Can You Have a Healthy Baby at Age 38
How Long Can You Await to Have a Baby?
Deep anxiety nigh the ability to have children afterwards in life plagues many women. But the decline in fertility over the form of a woman'due south 30s has been oversold. Here's what the statistics really tell us—and what they don't.
Editor's Annotation: Read more than stories in our series nearly women and political power.
In the tentative, post-9/11 spring of 2002, I was, at 30, in the midst of extricating myself from my get-go spousal relationship. My husband and I had met in graduate school only couldn't notice ii academic jobs in the same identify, then we spent the three years of our marriage living in dissimilar states. After I accepted a tenure-track position in California and he turned downwardly a postdoctoral research position nearby—the job wasn't expert enough, he said—it seemed clear that our living state of affairs was not going to change.
I put off telling my parents nearly the split for weeks, hesitant to disappoint them. When I finally broke the news, they were, to my relief, supportive and understanding. So my female parent said, "Have you read Time mag this week? I know you want to have kids."
Fourth dimension's cover that week had a infant on information technology. "Listen to a successful woman discuss her failure to bear a child, and the grief comes in layers of bitterness and regret," the story within began. A generation of women who had waited to offset a family was showtime to grapple with that decision, and one media outlet after another was wringing its easily about the steep turn down in women's fertility with age: "When It's Besides Late to Have a Baby," lamented the U.G.'s Observer; "Baby Panic," New York magazine announced on its cover.
The panic stemmed from the April 2002 publication of Sylvia Ann Hewlett'southward headline-grabbing book, Creating a Life, which counseled that women should have their children while they're young or risk having none at all. Within corporate America, 42 percent of the professional women interviewed by Hewlett had no children at historic period twoscore, and most said they deeply regretted it. Just as you program for a corner office, Hewlett advised her readers, you should programme for grandchildren.
The previous fall, an advertizing campaign sponsored past the American Society for Reproductive Medicine (ASRM) had warned, "Advancing historic period decreases your power to take children." Ane ad was illustrated with a baby bottle shaped like an hourglass that was—simply to brand the point glaringly obvious—running out of milk. Female fertility, the group appear, begins to decline at 27. "Should you accept your baby now?" asked Newsweek in response.
For me, that was no longer a viable selection.
I had e'er wanted children. Even when I was decorated with my postdoctoral inquiry, I volunteered to babysit a friend's preschooler. I frequently passed the fourth dimension in airports past chatting up frazzled mothers and blathering toddlers—a 2-year-old, quite to my surprise, once crawled into my lap. At a wedding I attended in my tardily 20s, I played with the groom'due south preschool-age nephews, often on the flooring, during the entire rehearsal and most of the reception. ("Do you lot fart?" i of them asked me in an overly loud vox during the rehearsal. "Everyone does," I replied solemnly, as his gramps laughed quietly in the next pew.)
Just, suddenly unmarried at thirty, I seemed destined to remain childless until at to the lowest degree my mid-30s, and perhaps always. Flying to a friend's hymeneals in May 2002, I finally forced myself to read the Time article. Information technology upset me so much that I began doubting my divorce for the first fourth dimension. "And God, what if I want to have two?," I wrote in my journal as the cold airplane sped over the Rockies. "First at 35, and if you wait until the kid is 2 to endeavor, more than likely you take the 2nd at 38 or 39. If at all." To reassure myself about the divorce, I wrote, "Nothing I did would have inverse the situation." I underlined that.
I was lucky: within a few years, I married once more, and this fourth dimension the match was much better. But my new husband and I seemed to face frightening odds against having children. Most books and Spider web sites I read said that one in three women ages 35 to 39 would not get pregnant within a year of starting to try. The first folio of the ASRM'due south 2003 guide for patients noted that women in their late 30s had a thirty percent chance of remaining childless altogether. The guide besides included statistics that I'd seen repeated in many other places: a woman's adventure of pregnancy was twenty percent each month at age 30, dwindling to five percent by age twoscore.
Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my take a chance to be a female parent?
Adue south a psychology researcher who'd published manufactures in scientific journals, some covered in the popular press, I knew that many scientific findings differ significantly from what the public hears about them. Soon subsequently my second wedding, I decided to become to the source: I scoured medical-research databases, and quickly learned that the statistics on women's age and fertility—used by many to make decisions well-nigh relationships, careers, and when to take children—were 1 of the more spectacular examples of the mainstream media'south failure to correctly report on and interpret scientific research.
The widely cited statistic that i in 3 women ages 35 to 39 will not be pregnant afterward a yr of trying, for case, is based on an article published in 2004 in the periodical Homo Reproduction. Rarely mentioned is the source of the information: French nascency records from 1670 to 1830. The gamble of remaining childless—xxx percent—was too calculated based on historical populations.
In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Nigh people assume these numbers are based on large, well-conducted studies of mod women, but they are not. When I mention this to friends and associates, past far the virtually mutual reaction is: "No … No style. Really?"
Surprisingly few well-designed studies of female person historic period and natural fertility include women born in the 20th century—just those that practise tend to paint a more than optimistic picture. One study, published in Obstetrics & Gynecology in 2004 and headed past David Dunson (now of Duke University), examined the chances of pregnancy among 770 European women. It found that with sexual practice at to the lowest degree twice a week, 82 percent of 35-to-39-yr-onetime women excogitate within a year, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their late 20s and early 30s was about identical—news in and of itself.) Another study, released this March in Fertility and Sterility and led by Kenneth Rothman of Boston University, followed 2,820 Danish women as they tried to get pregnant. Amidst women having sex during their fertile times, 78 percent of 35-to-40-twelvemonth-olds got pregnant within a year, compared with 84 percentage of 20-to-34-year-olds. A written report headed by Anne Steiner, an associate professor at the University of Due north Carolina School of Medicine, the results of which were presented in June, found that amid 38- and 39-year-olds who had been pregnant before, 80 percent of white women of normal weight got pregnant naturally inside vi months (although that percent was lower amongst other races and amid the overweight). "In our data, we're not seeing huge drops until historic period 40," she told me.
Even some studies based on historical birth records are more optimistic than what the press normally reports: 1 found that, in the days before birth control, 89 percentage of 38-year-old women were yet fertile. Another concluded that the typical adult female was able to go significant until somewhere between ages 40 and 45. Yet these more encouraging numbers are rarely mentioned—none of these figures appear in the American Society for Reproductive Medicine'due south 2008 commission stance on female age and fertility, which instead relies on the most-ominous historical data.
In short, the "baby panic"—which has by no ways abated since it striking me personally—is based largely on questionable data. We've rearranged our lives, worried endlessly, and forgone countless career opportunities based on a few statistics nigh women who resided in thatched-roof huts and never saw a lightbulb. In Dunson's study of modern women, the divergence in pregnancy rates at age 28 versus 37 is only about 4 pct points. Fertility does decrease with age, but the pass up is not steep plenty to keep the vast majority of women in their belatedly 30s from having a child. And that, afterward all, is the whole point.
I am at present the mother of iii children, all born afterward I turned 35. My oldest started kindergarten on my 40th birthday; my youngest was built-in five months subsequently. All were conceived naturally within a few months. The toddler in my lap at the airdrome is now mine.
Instead of worrying near my fertility, I now worry almost paying for child intendance and getting three children to bed on time. These are good problems to have.
