9 Things To Know About Conceiving As You Get Older
According to the Centers for Disease Control (CDC), the average age of women at childbirth is increasing. According to the CDC report, between 2000-2014, the percentage of women aged 25-29, 30-34, and 35 and over each increased. While research has found risks for both very young mothers and those over 35, there are some important things to know about conceiving as you get older, no matter your current age.
Fertility decreases as you age
I spoke with Dr. Erika Munch, a fertility specialist at the Texas Fertility Center and she laid it out for me. "Not every egg and sperm combination can make a baby," she said, and explained that the likelihood of an egg and sperm combination resulting in conception changes as we age. "When we are in our 20s, the chances of conceiving in any given cycle are around 20-25 percent. Between 30-35 that chance is 15-20 percent. After age 35, there is a much more rapid decline in fertility, and by age 40, this chance is less than ten percent."
Why does fertility decrease so much for women as they age? It has a lot to do with the number and quality of eggs she has available. Dr. Munch went on to explain that every woman has a finite number of eggs at birth. "As we age, the number of eggs we have decreases. Unfortunately, so does the quality," Dr. Munch said. "Our eggs are formed long before we are born, and the more time that passes before they're used, the less likely it is that the eggs will have the right genetic components in order to lead to a healthy pregnancy. This is why it gets harder to have a healthy pregnancy and avoid miscarriage as we get older."
Female fertility isn't the only concern
While a woman's age is an important consideration when it comes to having a baby, it isn't the only consideration. Women's health specialist and president of Sapphire Women's Health Group Dr. Donnica Moore (known as Dr. Donnica) explained that many women date and marry men their age or older. This means that even if a woman is not experiencing fertility issues related to age, her partner may be.
"Many couples mistakenly think that age doesn't affect male fertility, because some men can impregnate a woman at any age," she told me. In fact, she said, sperm counts for men overall have been dropping. "Average sperm concentrations for men have fallen for the last several decades, decreasing by 32 percent from 1989 to 2005," she said. "Approximately 1 in 5 men have a low sperm count (defined as less than 15 million sperm per milliliter), and the majority of men have a suboptimal sperm count — defined as less than 55 million sperm per milliliter." This can be difficult to address in many couples because as Dr. Donnica told me, men are often less willing to see a fertility specialist. She did point out, however, that there are now home sperm counting devices (like the Trak Male Fertility Testing System) that men can use to check their fertility at home.
Women in their 20s have fewer risks
We may often think of the risks related to pregnancy as being mostly about the baby, but there are risks for mothers as well and these also increase with age. I spoke with Dr. Lina Akopians, a specialist at the Southern California Reproductive Center, who told me that a woman in her 40s who is trying to get pregnant should see her regular doctor in addition to a fertility specialist before she even starts trying to have a baby. "I think it is very important for women in their 40s to be seen by their primary care physician and have a complete work up of their general health," Dr. Akopians said. "The risk of hypertensive diseases and diabetes increases in women with advanced maternal age. Therefore, they need to be evaluated prior to conceiving and monitored closely during their pregnancy."
Dr. Akopians told me that women in their 40s may also be diagnosed with other issues that could compromise general health, so working to be as healthy as possible is important. "It is important to have a healthy lifestyle which includes a well-balanced diet, exercise regimen, and coping mechanism to address any excess stress in life."
Deciding when to conceive can be a catch-22
Several of the specialists I spoke with mentioned maternal stress as a factor related to not only fertility, but a woman's psychological readiness to have a baby. While research has shown that women may delay pregnancy in pursuit of independence or a stable relationship, some experts suggest that this waiting game can lead to a catch-22. Dr. Evan Rosenbluth from the Reproductive Science Center of the Bay Area suggested that the amount of stress related to age of conception can be a "chicken or egg" question of which came first.
"Dealing with infertility has been proven to be just as stressful as being diagnosed with major diseases such as cancer," Dr. Rosenbluth said. "So, certainly, there can be major emotional and psychological consequences if we wait to conceive. On the other hand, women are often times are more psychologically prepared for motherhood as they age." Dr. Rosenbluth added that more financial security as we age can make the emotional transition to motherhood easier, but this is where the catch-22 comes into play. "Despite being more emotionally ready to conceive when we are older, it is much more difficult," Dr. Rosenbluth said. "This, in turn, causes stress. Some researchers have argued that stress can impact fertility as well."
Delivery could be more difficult depending on your age
In addition to health risks increasing as a woman gets older, problems during delivery are more likely to occur in women over 35, including placenta previa (when your placenta is low in your uterus, possibly covering your cervix), early delivery (before 32 weeks), the need for an emergency caesarean section, and postpartum hemorrhaging.
