Not Their First Time to Have a Baby

How Long Tin can You Wait to Have a Infant?

Deep anxiety virtually the ability to take children after in life plagues many women. Just the decline in fertility over the course of a woman's 30s has been oversold. Hither's what the statistics really tell us—and what they don't.

Geof Kern

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

In the tentative, post-9/11 spring of 2002, I was, at thirty, in the midst of extricating myself from my showtime marriage. My hubby and I had met in graduate school but couldn't observe two academic jobs in the same identify, so we spent the three years of our marriage living in different states. After I accepted a tenure-rails position in California and he turned down a postdoctoral inquiry position nearby—the job wasn't good plenty, he said—it seemed clear that our living situation was non going to change.

I put off telling my parents about the separate for weeks, hesitant to disappoint them. When I finally broke the news, they were, to my relief, supportive and understanding. And so my female parent said, "Have you read Time mag this week? I know yous want to take kids."

Fourth dimension's cover that calendar week had a baby on information technology. "Listen to a successful woman talk over her failure to conduct a kid, and the grief comes in layers of bitterness and regret," the story inside began. A generation of women who had waited to showtime a family was outset to grapple with that decision, and 1 media outlet after some other was wringing its hands about the steep pass up in women'south fertility with age: "When It'due south Too Belatedly to Have a Baby," lamented the U.M.'s Observer; "Baby Panic," New York magazine announced on its encompass.

The panic stemmed from the April 2002 publication of Sylvia Ann Hewlett's 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 percentage of the professional women interviewed by Hewlett had no children at historic period 40, and most said they deeply regretted it. Just as you programme for a corner part, Hewlett advised her readers, you should plan for grandchildren.

The previous fall, an advert campaign sponsored by the American Society for Reproductive Medicine (ASRM) had warned, "Advancing historic period decreases your ability to take children." One advert was illustrated with a baby bottle shaped like an hourglass that was—only to make the bespeak glaringly obvious—running out of milk. Female fertility, the grouping announced, begins to decline at 27. "Should you have your infant now?" asked Newsweek in response.

For me, that was no longer a viable pick.

I had always wanted children. Even when I was busy with my postdoctoral research, I volunteered to babysit a friend'south preschooler. I oftentimes passed the time in airports by chatting upward frazzled mothers and blathering toddlers—a 2-year-sometime, quite to my surprise, once crawled into my lap. At a hymeneals I attended in my late 20s, I played with the groom's preschool-historic period nephews, frequently on the flooring, during the unabridged rehearsal and virtually of the reception. ("Exercise you fart?" one of them asked me in an overly loud vox during the rehearsal. "Everyone does," I replied solemnly, every bit his grandfather laughed quietly in the next pew.)

But, suddenly unmarried at xxx, I seemed destined to remain childless until at least my mid-30s, and perchance e'er. Flying to a friend's wedding in May 2002, I finally forced myself to read the Time commodity. It upset me so much that I began doubting my divorce for the showtime time. "And God, what if I want to have two?," I wrote in my journal as the common cold plane sped over the Rockies. "Outset at 35, and if you await until the child is 2 to try, more than likely yous have the second at 38 or 39. If at all." To reassure myself about the divorce, I wrote, "Nothing I did would accept changed the state of affairs." I underlined that.

I was lucky: inside a few years, I married again, and this time the match was much better. But my new husband and I seemed to face frightening odds confronting having children. About books and Web sites I read said that one in three women ages 35 to 39 would not get meaning within a year of starting to endeavour. The get-go folio of the ASRM'due south 2003 guide for patients noted that women in their late 30s had a xxx percent take a chance of remaining childless altogether. The guide besides included statistics that I'd seen repeated in many other places: a adult female's chance of pregnancy was xx percent each month at age 30, dwindling to 5 percent past age 40.

Every time I read these statistics, my stomach dropped like a stone, heavy and foreboding. Had I already missed my chance to exist a female parent?

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 about them. Soon after my second wedding, I decided to go to the source: I scoured medical-research databases, and quickly learned that the statistics on women's age and fertility—used past many to make decisions about relationships, careers, and when to accept children—were one of the more spectacular examples of the mainstream media's failure to correctly report on and interpret scientific research.

The widely cited statistic that one in three women ages 35 to 39 will not exist pregnant after a year of trying, for example, 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—30 percentage—was too calculated based on historical populations.

