TAMAR MAGHULARIA
The Reproductive Clock — Time That Works Invisibly
Interviewed by Ekaterine Vaziri
Reproductive health does not begin on the day you decide to have a child. It starts much earlier, often when we aren’t even thinking about it. Time is an invisible yet decisive factor in this process: it doesn’t ask for our permission, it doesn’t stop, and it doesn’t wait for us to be ready.
Modern medicine gives us the opportunity to know more about our bodies, plan our futures, and, if necessary, postpone motherhood. However, the reality is more complex: the biological clock ticks faster than technology.
How well do we understand the importance of our own reproductive timeline? When is it “early” and when does it become “late”? And why do so many patients come to the doctor when their choices are already significantly limited?
We are discussing these topics with a gynecologist, a reproductive biologist, Professor Tamar Maghularia.
Let’s start with time. When should a person begin taking care of their reproductive health?
Taking care of reproductive health doesn’t begin when a person starts thinking about it; it starts much earlier, within the family.
The initial responsibility lies with the parents. From the moment a child is born, it is crucial to protect their general health, ensure proper development, prevent infections, and monitor their hormonal and physical growth.
Later, during adolescence, this care must evolve into raising awareness, providing education, and fostering healthy habits. It is at this precise age that one’s attitude toward one’s own body is formed.
It is extremely important that this topic is not taboo. When a teenager receives accurate and timely information, they make more responsible decisions regarding their reproductive health in the future.
In adulthood, this becomes a personal responsibility — regular consultations, preventive check-ups, and an awareness of one’s own reproductive reserve.
Reproductive health is an ongoing process, from childhood to adulthood.
And the earlier this care begins, the more opportunities we have to prevent future problems that become much more difficult to correct later on.
When we talk about having children, what significance does time hold?
Time is of crucial importance in reproduction, especially for a woman.
On average, a woman has about 30–35 active years when her reproductive potential is maximally mobilized. After this, the resource naturally depletes.
We often think we have time, but in reality, a woman’s ovarian reserve does not replenish, nor does it “wait.” It gradually diminishes, sometimes entirely imperceptibly.
In men, this process is relatively less abrupt, though this does not mean age is irrelevant. For healthy offspring, the age and health status of both partners are critically important.
When should we start monitoring our reproductive health?
Prevention should begin early, practically from the age when the reproductive system starts to function.
On average, the reproductive age is defined as 15 to 49 years, though this is merely a statistical framework.
It is highly important, as I mentioned earlier, for girls to develop a sense of responsibility toward their own health from an early age — initially with the help of their parents, and later independently.
A visit to a reproductologist should not be associated solely with the presence of a problem; it should be part of gathering information, practicing prevention, and gaining a better understanding of one’s own body.
In reproductive medicine, what mistakes do people make most often?
The most common mistake is procrastination.
People always live in hope and often think, “I’ll take care of this later.” But the reality is that in reproductive health, postponed decisions often reflect irreversibly on the outcomes.
Sometimes years pass without a person checking their reproductive status even once, and they come to the doctor only when their time resource is significantly depleted.
Modern medicine certainly gives us the ability to postpone motherhood to some extent, for example, through egg freezing. This is especially important for oncology patients, who can preserve their biological material before starting treatment. However, it is crucial that these decisions are made in an informed manner. Technologies offer possibilities, but they do not entirely replace natural biological processes.
What are the most frequent causes of infertility today?
The causes of infertility are diverse and often represent a combination of several factors.
These can be infectious, anatomical, hormonal, inflammatory, or other types of problems on either the female or male side.
According to modern data, about a third of cases are related to the female factor, a third to the male factor, and in the remaining cases, either both partners are involved, or the causes remain unexplained. But one of the most critical factors uniting all these causes is time. A delayed medical visit often reduces the effectiveness of treatment; this is precisely why prevention and timely diagnostics are critically important.
When a couple starts living together and wants a child, how long is it normal to wait, and when should they consult a doctor?
If a couple has regular sexual intercourse and does not use contraception, pregnancy should typically occur within a year. This is the timeframe that medicine considers a “normal wait.” However, age plays a decisive role here as well. If the woman is under 35, consulting a doctor is recommended after 12 months of unsuccessful attempts. After age 35, this timeframe is reduced to 6 months, because from this age onward, the reproductive reserve declines more rapidly. There are instances where waiting is not recommended at all — for example, if there are known hormonal disorders, irregular cycles, prior surgeries, or infections. In such cases, consulting a doctor at the very beginning of the process is advisable.
The most important thing is to understand this: waiting is not always a neutral time; often, it is time working against us. Therefore, an informed decision and a timely response significantly increase the chances of success.
What is the most difficult aspect of your practice?
The hardest moment is when you have to tell a patient that time has already become the deciding factor, and their reproductive capabilities are nearing an end. In these moments, empathy, proper communication, and preparing the patient for reality are extremely important. I often try to have this conversation as early as possible, back when there are still choices and opportunities available.
Career or a child — does such a choice really exist?
As a doctor, I believe this choice is often artificially created. Many goals in life are achievable later, but having a child is a unique experience bound by a specific timeframe.
What is a reproductologist’s main message at the end of this magazine interview?
Passport age does not equate to reproductive capability. A woman has a certain window of time during which she can realize her reproductive potential, and this period is irreplaceable. Therefore, the most important advice is — do not delay!