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. Aging 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.