I Missed My Chance to Have a Baby

How Long Can You Wait to Take a Infant?

Deep anxiety most the ability to take children later in life plagues many women. Simply the refuse in fertility over the course of a adult female's 30s has been oversold. Here's what the statistics really tell the states—and what they don't.

Geof Kern

Editor's Note: Read more stories in our series most women and political power.

In the tentative, mail-9/11 spring of 2002, I was, at 30, in the midst of extricating myself from my outset marriage. My married man and I had met in graduate school simply couldn't find two academic jobs in the same place, and then we spent the iii years of our marriage living in unlike states. After I accepted a tenure-track position in California and he turned down a postdoctoral enquiry position nearby—the job wasn't good enough, he said—it seemed clear that our living state of affairs was not going to change.

I put off telling my parents about the dissever for weeks, hesitant to disappoint them. When I finally broke the news, they were, to my relief, supportive and understanding. And so my mother said, "Have you read Fourth dimension mag this calendar week? I know you want to have kids."

Time'due south embrace that week had a infant on it. "Heed to a successful adult female talk over her failure to deport a kid, and the grief comes in layers of bitterness and regret," the story inside began. A generation of women who had waited to start a family was start to grapple with that decision, and 1 media outlet after another was wringing its hands about the steep decline in women's fertility with age: "When It'southward As well Tardily to Take a Baby," lamented the U.K.'s Observer; "Infant Panic," New York mag announced on its cover.

The panic stemmed from the April 2002 publication of Sylvia Ann Hewlett's headline-grabbing book, Creating a Life, which counseled that women should accept their children while they're immature or risk having none at all. Inside corporate America, 42 percentage of the professional women interviewed past Hewlett had no children at age 40, and most said they deeply regretted it. Just as you plan for a corner role, Hewlett advised her readers, you should plan for grandchildren.

The previous fall, an ad campaign sponsored by the American Society for Reproductive Medicine (ASRM) had warned, "Advancing age decreases your ability to have children." One ad was illustrated with a infant bottle shaped similar an hourglass that was—just to brand the bespeak glaringly obvious—running out of milk. Female fertility, the group announced, begins to reject at 27. "Should you have your baby at present?" asked Newsweek in response.

For me, that was no longer a viable pick.

I had always wanted children. Fifty-fifty when I was busy with my postdoctoral enquiry, I volunteered to babysit a friend'southward preschooler. I often passed the time in airports by chatting up frazzled mothers and babbling toddlers—a 2-twelvemonth-one-time, quite to my surprise, one time crawled into my lap. At a wedding I attended in my late 20s, I played with the groom's preschool-age nephews, oftentimes on the flooring, during the entire rehearsal and most of the reception. ("Do you fart?" one of them asked me in an overly loud vocalisation during the rehearsal. "Everyone does," I replied solemnly, as his granddad laughed quietly in the side by side pew.)

But, all of a sudden unmarried at 30, I seemed destined to remain childless until at least my mid-30s, and peradventure e'er. Flying to a friend's wedding in May 2002, I finally forced myself to read the Time commodity. It upset me and so much that I began doubting my divorce for the first time. "And God, what if I desire to have two?," I wrote in my journal equally the common cold plane sped over the Rockies. "Commencement at 35, and if you expect until the child is 2 to effort, more than likely you have the 2nd at 38 or 39. If at all." To reassure myself near the divorce, I wrote, "Nothing I did would have changed the state of affairs." I underlined that.

I was lucky: within a few years, I married again, and this time the lucifer was much better. But my new hubby and I seemed to face frightening odds against having children. Nigh books and Web sites I read said that 1 in iii women ages 35 to 39 would non become pregnant within a twelvemonth of starting to try. The outset folio of the ASRM'due south 2003 guide for patients noted that women in their late 30s had a 30 per centum chance of remaining childless altogether. The guide as well included statistics that I'd seen repeated in many other places: a woman'southward run a risk of pregnancy was twenty percent each month at age 30, dwindling to 5 percent by age 40.

Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my risk to be a mother?

As a psychology researcher who'd published articles in scientific journals, some covered in the popular printing, I knew that many scientific findings differ significantly from what the public hears virtually them. Shortly after my 2nd wedding, I decided to go to the source: I scoured medical-research databases, and speedily learned that the statistics on women's age and fertility—used by many to make decisions nearly relationships, careers, and when to accept children—were i of the more spectacular examples of the mainstream media'south failure to correctly report on and interpret scientific research.

The widely cited statistic that one in three women ages 35 to 39 volition not be pregnant afterwards a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French nascency records from 1670 to 1830. The chance of remaining childless—thirty per centum—was also calculated based on historical populations.

In other words, millions of women are existence told when to become significant based on statistics from a time before electricity, antibiotics, or fertility handling. Well-nigh people assume these numbers are based on large, well-conducted studies of modernistic women, just they are not. When I mention this to friends and assembly, past far the most common reaction is: "No … No style. Really?"

Surprisingly few well-designed studies of female person age and natural fertility include women born in the 20th century—just those that practise tend to paint a more optimistic picture. Ane written report, published in Obstetrics & Gynecology in 2004 and headed by David Dunson (at present of Duke Academy), examined the chances of pregnancy among 770 European women. It found that with sex activity at least twice a week, 82 percent of 35-to-39-yr-former women conceive inside a year, compared with 86 per centum of 27-to-34-year-olds. (The fertility of women in their belatedly 20s and early 30s was almost identical—news in and of itself.) Some other study, released this March in Fertility and Sterility and led by Kenneth Rothman of Boston University, followed two,820 Danish women as they tried to become pregnant. Among women having sex during their fertile times, 78 percent of 35-to-40-year-olds got pregnant within a year, compared with 84 percent of twenty-to-34-year-olds. A report headed by Anne Steiner, an associate professor at the University of North Carolina School of Medicine, the results of which were presented in June, found that amongst 38- and 39-year-olds who had been meaning before, eighty pct of white women of normal weight got pregnant naturally within half-dozen months (although that percentage was lower among other races and among the overweight). "In our information, we're not seeing huge drops until age 40," she told me.

Even some studies based on historical birth records are more than optimistic than what the printing unremarkably reports: One found that, in the days before nascence control, 89 pct of 38-year-quondam women were notwithstanding fertile. Another concluded that the typical adult female was able to get 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'southward 2008 commission stance on female age and fertility, which instead relies on the near-ominous historical data.

In short, the "infant panic"—which has by no means abated since it hit me personally—is based largely on questionable data. Nosotros've rearranged our lives, worried endlessly, and forgone endless career opportunities based on a few statistics virtually women who resided in thatched-roof huts and never saw a lightbulb. In Dunson's study of mod women, the difference in pregnancy rates at age 28 versus 37 is only about 4 percentage points. Fertility does decrease with age, but the turn down is non steep enough to proceed the vast majority of women in their belatedly 30s from having a child. And that, subsequently all, is the whole point.

I am now the mother of three children, all born after I turned 35. My oldest started kindergarten on my 40th birthday; my youngest was born v months later. All were conceived naturally within a few months. The toddler in my lap at the airport is at present mine.

Instead of worrying almost my fertility, I now worry about paying for child intendance and getting three children to bed on time. These are good problems to accept.

Nevertheless the memory of my abject terror nearly age-related infertility still lingers. Every time I tried to get pregnant, I was consumed by anxiety that my age meant doom. I was non lone. Women on Internet message boards write of scaling back their careers or having fewer children than they'd like to, because they can't acquit the thought of trying to become meaning later on 35. Those who have already passed the dreaded birthday ask for tips on how to stay at-home when trying to get pregnant, constantly worrying—simply as I did—that they volition never accept a child. "I'm scared because I am 35 and everyone keeps reminding me that my 'clock is ticking.' My grandmother fifty-fifty reminded me of this at my wedding reception," one newly married woman wrote to me afterward reading my 2012 advice book, The Impatient Woman's Guide to Getting Pregnant, based in part on my own feel. Information technology'south not merely grandmothers sounding this note. "What science tells united states of america about the aging parental body should alarm united states of america more than it does," wrote the journalist Judith Shulevitz in a New Republic 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 place? And why hasn't at that place been more than public pushback from fertility experts?

