polyps: These are benign tumors of the uterus that may lead to difficulty in conceiving. They may be completely incidental findings or may be associated with symptoms like heavy bleeding. If one is planning to postpone a pregnancy it is prudent to do a usg pelvis to rule out these. One has to remember that even if an usg is normal there are still chances of developing these tumors later. Also these tumors once removed have a tendency to recur. The treatment will however differ depending upon their size and location. Its best to sit across your gynaecologist and discuss the options.
- Surgical history: If a women has undergone any gastrointestinal (Appendix, bowel etc) surgeries in the past there are chances of adhesions in pelvis which may lead to subfertility.
Also surgeries in male partner – like inguinal (groin) hernias, hydrocele or varicocoele surgery, any testicular trauma (while playing football,cricket) may lead to fault with the sperm count and motility. Therefore if either of the partner has a significant surgical history, think twice before delaying pregnancy.
- Medical History: If either of the partner is suffering from medical disorders like high BP, thyroid disorders, diabetes or epilepsy, then it’s better to get the particular disease well controlled with medications before you conceive. It has to be remembered that some diseases may get flared up or may require higher dosage of medications during pregnancy so continuous monitoring is essential.
Also medications that are not safe during pregnancy could be converted to pregnancy safe medications way before planning the pregnancy. These are some essential points that should be considered before planning.
- Genetic predisposition: If one has a family history of genetically abnormal child (commonly downs or mongoloid child) or a history of infertility or multiple abortions in family its better to start planning early as there may be an abnormal gene running in one’s family. Even if detected there is seldom a cure available for genetic abnormalities. And as age of a women progresses the risk of genetic abnormal child is more.
- Smoking and tobacco consumption: All of us are aware that smoking and tobacco increase the risk of cancer. But what most of us are unaware is that these have detrimental effect on the gametes (ovum and sperm). Tobacco not only is responsible for the death of gametes but also causes defective gene formation. Also it leads to miscarriage, low birth weight babies, preterm or early delivery.
Now a days in addition to young men we find lots of young women who are smokers. Smoking may cause irreversible damage to the gametes. Stopping tobacco may not reverse the effect but stop the damage immediately.
- Obesity: This is a major problem in cities. Easy availability of junk food in addition to hectic work schedules has led to irregular and faulty eating habits. On top of that no one has the time and motivation to exercise. 10 years back this was a problem in young adults and now we find obese teenagers and kids.
It is well known that obesity leads to suppression of reproductive function in both men and women. Also the rate of miscarriage and preterm delivery are also more if the pregnant women is obese. Obesity may also predispose you to high BP, diabetes and heart disease at a very young age. So if you are planning a pregnancy, please start a good diet and exercise regimen. This applies not only to the women but also to the men. A healthy couple will not only produce a healthy fetus but will be able to give birth to a healthy baby and raise a healthy child. If none of the above points are relevant in your case and you want to plan a pregnancy at the later date, we would advise you to visit a gynaecologist and get some tests done. A routine examination and tests like basic hormonal profile (TSH/prolactin/CBC), an ultrasonography (USG) pelvis and Semen analysis need to be performed before taking any decision. Abnormality in any of these may need immediate attention and treatment so that it does nor worsen by the time you start planning. We advise all young couple who are planning to get married and who are just married to go through all the above points carefully and take appropriate action towards them. For some it may just be minor changes, few may require expert help from a dietician or gynaecologist or a physician. Young adults of our country are now capable of taking their own decisions, but it may occasionally be needed that one pays attention to what adults and experts advice. Taking a calculated decision will help to avoid any dejections and failure in future. Infertility clinics now a days are full of young adults wanting to have a child just because the right time was missed. Some repent there was no one to guide them while some did not pay heed to early signs and symptoms. Science has advanced so much that today we can make a 60 year old lady also pregnant, but if one takes out few years of their hectic schedules to give birth to a child, it will save you from all the mental, financial and physical stress involved in the infertility treatment. Our job as a doctor is to inform and educate you. Finally which path to choose will be the couple’s decision. Thinking wisely before making any decisions will avoid a lot of complications in your life.