Gynaecologist Dr Varshali Mali shares 5 health checks every woman above 35 should consider before planning pregnancy

Age 35 and beyond is known as advanced maternal age, where the risk to maternal and fetal health is higher than before. Dr Mali shares health checks to help.

Individuals can feel ready to become parents at any age. However, for women 35 years or older, the period is known as “advanced maternal age,” according to Dr Varshali Mali.

“At this stage, the chances of certain pregnancy-related complications rise, including miscarriage, genetic disorders, chromosomal conditions in the baby and diabetes and hypertension in the mother,” Dr Mali shared with HT Lifestyle.

“Fertility also declines gradually with age as both egg quantity and egg quality reduce. After 35, the chance of conception is about 15 to 20 percent per menstrual cycle, while the risk of miscarriage is around 20 per cent at age 35.”

However, that does not mean that it is unlikely to have a healthy pregnancy above the age of 35. As per the gynaecologist, early medical guidance, preconception checks and appropriate screening can help identify possible risks, detect certain congenital conditions, and support better planning through the pregnancy journey.

She went on to share five health checks that are necessary for women to go through while considering pregnancy after the age of 35. They are presented as follows.

 

1. Fertility and ovarian reserve

An ovarian reserve assessment, usually through AMH (Anti-Müllerian Hormone), early-cycle FSH (Follicle-Stimulating Hormone) and an ultrasound-based antral follicle count, helps understand how much time and flexibility a couple may have.

AMH reflects egg supply, not egg quality, so it should guide planning rather than create panic, noted Dr Mali.

2. Thyroid and hormonal health

A thyroid imbalance can quietly disturb ovulation and make it harder to conceive. If left untreated, it may also increase the risk of miscarriage and affect the baby’s early brain development.

A simple thyroid profile, including TSH, T3 and T4, is often advised before pregnancy, particularly for women above 30, those with irregular cycles, previous pregnancy loss, fertility concerns, unexplained weight changes, fatigue or other symptoms.

3. Diabetes and blood pressure screening

Blood sugar and blood pressure should be checked before trying to conceive, especially after 35. Tests such as HbA1c and fasting glucose can show whether diabetes or prediabetes needs attention. Regular blood pressure readings can help pick up hypertension early.

If these conditions are missed, they can raise the risk of gestational diabetes, preeclampsia, preterm birth and growth-related concerns for the baby. Managing them before pregnancy gives both mother and child a safer start.

4. Nutrition and deficiency checks

Ferritin, haemoglobin, vitamin D and B12 testing can reveal deficiencies that may worsen fatigue, anaemia or fetal growth concerns during pregnancy.

“Women planning pregnancy should also start taking folic acid, as it is recommended to consume 400 mcg daily to reduce the risk of neural tube defects,” stated the gynaecologist.

5. Reproductive health, infection, and immunity review

A pelvic examination and ultrasound can help detect fibroids, ovarian cysts, endometriosis or uterine lining concerns that may affect implantation or pregnancy. Immunity to rubella and varicella, along with STI screening for infections such as HIV, hepatitis B, hepatitis C and syphilis, should also be considered before conception.

“Planning pregnancy after 35 should begin with a frank, unhurried conversation with a gynaecologist,” shared Dr Mali. “These checks do not predict everything, but they help identify risks early, correct what can be corrected, and guide the couple on timing, treatment and care.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Dr. Varshali Mali is a senior consultant in the department of Obstetrics and Gynaecology at Surya Mother & Child Super Speciality Hospital, Pune.

 

 

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Simple blood test will tell you if you are approaching menopause

Menstrual cycle patterns are generally used as an indicator to predict the onset of menopause in women. This approach, however, is severely inaccurate and can pinpoint the beginning of menopause only within a window spanning across four years. In a new study that has been published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism, researchers have developed a blood test that can forecast the commencement of menopause with relatively better accuracy.

The study found that measuring levels of anti-Mullerian hormone (AMH) can predict when a woman’s final menstrual period will occur. AMH serves as an indicator of how many eggs a woman has remaining. Women are born with their lifetime supply of eggs, and the supply decreases as women approach menopause.

“Establishing a way to measure time to the final menstrual period has long been the holy grail of menopause research,” said co-lead author of the paper Nanette Santoro, M.D., of the University of Colorado Medical School in Aurora, Colorado.