Yet the retentiveness of my abject terror about age-related infertility all the same lingers. Every time I tried to become meaning, I was consumed by anxiety that my historic period meant doom. I was non alone. Women on Cyberspace bulletin boards write of scaling back their careers or having fewer children than they'd similar to, because they tin't conduct the idea of trying to get significant after 35. Those who have already passed the dreaded birthday ask for tips on how to stay calm when trying to get significant, constantly worrying—merely as I did—that they will never have a kid. "I'k scared because I am 35 and everyone keeps reminding me that my 'clock is ticking.' My grandmother even reminded me of this at my nuptials reception," one newly married woman wrote to me afterwards reading my 2012 advice book, The Impatient Woman's Guide to Getting Meaning, based in part on my own experience. It'south not just grandmothers sounding this annotation. "What scientific discipline tells us about the aging parental body should alarm us more than it does," wrote the journalist Judith Shulevitz in a New Democracy cover story late last year that focused, light amplification by stimulated emission of radiation-like, on the downsides of delayed parenthood.
How did the baby panic happen in the first identify? And why hasn't in that location been more than public pushback from fertility experts?
One possibility is the "availability heuristic": when making judgments, people rely on what's right in front of them. Fertility doctors see the effects of historic period on the success rate of fertility treatment every day. That's particularly true for in vitro fertilization, which relies on the extraction of a big number of eggs from the ovaries, because some eggs are lost at every stage of the difficult process. Younger women'due south ovaries respond amend to the drugs used to extract the eggs, and younger women's eggs are more likely to be chromosomally normal. Every bit a result, younger women'south IVF success rates are indeed much college—about 42 per centum of those younger than 35 will give nativity to a alive baby later on one IVF wheel, versus 27 percent for those ages 35 to xl, and just 12 pct for those ages 41 to 42. Many studies have examined how IVF success declines with historic period, and these statistics are cited in many research articles and online forums.
Yet simply near 1 per centum of babies born each year in the U.S. are a consequence of IVF, and almost of their mothers used the technique not because of their historic period, just to overcome blocked fallopian tubes, male infertility, or other issues: about 80 percent of IVF patients are 40 or younger. And the IVF statistics tell united states of america very picayune virtually natural conception, which requires merely one egg rather than a dozen or more, among other differences.
Studies of natural conception are surprisingly difficult to conduct—that's one reason both IVF statistics and historical records play an outsize function in fertility reporting. Mod birth records are uninformative, because most women take their children in their 20s and so utilise nascence control or sterilization surgery to prevent pregnancy during their 30s and 40s. Studies asking couples how long it took them to excogitate or how long they have been trying to get significant are as unreliable as human retentivity. And finding and studying women who are trying to get meaning is challenging, as there's such a narrow window betwixt when they start trying and when some will succeed.
Millions of women are being told when to go pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment.
Another problem looms even larger: women who are actively trying to get pregnant at historic period 35 or subsequently might be less fertile than the average over-35 adult female. Some highly fertile women will go pregnant accidentally when they are younger, and others will get pregnant quickly whenever they endeavour, completing their families at a younger age. Those who are left are, unduly, the less fertile. Thus, "the observed lower fertility rates amongst older women presumably overestimate the result of biological aging," says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Group at the National Plant of Ecology Health Sciences. "If we're overestimating the biological pass up of fertility with age, this will only be proficient news to women who have been almost captious in their nascency-control apply, and may be more fertile at older ages, on average, than our information would pb them to expect."
These mod-24-hour interval inquiry problems help explain why historical data from an age before birth command are so tempting. However, the downsides of a historical approach are numerous. Avant-garde medical care, antibiotics, and even a reliable food supply were unavailable hundreds of years ago. And the reject in fertility in the historical data may also stalk from older couples' having sex less often than younger ones. Less-frequent sex might take been especially likely if couples had been married for a long time, or had many children, or both. (Having more children of course makes information technology more than difficult to fit in sex, and some couples surely realized—eureka!—that they could avert having another mouth to feed by scaling back their nocturnal activities.) Some historical studies try to command for these problems in various ways—such equally looking only at just-married couples—just many of the same bug remain.
