Medical reports state that a woman’s peak reproductive years are between the late teens and late 20s. By age 30, fertility (the ability to get pregnant) starts to decline—the risks of miscarriage and stillbirth are higher in people who are older than 35.

People delay parenthood until 35 or older for a number of reasons; such as reaching higher education levels, establishing careers, social and cultural shifts, inflexible workplace policies, economic or housing uncertainty, and unemployment, according to studies reported by Medical News Today.

Men have been largely excluded from the "ticking biological clock” conversation, yet according to findings, the body’s biological clock for both men and women starts ticking when they hit their 30s. Just like how a woman’s egg number and quality decrease, a man’s sperm decreases too. So, why is there more focus on a woman’s ‘ticking clock’, and what are the risks of childbirth at a later point in life?

Dr Shakhnoza Abdukhalilova, a gynecologist at Deva Medical Centre in Nyarutarama, states that due to women being born with a limited number of eggs that decrease in quality and quantity over their reproductive lifetime, conceiving after the age of 35 (advanced maternal age) can be challenging.

"As we spend these eggs every month with our menstrual cycle, they lessen with time. This is why after the age of 35 to 40, there are fewer chances of conceiving, and if a woman conceives, there is an increased risk of miscarriage, stillbirth, and multiple births (if two or more babies grow in a woman’s uterus at the same time),” she says.

Abdukhalilova further highlights that advanced maternal age increases the risk of having a baby with chromosomal abnormalities (genetic conditions that occur due to a problem with one of the 23 pairs of chromosomes-bundles of tightly coiled DNA located within the nucleus of almost every cell in our body.)

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She adds that fertility also declines in men with age due to decreasing sperm counts, motility, and semen volume, stressing that all these age-related factors can harden conceiving for women.

Abdukhalilova says certain pregnancy-related medical conditions are also more common in older women, like gestational diabetes, placenta previa (where the placenta covers all or part of the cervix), and preeclampsia (high blood pressure).

She also says that women who are older are more likely to need a cesarean section.

Dr Kenneth Ruzindana, a consultant at Kigali University Teaching Hospital of Kigali (CHUK), says that if a woman is 45 years old and beyond, the risk increases twice to almost 93 per cent, which escalates the possibility of miscarriages.

He additionally notes that advanced maternal age also upsurges the risk of an ectopic pregnancy (pregnancy occurs when a fertilised egg implants and grows outside the main cavity of the uterus).

"Women aged 35 years and above are linked to four to eight increased risk for ectopic pregnancy compared to younger women.”

ALSO READ: When delayed conception is called infertility

Dr Iba Mayele, an obstetrician-gynecologist at Clinic Galien in Kimironko, says advanced maternal age is associated with an increased risk of adverse maternal perinatal outcomes, such as postpartum hemorrhage (when a woman has heavy bleeding after giving birth).

He adds that other complications could also be triggered, such as eclampsia, a rare but serious condition where high blood pressure results in seizures during pregnancy. Seizures are periods of disturbed brain activity that can cause episodes of staring, decreased alertness, and convulsions.

Mayele further says that women who get pregnant late could also experience cephalopelvic disproportion (a condition where the baby’s head or body is too large to fit through the mother’s pelvis), and adverse infant outcomes including preterm birth, poor fetal growth, low birth weight, and neonatal mortality (death in the first 28 days of life).

"The most common cause of the age-related decline in fertility is less frequent ovulation as women age, they begin to have occasional cycles where an egg is never released, at times, advanced maternal age conceiving could be difficult due to endometriosis fibroid, a decrease in cervical fluid, and chronic health problems like diabetes,” Mayele says.

Dos and don’ts

Mayele says women can still conceive and give birth to healthy babies if they take care of themselves, by paying special attention to the basics, like making a preconceptions appointment and seeking regular prenatal care.

"Eat a healthy diet during pregnancy because you need more folic acid, calcium, iron, vitamin D, and other essential nutrients, gain weight wisely, and stay active, for instance, regular physical activity can help ease discomfort during pregnancy, boost energy, and improve overall health.”

He warns against using risky substances such as alcohol and tobacco during pregnancy, explaining that alcohol can cause physical deformities, heart defects, mental retardation, and lifelong physical and behavioural problems.

He adds that cigarette smoking passes nicotine and other dangerous chemicals to the unborn baby, and upsurges the risk of a premature birth or stillbirth.