Author: Daniel F. Rychlik, M.D.
The proverbial biological clock never stops ticking. However, for women who desire a baby, the clock ticks louder with each passing year. Age is the key factor affecting fertility for women. And yes, even men’s fertility can be affected by age.
The National Center for Health Care Statistics’ annual report of fertility rates for 2000 and 2001 indicates that a woman’s fertility peaks between the ages of 25-29. It also dramatically showed that a 50% decrease in fertility rate started at age 34, and by age 40, the fertility rate decreased by 90% when compared to a 25-29 year old woman.
A woman is born with all the eggs (oocytes) she will ever have: six million at 20 weeks gestation; two million at birth; 400,000 at puberty. A total of 400 are ovulated over the course of a lifetime and, with each menstrual cycle, 1,000 eggs will leave the resting stage and start to mature.
Age affects oocyte quality. An egg mirrors the core paradigm of biological life-it doesn’t get better with age. Older eggs are not as healthy as younger ones and often lead to missed opportunities for fertilization, poor adhesion to the uterine wall or an early miscarriage. Despite the ticking of their “biological clocks,” advances in medical technology give hope to older women.
A woman who has postponed starting a family until she is in her mid-30s or older can turn to her physician or a fertility specialist to lend “Mother Nature” a helping hand if she is not able to conceive on her own. (Six months of unsuccessful trying is the accepted guideline for this age group.) Actually, a woman may call for that help even if she already has a child but is past age 34 and wants another child. The chances of success of any treatment, however, continue to diminish as a woman gets older.
Although men produce sperm throughout their post-puberty years, age can adversely impact their reproductive system, too. Couples who have been trying to get pregnant without success should not assume that the problem is exclusive to either person. A fertility work-up-basic blood tests and a semen analysis-will help to initially define the situation.
Subsequent treatment is specific to the individual couple. With information from those test results, your physician will be able to propose an appropriate treatment plan.
***Available fertility options include***
Fertility drugs may be given to a woman to trigger or regulate her ovulation, or to a man to increase his sperm count. Intrauterine insemination may be employed, giving the sperm a head start on fertilizing an egg by placing a prepared sample into the uterus. These two treatments may even be combined, further improving the chance of fertilization by increasing the number of eggs exposed to the sperm.
Another option for couples experiencing infertility is advanced reproductive therapies such as in vitro fertilization (IVF). In this procedure, egg and sperm are combined and carefully cultivated under laboratory conditions, and the developed embryos are placed into the uterus where they must implant themselves in the uterine wall. When age is a factor, donor egg IVF, where the eggs of a younger woman are used in the process, is a viable option that has been successful.
Other possibilities and combinations of treatments are also available. Although age continues to strongly impact the chances of conception, the fulfillment of parenthood is not limited to only the young; advanced reproductive medical technology may well hold the key for older parents-to-be.
Daniel F. Rychlik, M.D., F.A.C.O.G., is board certified in the sub-specialty of Infertility and Reproductive Endocrinology, and the specialty of OB/GYN by the American Board of Obstetrics and Gynecology. He is the associate medical director at the Fertility Treatment Center, an academic medical practice and one of the most comprehensive reproductive treatment facilities in the western United States with centers in Tempe, Scottsdale and Glendale. He is also a clinical instructor at the University of Arizona College of Medicine-Phoenix Campus. For more information, call (480) 831-2445 or visit www.fertilitytreatmentcenter.com.
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As I scroll through my social media feed, I understand how many people might be confused about the relationship between age and pregnancy. One headline implies that your ovaries turn to dust after 30, the next shows a 50-year-old celebrity having healthy twins.
So, how old is too old to get pregnant? The answer is complicated.
Falling fertility: A woman’s ability to get pregnant begins to decrease slightly at age 27, and then decreases significantly after the age of 37. The average healthy couple under the age of 30 has about 95% of conceiving within a year. Once you’re over 30, the chance of getting pregnant decreases by about 3% each year. After 40, the chance of conception drops to 5-10%, and by age 45, the chance plummets to less than 5%. Of course, these are the general statistics – there are always outliers. In the last week, I met with a 25-year-old struggling with infertility and a 46-year-old who found herself unexpectedly pregnant despite contraception.
Rising risk: As age increases, so does the risk of miscarriage and pregnancy complications. While the rate of early pregnancy loss is around 15-20% for women under 30, it begins to increase at the age of 35, and by age 40, the miscarriage rate is 40-50%. The risk of a baby having Down syndrome and other chromosomal abnormalities is also directly related to the level of “maturity” of the mother. The risk rises gradually with age, until age 35, and then the risk increases more rapidly. At age 35, the risk of Down syndrome is 1/350 – but by 45, the risk approaches 1/35. We also see a slight increased incidence of preeclampsia, gestational diabetes, C-section, and stillbirth in moms over the age 40, so additional ultrasounds and testing are often ordered in older moms.
https://www.edenfertilitycenters.com/January 29, 2020 - 4:43am
I must respectfully challenge your comment about considering the child of an "older" parent. First of all, at what age would you consider a woman to be "too old?" It is extaordinarily rare for a woman to have a child past the early 40s. Are you are suggesting that a mother of that age is going to be too "elderly" to bring up a happy, healthy child?
First of all, my mother is 70, and I would put her up against my mid-40s friends in overall energy and health. She exercises daily, eats well, is slim and looks terrific. She has made the choice to take care of her health.
However, many of her friends are seriously overweight, as of course is a large percentage of the American population. Their eating habits are atrocious and they can't walk around the mall let alone start a fitness program. And that situation, I believe, is totally within their control. They have simply chosen not to care for themselves to live life to the fullest.
So I come back to a woman who wants to have a child in her 40s and compare her to someone who gives birth in her 20s or 30s. Is the 40-year-old really giving her child a less fulfilling life because she is older? That's a tremendous blanket statement you're making.
I have many friends who have gone through extreme depression after starting families in their 20s, and trust me, their kids know that mommy is depressed, mommy is snippy, mommy and daddy don't seem to like each other very much. They've been married for 10, 15 years at this point, and I have heard every sad, cliched story about their marriages, how they gave up this or that, how they don't know who they are, they have no life outside their kids, how they wish they had made the choices I made, how they did it all because that's what they were supposed to do. They didn't ACTIVELY participate in their own lives. They just let everything happen and went along with it.
The American family is such a cliche. How could you possibly think that a set of mature parents who choose later in life to make such a tremendous commitment -- and because they *want* to, not because they think they have to or have no other option -- could give their family less happiness, joy and caring just because they do it later in life? Because they're going to be "elderly" when the kids go to college? "Elderly" is a state of mind and of general health. And I hardly think 60s or 70s is elderly, unless you can't tie your shoes or walk up the stairs without falling over. And that is something that I believe we can all avoid.
I won't even get into the economic argument for having children later.October 11, 2008 - 12:30pm
It seems unfair that a man can father past middle age can father a child and be looked upon as remarkably virile, while a woman who bears a child past middle age can be looked upon as though she's sadly desperate or just plain nuts. I think there is such a thing as being too old for new parenthood that goes beyond how old the ovum are.
IMHO, I think the consideration has to be given to the child. What will their quality of life be? Will the child have to be caring for an elderly parent who should otherwise be enjoying a a healthy, active life with her?
I'm sure older first moms struggle with this.October 9, 2008 - 7:50pm