The best mode to assess fertility might be to mensurate "cycle viability," or the chance of getting pregnant if a couple has sex activity on the nigh fertile day of the woman's bicycle. Studies based on cycle viability employ a prospective rather than retrospective design—monitoring couples as they attempt to get pregnant instead of asking couples to call up how long it took them to get pregnant or how long they tried. Cycle-viability studies also eliminate the demand to account for older couples' less active sexual practice lives. David Dunson'southward assay revealed that intercourse two days earlier ovulation resulted in pregnancy 29 per centum of the time for 35-to-39-year-old women, compared with almost 42 percentage for 27-to-29-year-olds. So, past this measure, fertility falls by well-nigh a third from a adult female'southward belatedly 20s to her late 30s. Yet, a 35-to-39-year-sometime's fertility two days before ovulation was the aforementioned as a 19-to-26-year-old's fertility three days earlier ovulation: according to Dunson'southward data, older couples who time sex just one 24-hour interval better than younger ones will finer eliminate the age difference.
Don't these numbers contradict the statistics you lot sometimes see in the popular press that only 20 percent of xxx-year-former women and 5 percent of 40-year-onetime women get pregnant per bike? They do, just no journal article I could locate independent these numbers, and none of the experts I contacted could tell me what data prepare they were based on. The American Social club for Reproductive Medicine's guide provides no commendation for these statistics; when I contacted the association'southward press office asking where they came from, a representative said they were simplified for a pop audience, and did not provide a specific commendation.
Dunson, a biostatistics professor, thought the lower numbers might exist averages across many cycles rather than the chances of getting pregnant during the first bike of trying. More women will become pregnant during the first cycle than in each subsequent one because the most fertile will conceive quickly, and those left volition have lower fertility on average.
Most fertility problems are not the result of female age. Blocked tubes and endometriosis (a condition in which the cells lining the uterus also grow exterior it) strike both younger and older women. Almost one-half of infertility problems trace dorsum to the man, and these seem to be more common among older men, although research suggests that men'due south fertility declines only gradually with age.
Fertility problems unrelated to female age may as well explain why, in many studies, fertility at older ages is considerably higher among women who have been significant before. Amongst couples who haven't had an accidental pregnancy—who, equally Dr. Steiner put it, "have never had an 'oops' "—sperm problems and blocked tubes may be more probable. Thus, the data from women who already have a child may give a more than accurate picture of the fertility decline due to "ovarian crumbling." In Kenneth Rothman's study of the Danish women, amongst those who'd given birth at least once previously, the chance of getting pregnant at age 40 was similar to that at age 20.
Older women'due south fears, of grade, extend beyond the ability to get pregnant. The rates of miscarriages and birth defects rise with age, and worries over both accept been well ventilated in the popular printing. But how much exercise these risks actually rise? Many miscarriage statistics come from—you guessed information technology—women who undergo IVF or other fertility treatment, who may have a higher miscarriage risk regardless of age. Nonetheless, the National Vital Statistics Reports, which draw information from the general population, find that 15 percent of women ages twenty to 34, 27 percent of women 35 to 39, and 26 percentage of women 40 to 44 report having had a miscarriage. These increases are hardly insignificant, and the true charge per unit of miscarriages is higher, since many miscarriages occur extremely early in a pregnancy—before a missed period or pregnancy exam. Yet it should be noted that even for older women, the likelihood of a pregnancy's continuing is near three times that of having a known miscarriage.
What about nascence defects? The risk of chromosomal abnormalities such as Down syndrome does ascension with a woman'south historic period—such abnormalities are the source of many of those very early, undetected miscarriages. All the same, the probability of having a child with a chromosomal aberration remains extremely depression. Fifty-fifty at early fetal testing (known as chorionic villus sampling), 99 percent of fetuses are chromosomally normal amongst 35-yr-old significant women, and 97 percent amidst xl-twelvemonth-olds. At 45, when most women tin no longer become pregnant, 87 percent of fetuses are nevertheless normal. (Many of those that are not will later be miscarried.) In the near future, fetal genetic testing volition exist done with a simple blood examination, making it even easier than it is today for women to get early information almost possible genetic bug.
What does all this hateful for a woman trying to decide when to have children? More specifically, how long can she safely wait?
