Is it possible to get pregnant despite the menopause? Although it does not happen often, a woman has the chance to conceive naturally during premenopause or through a method of in vitro with a donor egg after menopause. If symptoms heralding the cessation of ovarian function can be recognised, the process can be mitigated with appropriate therapy. However, menopause itself is irreversible. On the other hand, just before the onset of menopause, pregnancy is still viable because cycles, although increasingly irregular, may be ovulatory.

Why does female fertility decline with age?

A woman's peak reproductive period is from her late teens to the age of 25. After the age of 30, fertility begins to decline markedly. The decline becomes more rapid once the middle of the third decade is reached. By the age of 45, fertility declines so much that becoming pregnant naturally is unlikely for most women.

This is because the quality and number of eggs remaining in the ovaries gradually decreases over the course of a lifetime. The main reason for this phenomenon lies in the ovarian reserve. This is the stock of ova that provide the potential opportunity for fertilisation and pregnancy. The size of the reserve is strongly genetically determined. If it is low, it can be the cause of premature menopause. The number of eggs cannot be precisely determined, especially as the ovarian reserve varies from woman to woman. However, it can be estimated.

The ovarian reserve reaches its maximum value in the sixth month of a girl's foetal life. Then its level reaches up to 8 million ova. A huge drop occurs even before birth, when this pool decreases to or 3 -4 million. Thereafter, the ovarian reserve can be estimated at:

from 1.5 million oocytes at maturity in each ovary,
approximately 800 000 oocytes at 30 years of age,
approximately 25,000 oocytes after the age of 37,
approximately 1,000 oocytes after the age of 50.

What is the menopause?

Menopause is the period that marks the end of menstrual cycles. This is when there is a cessation of ovarian function, associated with the depletion of ovarian follicle resources. It is recognised after 12 months without menstruation. It is usually accompanied by characteristic symptoms such as hot flashes, sleep disturbances, vaginal dryness, skin deterioration, mood disorders, reduced energy levels or decreased well-being.

Women theoretically remain fertile until menopause. The average age of menopause is 51, but some women become unable to become pregnant in the middle of their fourth decade of life (mainly due to a decline in the quality of their egg cells). The process of menopause cannot be stopped and biological pregnancy after menopause will no longer be possible. It is also not possible to influence the level of ovarian reserve. However, it is possible to improve the quality of the ova, which increases the chance of conceiving before entering menopause. A healthy lifestyle, avoidance of stimulants and stress, and a proper diet rich in omega-3 fatty acids, antioxidants and folic acid play a key role. Taking care of yourself is helpful in the prevention of premature menopause.

Premature menopause and pregnancy

Premature cessation of ovarian function, commonly referred to as premature menopause, is associated with a decrease in ovarian activity and a drop in oestrogen and progesterone levels before the age of forty. Last menstruation, despite young age, derailed the chance of becoming pregnant naturally.

If you notice worrying symptoms, do not delay visiting your doctor. The specialist will then order tests, including a vaginal ultrasound and tests of hormone levels - primarily oestrogen, progesterone, FSH and AMH. Based on the results, hormone replacement therapy may be ordered. The therapy will not prolong fertility, but will reduce bothersome symptoms .

Premenopause signals a decline in fertility, but at the same time it does not mean a loss of fertility. Although menstrual periods are increasingly irregular and more and more cycles are ovulatory, there is still a real chance of pregnancy, even with the symptoms of menopause. However, if a woman is not planning motherhood, she must not skip contraception during this period.

Pregnancy after menopause - is it possible?

If you suffer from premature ovarian failure, your treatment options are limited. One method that restores hope for motherhood is in vitro fertilisation with a donor egg. Donors are young and tested women. Their identity remains anonymous for the recipients. The Invimed clinic runs a special programme with genetic matching, which minimises the risk of genetic diseases in the child. The final selection is made by the doctor, according to the phenotypic characteristics of the recipients and the patient's blood group.

The recipient and the partner who is to be the sperm donor will undergo a series of tests before the procedure. Once the results are complete, the doctor prescribes hormone therapy to the recipient in order to prepare the uterus to receive the fertilised embryos. The donor eggs are fertilised in the laboratory with sperm from the partner or donor. A few days after fertilisation, the embryos are transferred to the recipient's uterus. Oocyte adoption gives the woman the opportunity to experience pregnancy, birth and motherhood. However, the child will not be genetically related to her, but to the father and the egg donor.

Substantive consultation: Robert Gizler, MD - specialist gynaecologist-obstetrician, medical director of the Invimed clinic in Wrocław