In other words, millions of women are being told when to get significant based on statistics from a time earlier electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but 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 age and natural fertility include women born in the 20th century—only those that do tend to paint a more optimistic picture. One report, published in Obstetrics & Gynecology in 2004 and headed past David Dunson (now of Knuckles University), examined the chances of pregnancy among 770 European women. It found that with sexual practice at least twice a week, 82 percentage of 35-to-39-yr-onetime women conceive within a yr, compared with 86 percent of 27-to-34-year-olds. (The fertility of women in their late 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 equally they tried to get pregnant. Among women having sex activity during their fertile times, 78 percent of 35-to-40-year-olds got pregnant inside a year, compared with 84 percent of 20-to-34-year-olds. A study 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 among 38- and 39-yr-olds who had been pregnant earlier, 80 per centum of white women of normal weight got pregnant naturally within six months (although that percentage was lower among other races and amid the overweight). "In our data, we're not seeing huge drops until age twoscore," she told me.

Fifty-fifty some studies based on historical birth records are more optimistic than what the press normally reports: I found that, in the days before nascency control, 89 percent of 38-year-one-time women were yet fertile. Another concluded that the typical woman was able to go pregnant until somewhere betwixt ages forty and 45. Yet these more than encouraging numbers are rarely mentioned—none of these figures appear in the American Society for Reproductive Medicine's 2008 committee opinion on female historic period and fertility, which instead relies on the virtually-ominous historical data.

In short, the "baby 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 countless career opportunities based on a few statistics about women who resided in thatched-roof huts and never saw a lightbulb. In Dunson'south report of modernistic women, the difference in pregnancy rates at age 28 versus 37 is only virtually 4 percentage points. 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. And that, afterwards all, is the whole bespeak.

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

Instead of worrying about my fertility, I now worry nearly paying for child care and getting iii children to bed on time. These are good problems to have.

Yet the retentivity of my abject terror about age-related infertility withal lingers. Every time I tried to get pregnant, I was consumed by feet that my historic period meant doom. I was non alone. Women on Internet bulletin boards write of scaling dorsum their careers or having fewer children than they'd similar to, because they tin't deport the thought of trying to get meaning after 35. Those who have already passed the dreaded birthday inquire for tips on how to stay calm when trying to become pregnant, constantly worrying—simply as I did—that they will never have a child. "I'm scared because I am 35 and everyone keeps reminding me that my 'clock is ticking.' My grandmother even reminded me of this at my wedding reception," 1 newly married woman wrote to me after reading my 2012 advice volume, The Impatient Woman's Guide to Getting Significant, based in role on my own experience. It'due south non just grandmothers sounding this note. "What science tells us about the aging parental body should warning us more than it does," wrote the journalist Judith Shulevitz in a New Commonwealth cover story tardily concluding yr that focused, laser-like, on the downsides of delayed parenthood.

How did the baby panic happen in the first place? And why hasn't there been more public pushback from fertility experts?

Ane possibility is the "availability heuristic": when making judgments, people rely on what's right in forepart of them. Fertility doctors encounter the effects of age on the success charge per unit of fertility treatment every day. That's peculiarly truthful 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's ovaries answer better to the drugs used to extract the eggs, and younger women'southward eggs are more likely to be chromosomally normal. As a outcome, younger women's IVF success rates are indeed much higher—about 42 percentage of those younger than 35 will requite nascency to a live baby afterwards one IVF cycle, versus 27 pct for those ages 35 to 40, and merely 12 percent for those ages 41 to 42. Many studies have examined how IVF success declines with historic period, and these statistics are cited in many enquiry articles and online forums.

Nevertheless simply most i percent of babies born each yr in the U.Southward. are a result of IVF, and near of their mothers used the technique not because of their age, but to overcome blocked fallopian tubes, male infertility, or other problems: about 80 percentage of IVF patients are twoscore or younger. And the IVF statistics tell us very niggling about natural formulation, which requires just ane egg rather than a dozen or more, among other differences.

Studies of natural conception are surprisingly hard to conduct—that's 1 reason both IVF statistics and historical records play an outsize part in fertility reporting. Modern birth records are uninformative, considering near women have their children in their 20s and so utilize birth control or sterilization surgery to prevent pregnancy during their 30s and 40s. Studies asking couples how long it took them to conceive or how long they accept been trying to get pregnant are as unreliable as human retentiveness. And finding and studying women who are trying to get pregnant is challenging, as there's such a narrow window between when they start trying and when some will succeed.

Millions of women are being told when to get pregnant based on statistics from a fourth dimension before electricity, antibiotics, or fertility handling.