Ane possibility is the "availability heuristic": when making judgments, people rely on what'south right in forepart of them. Fertility doctors run into the effects of age on the success rate of fertility handling every twenty-four hour period. That'due south particularly true for in vitro fertilization, which relies on the extraction of a large number of eggs from the ovaries, because some eggs are lost at every stage of the hard process. Younger women'southward ovaries reply better to the drugs used to excerpt the eggs, and younger women's eggs are more likely to be chromosomally normal. Equally a result, younger women's IVF success rates are indeed much college—virtually 42 percent of those younger than 35 will give birth to a live babe after 1 IVF cycle, versus 27 percent for those ages 35 to 40, and simply 12 percent for those ages 41 to 42. Many studies take examined how IVF success declines with age, and these statistics are cited in many enquiry manufactures and online forums.

Yet just nigh 1 percent of babies born each yr in the U.South. are a result of IVF, and almost of their mothers used the technique not because of their age, only to overcome blocked fallopian tubes, male infertility, or other issues: most 80 pct of IVF patients are 40 or younger. And the IVF statistics tell united states very lilliputian almost natural conception, which requires simply one egg rather than a dozen or more than, amid other differences.

Studies of natural conception are surprisingly difficult to conduct—that's one reason both IVF statistics and historical records play an outsize role in fertility reporting. Modernistic birth records are uninformative, because most women have their children in their 20s and and so use birth control or sterilization surgery to foreclose pregnancy during their 30s and 40s. Studies request couples how long it took them to conceive or how long they accept been trying to become significant are as unreliable as man memory. And finding and studying women who are trying to get pregnant is challenging, equally there's such a narrow window betwixt when they start trying and when some will succeed.

Millions of women are being told when to become significant based on statistics from a fourth dimension before electricity, antibiotics, or fertility treatment.

Another problem looms even larger: women who are actively trying to get pregnant at historic period 35 or later might be less fertile than the average over-35 adult female. Some highly fertile women will become significant accidentally when they are younger, and others will get pregnant apace whenever they try, completing their families at a younger age. Those who are left are, disproportionately, the less fertile. Thus, "the observed lower fertility rates among older women presumably overestimate the effect of biological aging," says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Grouping at the National Institute of Environmental Health Sciences. "If we're overestimating the biological refuse of fertility with age, this will but be good news to women who take been near fastidious in their birth-control use, and may be more fertile at older ages, on boilerplate, than our data would atomic number 82 them to expect."

These modern-24-hour interval research problems help explicate why historical information from an age before birth command are and then tempting. Yet, the downsides of a historical approach are numerous. Advanced medical care, antibiotics, and even a reliable food supply were unavailable hundreds of years ago. And the decline in fertility in the historical data may likewise stem from older couples' having sexual practice less often than younger ones. Less-frequent sexual activity might have been especially likely if couples had been married for a long time, or had many children, or both. (Having more children of course makes it more than difficult to fit in sex, and some couples surely realized—eureka!—that they could avoid having another mouth to feed by scaling dorsum their nocturnal activities.) Some historical studies try to control for these issues in diverse means—such as looking only at just-married couples—but many of the same bug remain.