This question tin can't exist answered with absolutely certainty, for 2 big reasons. Outset, while the data on natural fertility among mod women are proliferating, they are still sparse. Collectively, the three modern studies past Dunson, Rothman, and Steiner included only about 400 women 35 or older, and they might non exist representative of all such women trying to conceive.
2nd, statistics, of course, can tell us only about probabilities and averages—they offer no guarantees to any particular person. "Fifty-fifty if we had expert estimates for the average biological turn down in fertility with historic period, that is still of relatively limited utilise to individuals, given the large range of fertility found in healthy women," says Allen Wilcox of the NIH.
So what is a woman—and her partner—to do?
The information, imperfect as they are, suggest two conclusions. No. one: fertility declines with age. No. ii, and much more relevant: the vast majority of women in their late 30s will be able to go pregnant on their own. The bottom line for women, in my view, is: plan to take your terminal kid past the time you plough xl. Beyond that, you're rolling the dice, though they may still come up up in your favor. "Fertility is relatively stable until the tardily 30s, with the inflection indicate somewhere around 38 or 39," Steiner told me. "Women in their early 30s tin can think about years, but in their late 30s, they need to be thinking virtually months." That's also why many experts advise that women older than 35 should see a fertility specialist if they haven't conceived after six months—particularly if it'south been half-dozen months of sexual activity during fertile times.
In that location is no single best fourth dimension to have a kid. Some women and couples volition find that starting—and finishing—their families in their 20s is what's best for them, all things considered. They just shouldn't permit alarmist rhetoric push them to become parents earlier they're gear up. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities, and moderately lowers the risk of miscarriage. But it besides carries costs for relationships and careers. Literally: an assay by i economist found that, on boilerplate, every year a woman postpones having children leads to a 10 percent increase in career earnings.
For women who aren't ready for children in their early 30s but are still worried about waiting, new technologies—albeit imperfect ones—offering a third option. Some women choose to freeze their eggs, having a fertility dr. extract eggs when they are however young (say, early 30s) and cryogenically preserve them. So, if they haven't had children by their self-imposed deadline, they can thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs will be younger, success rates are theoretically college. The downsides are the expense—perhaps $ten,000 for the egg freezing and an boilerplate of more than than $12,000 per cycle for IVF—and having to use IVF to become significant. Women who already have a partner can, alternatively, freeze embryos, a more than common procedure that also uses IVF technology.
At home, couples should recognize that having sexual activity at the most fertile time of the cycle matters enormously, potentially making the deviation between an easy formulation in the bedroom and expensive fertility treatment in a clinic. Rothman'south study constitute that timing sexual activity around ovulation narrowed the fertility gap between younger and older women. Women older than 35 who want to get pregnant should consider recapturing the glory of their 20‑something sex lives, or learning to predict ovulation past charting their cycles or using a fertility monitor.
I wish I had known all this back in the leap of 2002, when the media coverage of age and infertility was deafening. I did, though, observe some relief from the smart women of Saturday Nighttime Alive.
"According to author Sylvia Hewlett, career women shouldn't wait to have babies, because our fertility takes a steep drop-off after age 27," Tina Fey said during a "Weekend Update" sketch. "And Sylvia's right; I definitely should have had a baby when I was 27, living in Chicago over a biker bar, pulling downwards a absurd $12,000 a year. That would have worked out great." Rachel Dratch said, "Yeah. Sylvia, um, thanks for reminding me that I have to hurry up and have a infant. Uh, me and my iv cats volition go right on that."
"My neighbor has this ambrosial, cute picayune Chinese infant that speaks Italian," noted Amy Poehler. "So, yous know, I'll just buy i of those." Maya Rudolph rounded out the bluster: "Yes, Sylvia, perhaps your next book should tell men our age to stop playing M Theft Auto III and holding out for the chick from Alias." ("Yous're not gonna get the chick from Alias," Fey brash.)
11 years later, these four women have eight children amidst them, all but one born when they were older than 35. It'south good to be right.
Source: https://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/
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