Fertility and Aging
Now that I’m on the other side of 35 (37 this summer) with two children, I no longer worry about my fertility.
I was always determined to be done having children by 35. As each month of not getting pregnant in my early 30s passed, I panicked about 35 being that much closer. I did manage however to give birth to my second—and last—child three months before my 35th birthday.
However, I have friends in my same age group who either have not had children yet—and intend to—or who are hoping to add to their families. They have very real anxieties that although they are not “old” by any reasonable sense of the word; there is this impending sense of being too old to have children the further away one is from 30.
Just because one is over 35 does not mean that having a child is impossible.
The decline in fertility after 35 isn’t as steep or as rapid as it has been made out to be. American psychologist Jean Twenge wrote an eye-opening article for “The Atlantic” in 2013 that dispelled the myth that fertility is all downhill after 35.
She pointed out that the common belief that 1 in 3 women between 35 and 39 will not be pregnant within a year actually comes from French birth records from 1670-1830. Twenge wrote,
“Millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment.”
There have not been many studies on female age and natural fertility for women in our time, but Twenge shares that the ones that do exist “paint a more optimistic picture.” She ended her piece (now 5 years old) stating, “Fertility does decrease with age, but the decline is not steep enough to keep the vast majority of women in their late 30s from having a child.”
That’s the good news. As with all medical issues, trust your gut and seek expert help as needed. A reproductive specialist should be seen if you are over 35, tried for 12 months, had multiple miscarriages or have been previously diagnosed with a condition that causes infertility.
Even more key is to understand how your body works and what is normal and abnormal. Facing fertility issues can be very scary, so it’s important to be proactive and seek help if needed.
Obviously, I knew the basics of procreation, but sex education classes happened a long time ago for me and they hardly covered the nitty gritty details of a woman’s cycle.
I learned so much about my body and had so many questions answered from this book that I now recommend it to everyone.
Weschler recommends tracking your cycle for three months to learn when the best times are to try and get pregnant and to identify any potential issues. What does this mean exactly?
Fertility Awareness is a method of tracking ovulation to accurately determine when you are most fertile. There are a few methods:
The Temperature Method: Taking your temperature in the morning every day before getting out of bed. Using a basal body thermometer is best for accuracy.
The Cervical Mucus Method: Checking your cervical mucus every day.
The Calendar Method: Charting your menstrual cycle on a calendar or app.
Combining these methods will actually provide the most accurate results. There are multiple apps where you can enter this information to track your cycle.
Medically, if a woman is under 35 and has been trying for a year without results, she should see a doctor. Women over 35 should see a doctor if they are not pregnant in 6 months.
What exactly happens to fertility when a woman is over 35? Ovulation occurs less frequently, as ovarian reserve declines in terms of both quality and quantity. There could be scar tissue around the uterus or fallopian tubes. Women could have fibroids or chronic health issues like high blood pressure. Cervical mucus, which carries sperm to the egg, could decline as well. There are also higher rates of miscarriage among “geriatric” pregnancies, when women are between 35 and 45.
There are higher chances of older couples needing reproductive assistance, but even then, the chances are lessened with age.
With IVF (In Vitro Fertilization), there is a 30-35% chance per cycle up until 30 years old, but then the rates fall by 20% at age 40 and 5% by 45. This correlates with the monthly chances of getting pregnant naturally: 20% at age 30 and 5% by 40.
This should by no means discourage older couples from trying to get pregnant.
The first step is to see a doctor for a preliminary fertility evaluation. This can be done through a regular OB/GYN, although if a couple is 40, it is recommended that they should see a specialist right away.
During this evaluation, you and your partner will have physical exams and share your medical and sexual history. As 50% of all fertility issues are caused by male factor infertility, men will have their semen analyzed. This will check sperm count, as well as the sperm’s motility (movement) and structure. It used to be that women alone were blamed for age-related infertility, but more recently studies have proven that semen quantity peaks between the ages 30 and 35. Sperm motility also declines.
For women, it’s vital to make sure ovulation is happening, which can be checked through blood tests that assess hormone levels. These include FSH (day 3 follicle stimulating hormone), LH (luteinizing hormone), E2 (estradiol), AMH (anti-mullerian hormone that evaluates egg supply), as well as testosterone, progesterone and thyroid stimulating hormones among others.
Ultrasounds are used to check the ovaries. Women also will need their fallopian tubes and uterus checked through a hysterosalpingogram, an x-ray that checks to see if the tubes are open.
If all of that is normal, it might be recommended that a woman undergo a laparascopy, a surgical procedure used to study the ovaries, uterus, fallopian tubes and abdominal cavity. Certain conditions, like endometriosis, are only diagnosed and treated through laparoscopic surgery.
While a regular OB/GYN typically can run initial blood tests and order a sperm analysis and an HSG, a consultation with a specialist will determine what other tests are necessary to get to the root of the fertility issues.
Once a specialist has identified the issues, a course of treatment can be decided on, whether that means timed intercourse or IVF.
Be prepared for a lengthy testing process and the possibility of reproductive assistance, but also keep your eye on the prize. There are so many options for parenthood now from natural conception to surrogacy to adoption.
I was under 35 and had been trying for 10 months when I took it upon myself to see a reproductive endocrinologist. He immediately suggested that I had endometriosis based on my menstrual cycle history. Surgery confirmed this and we launched into fertility treatments that eventually led to my daughter’s conception through IVF.
While I had age on my side, it still took close to three years from when I started trying to get pregnant to when I had my first daughter at 33. I worried about how long it would take to have a second baby, especially as I was getting closer to 35. I was lucky, though, to get pregnant spontaneously right after I turned 34.
If you are over 35 and thinking of starting (or adding to) your family, don’t despair over your age. Take the time to chart your cycle, be open about your timeline with your OB/GYN and don’t be afraid to reach out to a specialist for help.
After all, it’s up to you to take charge of your fertility.