The best way to assess fertility might be to measure "wheel viability," or the chance of getting pregnant if a couple has sex on the virtually fertile day of the adult female's cycle. Studies based on cycle viability use a prospective rather than retrospective blueprint—monitoring couples as they try to get pregnant instead of request couples to call up how long it took them to go pregnant or how long they tried. Cycle-viability studies likewise eliminate the need to account for older couples' less active sex lives. David Dunson's analysis revealed that intercourse two days before ovulation resulted in pregnancy 29 percent of the fourth dimension for 35-to-39-year-old women, compared with almost 42 percent for 27-to-29-year-olds. So, by this measure, fertility falls past about a third from a adult female's tardily 20s to her late 30s. However, a 35-to-39-year-old'due south fertility ii days earlier ovulation was the same as a 19-to-26-year-sometime's fertility iii days before ovulation: according to Dunson's data, older couples who fourth dimension sex just one day better than younger ones will finer eliminate the historic period difference.

Don't these numbers contradict the statistics you lot sometimes run into in the pop printing that only 20 percent of thirty-year-former women and 5 percent of 40-yr-old women become pregnant per cycle? They do, but no journal article I could locate contained these numbers, and none of the experts I contacted could tell me what data prepare they were based on. The American Gild for Reproductive Medicine'south guide provides no citation for these statistics; when I contacted the association'southward press part request where they came from, a representative said they were simplified for a pop audience, and did not provide a specific citation.

Dunson, a biostatistics professor, thought the lower numbers might be averages beyond many cycles rather than the chances of getting pregnant during the get-go cycle of trying. More than women will get pregnant during the first cycle than in each subsequent i because the most fertile will conceive quickly, and those left will accept lower fertility on boilerplate.

Most fertility problems are not the result of female age. Blocked tubes and endometriosis (a status in which the cells lining the uterus likewise abound exterior it) strike both younger and older women. Almost half of infertility problems trace dorsum to the human being, and these seem to exist more mutual among older men, although inquiry suggests that men's fertility declines only gradually with historic period.

Fertility issues unrelated to female historic period may also explain why, in many studies, fertility at older ages is considerably college among women who accept been pregnant before. Amidst couples who haven't had an accidental pregnancy—who, as Dr. Steiner put it, "have never had an 'oops' "—sperm issues and blocked tubes may be more likely. Thus, the data from women who already take a kid may give a more authentic movie of the fertility decline due to "ovarian aging." In Kenneth Rothman'due south study of the Danish women, among those who'd given birth at to the lowest degree in one case previously, the risk of getting meaning at age 40 was similar to that at age xx.

Older women's fears, of course, extend beyond the ability to become pregnant. The rates of miscarriages and birth defects ascent with age, and worries over both have been well ventilated in the popular press. Just how much do these risks actually rise? Many miscarriage statistics come from—you guessed it—women who undergo IVF or other fertility treatment, who may accept a higher miscarriage risk regardless of historic period. Yet, the National Vital Statistics Reports, which describe data from the full general population, detect that 15 percent of women ages 20 to 34, 27 percent of women 35 to 39, and 26 percent of women 40 to 44 written report having had a miscarriage. These increases are hardly insignificant, and the true rate of miscarriages is higher, since many miscarriages occur extremely early in a pregnancy—earlier a missed flow or pregnancy test. Yet it should exist noted that fifty-fifty for older women, the likelihood of a pregnancy's continuing is nearly three times that of having a known miscarriage.

What well-nigh birth defects? The take chances of chromosomal abnormalities such as Down's syndrome does rise with a woman's age—such abnormalities are the source of many of those very early, undetected miscarriages. However, the probability of having a child with a chromosomal abnormality remains extremely low. Even at early fetal testing (known as chorionic villus sampling), 99 pct of fetuses are chromosomally normal among 35-year-former pregnant women, and 97 percent among 40-yr-olds. At 45, when most women can no longer get significant, 87 percent of fetuses are still normal. (Many of those that are not will later be miscarried.) In the near future, fetal genetic testing volition exist washed with a simple blood examination, making information technology even easier than information technology is today for women to get early information almost possible genetic issues.

Westlid does all this mean for a adult female trying to decide when to have children? More than specifically, how long can she safely await?

This question can't be answered with admittedly certainty, for two large reasons. First, while the data on natural fertility among modern women are proliferating, they are notwithstanding sparse. Collectively, the 3 modern studies by Dunson, Rothman, and Steiner included only virtually 400 women 35 or older, and they might non exist representative of all such women trying to conceive.