Another problem looms even larger: women who are actively trying to get meaning at historic period 35 or later might be less fertile than the average over-35 woman. Some highly fertile women will get pregnant accidentally when they are younger, and others will get pregnant quickly whenever they try, completing their families at a younger age. Those who are left are, unduly, the less fertile. Thus, "the observed lower fertility rates among older women presumably overestimate the result of biological aging," says Dr. Allen Wilcox, who leads the Reproductive Epidemiology Group at the National Institute of Environmental Health Sciences. "If we're overestimating the biological decline of fertility with age, this will only exist practiced news to women who have been about fastidious in their nascence-control use, and may be more fertile at older ages, on average, than our data would atomic number 82 them to expect."

These modern-day research issues assistance explain why historical data from an historic period before birth control are so tempting. Withal, 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 also stem from older couples' having sexual practice less ofttimes than younger ones. Less-frequent sexual practice might have been peculiarly likely if couples had been married for a long time, or had many children, or both. (Having more children of course makes it more hard 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 endeavor to control for these issues in diverse ways—such equally looking only at just-married couples—just many of the same problems remain.

The best way to appraise fertility might be to mensurate "cycle viability," or the risk of getting pregnant if a couple has sexual practice on the most fertile twenty-four hours of the woman's cycle. Studies based on bicycle viability employ a prospective rather than retrospective design—monitoring couples as they attempt to get pregnant instead of request couples to recall how long it took them to get significant or how long they tried. Cycle-viability studies also eliminate the need to business relationship for older couples' less active sex activity lives. David Dunson'south analysis revealed that intercourse two days before ovulation resulted in pregnancy 29 per centum of the time for 35-to-39-year-old women, compared with about 42 percent for 27-to-29-twelvemonth-olds. Then, by this mensurate, fertility falls by about a 3rd from a woman'due south late 20s to her late 30s. However, a 35-to-39-twelvemonth-onetime's fertility two days before ovulation was the same as a 19-to-26-year-old's fertility three days before ovulation: according to Dunson'due south information, older couples who time sex only 1 day better than younger ones will effectively eliminate the historic period difference.

Don't these numbers contradict the statistics you sometimes see in the popular press that just 20 pct of 30-twelvemonth-old women and 5 percent of 40-twelvemonth-sometime women get significant per cycle? They exercise, but no journal commodity I could locate contained these numbers, and none of the experts I contacted could tell me what data set they were based on. The American Society for Reproductive Medicine's guide provides no commendation for these statistics; when I contacted the clan's press office asking where they came from, a representative said they were simplified for a popular audition, and did not provide a specific citation.

Dunson, a biostatistics professor, thought the lower numbers might be averages across many cycles rather than the chances of getting pregnant during the first cycle of trying. More women will go pregnant during the first cycle than in each subsequent one considering the most fertile will conceive speedily, and those left volition accept lower fertility on average.

Most fertility bug are non the result of female age. Blocked tubes and endometriosis (a status in which the cells lining the uterus also abound exterior it) strike both younger and older women. Almost half of infertility problems trace dorsum to the man, and these seem to exist more than common amidst older men, although research suggests that men's fertility declines just gradually with age.

Fertility problems unrelated to female age may besides explicate why, in many studies, fertility at older ages is considerably college amongst women who have been pregnant before. Among couples who haven't had an adventitious pregnancy—who, as Dr. Steiner put information technology, "take never had an 'oops' "—sperm issues and blocked tubes may be more likely. Thus, the data from women who already have a kid may give a more than accurate picture of the fertility decline due to "ovarian aging." In Kenneth Rothman's report of the Danish women, amongst those who'd given nascency at least once previously, the run a risk of getting pregnant at age 40 was similar to that at age twenty.

Older women's fears, of course, extend beyond the ability to become pregnant. The rates of miscarriages and birth defects rise with age, and worries over both have been well ventilated in the popular printing. Only how much do these risks actually ascension? Many miscarriage statistics come from—y'all guessed it—women who undergo IVF or other fertility treatment, who may take a higher miscarriage take chances regardless of age. Nonetheless, the National Vital Statistics Reports, which draw data from the general population, find that xv pct of women ages xx to 34, 27 pct 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 college, since many miscarriages occur extremely early in a pregnancy—earlier a missed menses or pregnancy exam. Yet it should be noted that even for older women, the likelihood of a pregnancy'due south continuing is nearly iii times that of having a known miscarriage.

