With the recent announcement of Meghan Markle and Prince Harry’s engagement, the focus is once again on the effect of advanced maternal age on fertility. Women are waiting longer and longer to start a family and this is having significant impacts on the prevalence of infertility. Meghan Markle is 36 and her and Prince Harry have already hinted at wanting to start a family. What impact will her age have on her plans to start a family? What should women know about the impact of age on fertility?
How Common is Advanced Maternal Age?
It is becoming more and more common for women to put off motherhood well into their 30s. Advanced maternal age is defined as a woman giving birth after 35. In 2014 9% of first births were to women over 35 years of age. The average age of women having their first child increased to over 26 in 2014. This is an substantial increase from 21 in 1970.
Women are putting off motherhood for careers and education. More and more women are going to graduate schools and changing careers early in life. The other reason women are putting off motherhood is because they are putting off marriage. Women are dating for longer and dating more people. This isn’t necessarily a bad thing. With the increased use of contraception women are able to spend more of their lives dating. Delaying marriage typically delays starting a family. And waiting until you are in your 30s or 40s to start a family can significantly impact your chances of having children.
Do Women Know?
Do women know how putting off motherhood can affect their chances of having children? Do women know that on average their fertility begins to decline at 24? I am not saying all women desire to have children. But for the women who do plan to start families, they should be informed.
As a midwife I believe it is my duty to inform women of the decrease in fertility with age. When a woman in her late 20s or 30s comes to me for contraception I am more than happy to help her obtain contraception. But at the same time it is my responsibility to inform her that fertility declines with age and the risks of pregnancy increase with age.
What causes the decrease in fertility?
Women’s decrease in fertility occurs due to 2 main factors. The first factor is a reduction in the number of remaining eggs. This causes a decrease in the occurrence of ovulation and without an egg to fertilize, fertility decreases.
The second factor is in the quality of the eggs. With age the rate of mutations in the eggs increases. When eggs are released with mutations these mutations either don’t allow a pregnancy to occur, result in miscarriage or result in a child with genetic anomalies. This is why older women are at a higher risk of having a child with genetic mutations such as Down Syndrome.
When does the decline in fertility occur?
I said fertility begins to decline at age 24. That is because women 24 years of age have the highest rate of pregnancy resulting from unprotected sex. However, throughout a woman’s 20s fertility remains high. It isn’t until the early 30s that fertility begins to significantly decline. At the age of 37 a rapid decline in fertility begins and by the age of 43 very few women can obtain pregnancy spontaneously (without the use of IVF).
One study looked at the likelihood of pregnancy when women had sex on their most fertile day. The study divided the women into 3 categories. Below are the results:
|Women 19-26||50% chance of becoming pregnant in 1 cycle|
|Women 27-34||40% chance of becoming pregnant in 1 cycle|
|Women 35-39||30% chance of becoming pregnant in 1 cycle|
What can women in their 20s and early 30s do?
If you don’t plan on trying for a baby soon, but you know you will want a baby down the road- consider freezing your eggs. It can be expensive, but some employers are now paying for it.
If you are considering freezing your eggs, do it as soon as possible. The age at which you freeze your eggs has a significant impact on the quality of the eggs. However, the success rates of pregnancy using frozen eggs is unknown. Most studies look at frozen donor eggs. With the use of frozen donor eggs the rate of pregnancy success is almost 50%! However donor eggs come from young and healthy women. So if you wait until you are in your 30s you can assume your success rate is likely lower than 50%.
Another option is to freeze an embryo. The likelihood of success with a frozen embryo is higher. However, there is a catch. In order to freeze an embryo you need to know who you want to make a baby with. Freezing an embryo is a good option for a couple that knows they want to oneday start a family, but they aren’t ready quite yet.
It also also important to practice self care to maintain your fertility as high as possible. Use protection when having sex. Sexually transmitted infections (STIs) can cause scarring in the fallopian tubes resulting in issues with fertility. Maintain a healthy weight and engage in regular exercise. See your midwife, nurse practitioner or gynecologist regularly. Your provider will make sure you are getting your PAP Smear, testing for STIs and screen for any abnormalities in your menstrual cycle.
What can women in their mid and late 30s do?
Start trying to have a baby today! If you know in your heart you want to have a baby and become a mom- why wait? More women today are becoming single moms and using donor sperm to start their family. You don’t need to wait for a man (or partner). Get started as soon as possible. Your doctor will do all the testing to assess your ability to have a baby using donor sperm. He or she will likely recommend IVF over IUI (intrauterine insemination) due to the higher success rates.
If your ovarian reserve is low and you can’t use your own eggs, then you can consider using a donor embryo. This gives you the ability to carry a fetus and become pregnant with an embryo from donor sperm and a donor egg.
Of course, the last, but not least option is adoption. Adoption can give you the family you want regardless of your age or marital status. However, don’t be fooled- adoption can also be a long and expensive road.
My advice to all women
Don’t wait! If starting a family is important to you don’t let other things get in the way. You can’t do anything about your age so the sooner the better. I’m not saying school and jobs aren’t important. You need to make sure the time is right for you and that you are ready to have a baby. But it is important to know the effects of age on fertility.
Age also affects men’s fertility, just as advanced maternal age affects a woman’s fertility. Men’s fertility begins to decline at 35 and then again at 40. Additionally, advanced paternal age can have an effect on fetal outcomes such as autism and genetic disorders. Checkout my article on Advanced Paternal Age