While risks increase as a woman gets older, that doesn't mean that pregnancy when you're young is without risks. Research has shown that women who are between 15-19 years old have a higher risk for severe preeclampsia, eclampsia, and fetal distress during delivery. While complications are always possible, it is important to discuss your risk with your doctor ahead of time, particularly those risks associated with factors you can't change, like your age.
Infertility can happen in your 20s
"I have had clients that were premenopausal in their mid 20s, which might be surprising to hear," fertility expert and founder of The Fertilitites Unite Project Tasha Blasi told me. "This is rare, but if you are in your 20s and actively try to get pregnant for a year and cannot, fertility tests done such as day three blood work to check for hormone levels with will tell the doctors about your egg reserve."
She also told me that a woman who has had an eating disorder or who is a heavy smoker will also have a harder time getting pregnant. Blasi suggested that women should get three blood tests before they start trying to conceive at any age. "The first is to determine if she has a blood clotting disorder," Blasi said. "The second is to determine is she has a MTHFR mutation, which means the person cannot break down folic acid, which is needed to prevent birth defects in the fetus specifically in relation to the brain and spine, and the third is a genetic panel." According to Blasi, these blood tests could save a woman from birth defects, multiple miscarriages, or failed rounds of in vitro fertilization.
You may want to consider genetic testing
Prenatal testing has evolved a great deal since the 1970s and can not only tell you sooner than ever about your baby's sex, it may allow for the earlier detection of common defects. The risk for these defects increases as we age because not only does the amount of eggs we have decrease with age, Dr. Rosenbluth told me so does the quality. "At 35 years old, approximately 35 percent of our eggs are abnormal," Dr. Rosenbluth said. "At 38 years old 50 percent and at 41 years old 70 percent of are eggs are abnormal!"
Dr. Rosenbluth said this is why it not only becomes more difficult to conceive as we age but miscarriage rates and birth defects also increase. This is why doctors often advise women over 35 to get genetic testing and Dr. Rachel Abrams agrees. "It's a personal choice whether to do genetic testing, but something I would advise unless a women has strong feelings against it," Dr. Abrams told me. "It doesn't mean you're going to abort the fetus if you find something wrong, but it's something you may want to know ahead of time."
Dr. Abrams said that if there is a genetic defect, some families feel more prepared when the child arrives by knowing ahead of time. "Given the increased risk of abnormalities when a woman is over 35 it's certainly worth thinking about," she said, noting that older fathers also can be an issue and cause more abnormalities in the fetus, even if the mother is still young.
You have options if you have trouble conceiving
With all of these factors related to age, what happens if you find you aren't able to conceive easily? I spoke with Kim Overton who went spent more than three years going through the fertility process from intrauterine insemination (IUI), in vitro fertilization (IVF), and surrogacy. When Overton was 35 and single she found out she had fibroid tumors. She made the decision to have a child on her own and at 39 she delivered her son without any fertility medications. When she decided to have a second child, however, she said "that's where the major problems kicked in."
After first trying IUI unsuccessfully, she tried a round of IVF. It was during this expensive procedure that she found out she did not have many healthy eggs. At the end of that first round of IVF, she had nine embryos left and only one was healthy. It was then she considered surrogacy. "I even had people around me asking if I should give up," Overton said. "I said 'This is a personal decision and I'm not quite done yet.'" While talking to her cousin, who Overton said is like a sister to her, she made the joke that she needed a new uterus. Her cousin called her daughter who was excited to help. "She called me excited about it, it was very surreal," Overton told me. "It made me think, 'Okay, this could happen. I have a chance.'" Overton was 45 when her second child was born via surrogacy. During the process she met her now-husband who had his own child, taking her family of two to a family of five.
If you want a child, there's a way to do it
Having a child at any age is a big decision and there are lots of things to consider, but every person I spoke with stressed the need for self-awareness and being ready, whatever that means to you. Kim Overton is proof that even if you're single, in your mid-30s, and struggling with infertility, it can happen. "For any woman who is single and 35, just open your mind and your heart and don't give up wanting what you want no matter what people say. If you want a child, there's a way to do it. Don't get discouraged," she told me. "It's not going to look the way we thought when we were young girls and that's okay. The love that we have with our kids is just amazing and it came about in a very different way, but it's exactly what I wanted. I'm a mom, and that's what matters." Overton found support in a group called Single Mothers by Choice and in her close friends who understood her journey. Whether you're thinking of having a baby or actively trying, there is a lot to consider, but there are a lot of people who can help.