What about birth defects? The risk of chromosomal abnormalities such equally Down syndrome does rise with a adult female's age—such abnormalities are the source of many of those very early, undetected miscarriages. Even so, the probability of having a child with a chromosomal abnormality remains extremely low. Fifty-fifty at early fetal testing (known as chorionic villus sampling), 99 pct of fetuses are chromosomally normal among 35-year-old pregnant women, and 97 percent among 40-year-olds. At 45, when virtually women can no longer get pregnant, 87 percentage of fetuses are still normal. (Many of those that are not will later exist miscarried.) In the near future, fetal genetic testing volition exist washed with a unproblematic blood test, making it even easier than it is today for women to get early information about possible genetic problems.

Wlid does all this mean for a adult female trying to decide when to take children? More specifically, how long can she safely wait?

This question tin't be answered with absolutely certainty, for ii big reasons. Kickoff, while the data on natural fertility among modern women are proliferating, they are still thin. Collectively, the iii modern studies past Dunson, Rothman, and Steiner included only most 400 women 35 or older, and they might not exist representative of all such women trying to excogitate.

2d, statistics, of course, can tell us only about probabilities and averages—they offer no guarantees to any particular person. "Fifty-fifty if we had good estimates for the average biological pass up in fertility with age, that is nonetheless of relatively express use to individuals, given the large range of fertility found in salubrious women," says Allen Wilcox of the NIH.

So what is a adult female—and her partner—to practice?

The data, imperfect as they are, propose 2 conclusions. No. 1: fertility declines with age. No. ii, and much more relevant: the vast majority of women in their late 30s will be able to get pregnant on their own. The bottom line for women, in my view, is: plan to have your terminal child by the time you plow xl. Across that, you're rolling the dice, though they may however come upwards in your favor. "Fertility is relatively stable until the late 30s, with the inflection bespeak somewhere around 38 or 39," Steiner told me. "Women in their early 30s can think about years, just in their late 30s, they demand to be thinking about months." That's likewise why many experts propose that women older than 35 should see a fertility specialist if they oasis't conceived afterwards six months—particularly if it's been six months of sexual practice during fertile times.

There is no single best time to have a child. Some women and couples will find that starting—and finishing—their families in their 20s is what's best for them, all things considered. They merely shouldn't let alarmist rhetoric push them to become parents earlier 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 too carries costs for relationships and careers. Literally: an analysis by one economist plant that, on average, every year a woman postpones having children leads to a 10 percent increase in career earnings.

For women who aren't gear up for children in their early 30s but are yet worried nearly waiting, new technologies—admitting imperfect ones—offer a tertiary option. Some women cull to freeze their eggs, having a fertility doc extract eggs when they are still young (say, early 30s) and cryogenically preserve them. Then, if they haven't had children past their self-imposed borderline, they can thaw the eggs, fertilize them, and implant the embryos using IVF. Because the eggs will be younger, success rates are theoretically higher. The downsides are the expense—perhaps $ten,000 for the egg freezing and an average of more than than $12,000 per cycle for IVF—and having to use IVF to get pregnant. Women who already have a partner can, alternatively, freeze embryos, a more common procedure that as well uses IVF engineering science.

At home, couples should recognize that having sexual activity at the most fertile time of the bike matters enormously, potentially making the deviation betwixt an easy formulation in the bedroom and expensive fertility treatment in a clinic. Rothman'south study found that timing sex around ovulation narrowed the fertility gap betwixt younger and older women. Women older than 35 who want to become pregnant should consider recapturing the celebrity of their 20‑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, discover some relief from the smart women of Saturday Night Live.

"According to author Sylvia Hewlett, career women shouldn't wait to accept 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 take had a baby when I was 27, living in Chicago over a biker bar, pulling down a cool $12,000 a year. That would have worked out great." Rachel Dratch said, "Yeah. Sylvia, um, thanks for reminding me that I have to bustle up and accept a baby. Uh, me and my four cats will get right on that."

"My neighbor has this adorable, beautiful little Chinese infant that speaks Italian," noted Amy Poehler. "So, you know, I'll simply buy one of those." Maya Rudolph rounded out the rant: "Yeah, Sylvia, mayhap your next book should tell men our age to stop playing G Theft Auto III and holding out for the chick from Allonym." ("You're not gonna get the chick from Allonym," Fey advised.)

Eleven years subsequently, these four women have eight children among them, all just one born when they were older than 35. Information technology's good to be correct.

desrosierssympurs.blogspot.com

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

Share this post