“Using bleeding patterns or previously available tests to predict the time to menopause can only help us narrow the window to a four-year period, which is not clinically useful. Women can make better medical decisions with the more complete information offered by new, more sensitive anti-Mullerian hormone measurements.”

For women who are determining whether to have surgery to manage fibroids or whether it is safe to stop using birth control, having an AMH measurement can provide additional information about the timing of menopause, Santoro said. A low AMH level in a woman who is more than 48 years old indicates that menopause is likely approaching.

A part of the Study of Women’s Health Across the Nation (SWAN), this research analyzed blood tests conducted on 1,537 women between the ages of 42 and 63. The long-term SWAN study monitored changes in women’s health as they went through the menopausal transition. For this study, participants’ blood samples were tested for AMH levels as well as follicle-stimulating hormone, another reproductive hormone.

Researchers used a more sensitive test than what has been available previously to measure the participants’ AMH levels. This process made it possible to predict the final menstrual period’s timing within 12 to 24 months in women in their late 40s and early 50s. “Researchers have long thought AMH would be a superior marker of the time to menopause, but tests haven’t been sensitive enough to detect the very, very low levels that occur in the year or two leading up to menopause,” said co-lead author Joel S. Finkelstein of Massachusetts General Hospital in Boston, Mass.

“It took a cohort like the Study of Women’s Health Across the Nation (SWAN), which followed the same women year after year from well before menopause until well after, to get the kind of data necessary to be able to demonstrate the predictive value of AMH.

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Treating latent TB of the uterus improves pregnancy outcomes in infertile women Inbox

Treatment led to better quality eggs, implantation rate

For the first time, researchers have been able to find a direct association between latent TB of the endometrium (inner lining of the uterus) and fewer eggs in the ovary, technically called low ovarian reserve, in infertile women.

Compared with infertile women who did not have latent TB, there was significant improvement in pregnancy outcome in women with latent TB who had successfully completed the standard TB therapy lasting six months. Results of the study were published in the journal recently.

Low ovarian reserve

“We came across infertile women with low ovarian reserve having latent TB. So we wanted to find out if there was indeed any association between latent TB and low ovarian reserve in these women. Loss of fertility due to latent TB has not been studied before,” says a Dr. The team led by her undertook an observational study involving 431 infertile women with latent TB and 453 infertile women without latent TB. The women included in the study were in the 21–38 years age group and had infertility for more than two years and had received at least six cycles of ovulation induction with or without undergoing intrauterine insemination or IVF.

Though latent TB is generally believed not to have any clinical significance, earlier studies have shown that latent TB does cause silent inflammation. The present study did not look at whether latent TB was causing inflammation leading to loss of eggs. “The objective of the present study was not to find out how latent TB caused a reduction in ovarian reserve,” Dr. says.

Other causes

“Inflammation of the endometrium could affect the ovaries too or the TB bacteria could be present in the ovaries as well,” says one of the authors of the paper.

After completion of treatment for latent TB, infertile women had nearly 52% successful pregnancy compared with 40.5% in the case of infertile women who did not have latent TB.

Latent TB treatment did improve the chances of pregnancy. But the study did not look at whether the treatment halts the decline in eggs. “The women must be followed up for one year and the hormone that serves as a marker for ovarian reserve has to be tested to know if treatment halts ovarian decline,” says the Dr. 

“We know when the ovarian environment is affected the quality of eggs also gets affected. So what we saw was after the treatment, women had better quality eggs and the implantation rate was also proportionately higher when IVF was done,” says Dr. 

“If doctors come across infertile women with lower than normal anti-Mullerian hormone (AMH) [which serves as a marker for ovarian reserve] then they may test for latent TB of the endometrium and start treatment to improve the pregnancy outcome,” says Dr. 

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The mother’s age at menopause is a key determinant of a daughter’s fertility.

Her mother’s early menopause at the age of 39 had held no real meaning for Asha when she was a teenager. If anything, it had meant the end of the mood swings and irritability that her mother constantly unleashed. Now aged 32 and ready to plan her own family, Asha got a rude shock when her gynaecologist diagnosed her long absent periods as pre-menopausal symptoms. Blood tests confirmed it, and showed that her egg reserves were rapidly depleting. An assessment of her family history helped the doctor diagnose hereditary infertility.

A mother’s age at menopause 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 characterised 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.

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. Ageing ovaries cannot produce mature eggs.

Advanced assisted reproductive methods like In Vitro Fertilisation and egg freezing have revolutionised 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.

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