For many of us women these days, having a baby before the age of 25 is the last thing on our mind. It could be due to finishing up school or advancing in careers, as well as the time it takes to find the right partner. Our bodies, however, are on a biological clock and do not pay attention to whether we are ready or not. In fact, we are most fertile between the ages of 20-24. This means that our fertility starts to decline at 25 years of age. It’s not until the age of 35, however, that fertility declines more rapidly. By the time we are 40 years old, we have less than a 5% chance of conceiving per cycle. You may be asking: what about movie stars like Nicole Kidman and Halle Barry, they were in their 40s and got pregnant? Yes, it’s big news right now when a movie star in their 40s get pregnant, but this isn’t the reality for every woman. We met with expert in fertility, Dr. Don Aptekar, to get the answer to the question, “Am I too old to have a baby, or alternatively, how long can I wait?”
Q&A with Dr. Don Aptekar:
Q: When am I too old to have a baby?
A: The simple answer is that there is no ‘I can’t get pregnant due to age’ until after menopause. This question, however, is individually based and no doctor can answer that question right off the bat. I see patients in their late 30s that have to use donor eggs since they no longer have any quality eggs left. Yet, just the other day, I had a 47 year old patient come in who had spontaneously gotten pregnant.
Q: Is there a test I can do to check on my egg reserve?
A: While there is a test that we can do to test your ovarian reserve, it is only an estimate. Two common tests include the FSH test and the clomid tests. These tests measure hormone levels that can give some insight into your egg quantity. The problem is that this shows you the results for that particular month, not for the entire year. Also, these tests can only give you insight about the quantity of eggs, not the quality.
If you are really concerned about how many eggs you have left, you could take the test and it will give you some insight on to when to try.
Q: Does age affect how long you should try before getting help?
A: Yes, if you are 34 or younger, you should not worry about anything being wrong until after trying to conceive for a year. If you are over 35, since time is of the essence, you should see a doctor after 6 months of trying. Trying means timing your ovulation and having intercourse during your most fertile window each month.
At 35, most women have a 15 to 20 percent chance of getting pregnant in a given month. That could mean a 78 percent chance of conceiving within the year
Q: I’m over 35 and have been trying for 6 months and still not pregnant, do I have a problem?
A: If you have been trying for 6 months or longer, please know that this does not necessarily mean that there is a problem. Since the percent chance of getting pregnant is lower per month, it may take you 1 to 2 years to get pregnant. For roughly 30 percent of women age 35, it make take a year or more to conceive.
Q: Why is it harder to get pregnant as you get older?
A: It’s either hard or it’s not. I have a lot of 38 year old patients get pregnant on their own quite easily or at least within a year. But statistically speaking, after 35 years of age, it’s harder for a woman to get pregnant and stay pregnant. The most common reason is reduced egg quality. Once you are 38, your eggs are running out. So it may take longer because you may have fewer chances per year to get pregnant. Women in their 20s likely ovulate 12 times in a year, while some women over 35 may only ovulate 4 times in a year.
Q: Will fertility treatments solve the age issue?
A: Science is advancing rapidly and we have managed to get older women pregnant, especially if they are open to ideas such as donor eggs. If you want to use your own eggs though, even treatments, such as IVF, are less likely to be successful once you pass 38 and success rates decline even more rapidly in your forties.
Q: I have had two miscarriages, could this be age related?
A: It's sadly more common for older women to have a miscarriage or an ectopic pregnancy. It does not mean that you are too old to carry a pregnancy. If you are 33 years old, and you want to have two kids, you have a 25-30% chance to miscarry each time you conceive.
As you get older, you are more likely to have chromosomal defects which is why miscarriages are more likely to happen. If you are terrified, please don’t be. It is still more likely for you to have a healthy pregnancy rather than not.
Q: I’m having a hard time getting pregnant with my second child. What is wrong?
A: Many of my patients get stressed about how long it is taking with trying for their second or third child. There is no ideal age gap so don’t stress if you are having a hard time, particularly if you had a miscarriage because that means you still can get pregnant. As you get older it is harder to get pregnant and stay pregnant.
Q: I’m in my 20s or early 30s should I be concerned about getting pregnant soon?
A: People would say you should begin to stress at 35, but you don’t have a problem until you have one: you don’t want to make a problem based on a statistic. Don’t beat yourself up about wishing you had started early. If your career is really important and/or it took time to find the right partner, that is what you needed to do. You still have time. I don’t worry for my patients until they are about 38.
Q: When can women not get pregnant anymore?
A: Menopause. I saw someone at 47 get pregnant spontaneously but that is really rare. I don’t prescribe birth control anymore two years after menopause to be sure not to get pregnant.
Q: Should I freeze my eggs?
A: I don't highly recommend it because it’s a very expensive approach. You may pay all that money and then meet Mr. Right the next month, or you could meet someone with kids and you are done. That said, I have seen circumstances where it was a good idea for my patient. One was a woman who was a 38 year old professional and then married a guy 8-10 years younger and she was happy to conceive with one of the eggs.
Q: Did I wait too long to freeze my eggs?
A: “The best time to plant a tree was 10 years ago the second best time is today.” In other words, no point in worrying about what you can’t change. You can freeze your eggs up until age 40. Honestly, you probably aren’t going to need it. I recommend having a partner to help you raise a family, but if you think you won’t find anyone, you can do it on your own. I have one very successful friend, Ivy league educated and all, but never found the right guy. At 39, she froze her first set of eggs and then had two kids on her own.
Be reassured that despite the slightly increased risks, you are still more likely to have a healthy baby than not, even if you are in your mid-40s. Getting pregnant in the first place is probably the biggest obstacle you'll face. If you are aged 35 to 39, it could take you a couple of years to conceive even if you are having unprotected sex twice a week. For about 82 percent of women aged 35 to 39, it takes a year or less to conceive, for another 8 percent it takes one to two years to conceive, leaving 10 percent still trying after two years. So you may need to be patient.