2d, statistics, of class, can tell us merely well-nigh probabilities and averages—they offer no guarantees to whatsoever particular person. "Even if we had adept estimates for the average biological decline in fertility with age, that is still of relatively limited utilise to individuals, given the big range of fertility found in salubrious women," says Allen Wilcox of the NIH.

So what is a woman—and her partner—to exercise?

The data, imperfect equally they are, suggest two conclusions. No. 1: fertility declines with age. No. 2, and much more relevant: the vast majority of women in their tardily 30s will be able to become pregnant on their own. The bottom line for women, in my view, is: program to accept your concluding child by the time you turn 40. Beyond that, you're rolling the dice, though they may still come up in your favor. "Fertility is relatively stable until the late 30s, with the inflection betoken somewhere around 38 or 39," Steiner told me. "Women in their early on 30s can recollect nearly years, but in their belatedly 30s, they need to be thinking about months." That'south also why many experts advise that women older than 35 should see a fertility specialist if they haven't conceived later on half dozen months—particularly if it'south been six months of sexual activity during fertile times.

There is no unmarried best fourth dimension to take a kid. Some women and couples will notice that starting—and finishing—their families in their 20s is what's best for them, all things considered. They just shouldn't let alarmist rhetoric push them to go parents before they're ready. Having children at a young age slightly lowers the risks of infertility and chromosomal abnormalities, and moderately lowers the risk of miscarriage. But it also carries costs for relationships and careers. Literally: an analysis by one economist institute that, on average, every year a adult female postpones having children leads to a 10 pct increase in career earnings.

For women who aren't prepare for children in their early 30s just are still worried near waiting, new technologies—albeit imperfect ones—offer a 3rd selection. Some women choose to freeze their eggs, having a fertility medico excerpt eggs when they are still immature (say, early 30s) and cryogenically preserve them. Then, if they haven't had children by their self-imposed borderline, they tin can thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs volition be younger, success rates are theoretically college. The downsides are the expense—possibly $10,000 for the egg freezing and an boilerplate of more than $12,000 per cycle for IVF—and having to use IVF to get meaning. Women who already have a partner can, alternatively, freeze embryos, a more common process that also uses IVF applied science.

At home, couples should recognize that having sex at the most fertile time of the bike matters enormously, potentially making the difference between an like shooting fish in a barrel formulation in the bedroom and expensive fertility treatment in a dispensary. Rothman's study institute that timing sex effectually ovulation narrowed the fertility gap between younger and older women. Women older than 35 who desire to get pregnant should consider recapturing the celebrity of their twenty‑something sex lives, or learning to predict ovulation by charting their cycles or using a fertility monitor.

I wish I had known all this back in the spring of 2002, when the media coverage of age and infertility was deafening. I did, though, find some relief from the smart women of Sat Dark Live.

"Co-ordinate to writer Sylvia Hewlett, career women shouldn't await to have babies, because our fertility takes a steep drop-off after age 27," Tina Fey said during a "Weekend Update" sketch. "And Sylvia'south right; I definitely should have had a babe when I was 27, living in Chicago over a biker bar, pulling downwards a cool $12,000 a year. That would have worked out great." Rachel Dratch said, "Yeah. Sylvia, um, thanks for reminding me that I accept to hurry upward and have a infant. Uh, me and my four cats will get right on that."

"My neighbor has this ambrosial, beautiful little Chinese babe that speaks Italian," noted Amy Poehler. "And then, you know, I'll just buy one of those." Maya Rudolph rounded out the rant: "Yeah, Sylvia, mayhap your next book should tell men our age to stop playing Thousand Theft Machine 3 and belongings out for the chick from Allonym." ("You're non gonna get the chick from Alias," Fey brash.)

Eleven years afterwards, these iv women have eight children among them, all just one built-in when they were older than 35. It's good to exist right.

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Source: https://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/

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