Women of all ages know far too well what it's like to hear their biological clock ticking away. It can be stressful knowing there's a time limit to fertility, but as with all health issues, knowledge is power. Here's a look at the pros and cons of attempting to get pregnant in each decade, and what you can do to better your chances.
Odds of Getting Pregnant
Biologically, this is the prime time to get pregnant. In fact, the odds that a woman in her 20s will get pregnant each month are around 20 to 25 percent, the highest they'll ever be. But this doesn't mean that young women can't face fertility issues. "No one is immune to infertility," says Richard Paulson, M.D., chief of the division of reproductive endocrinology and infertility at the Keck School of Medicine of the University of Southern California. "While women in their 20s generally have good egg quality, all the other causes of infertility can still be present, such as tubal issues and low sperm count in the male partner."
From a physical standpoint, there are many benefits to starting a family in your 20s. Not only do you have higher odds of getting pregnant, you also have lower chances of experiencing complications such as miscarriages and chromosomally abnormal pregnancies, as well as health issues that include gestational diabetes. On average, younger women's bodies can often handle the demands of pregnancy better than their older counterparts can, and new moms in their 20s may have a lot more energy to run after toddlers. Plus, if you want to have a large family, you'll have more time to space out birthing your kids. Just keep in mind: Many experts recommend that women wait at least 18 months or more before trying to get pregnant again. Talk to your doctor about what's best for you.
The risk of developing preeclampsia -- when a pregnant woman develops high blood pressure and protein in her urine -- is highest among first pregnancies, when most women in their 20s are likely expecting for the first time. Preeclampsia, in rare cases, can lead to serious complications for both the mother and fetus, but it is usually manageable.
There's also the emotional factor of having kids at a young age, especially when women veer off their professional path, which they might regret down the road. "Many women who conceive in their 20s feel like they didn't pursue their dreams or achieve the career goals they had hoped they would," explains Aimee Raupp, fertility expert and author of Yes, You Can Get Pregnant: Natural Ways to Improve Your Fertility Now and into your 40s. "Some say they rushed into getting married or finding their partner and now have some regrets surrounding their relationship." (Of course, that's not always the end of the story: Once these women's kids are older, many resume following their passions.)
Some women in their 20s still have a lot of debt (like school loans) and they might not be as financially secure as they'd like to be before bringing a child into the mix. This can add a lot of stress to any relationship.
All pregnancies come with risks, but many risks increase with age. According to the American Pregnancy Association, the risk of having a baby with Down syndrome is 1/1600 at age 20 and 1/1300 at age 25. Risks of any chromosomal abnormality are 1/526 and 1/476, respectively. But keep in mind that these are the risks at birth. "The vast majority of pregnancies with chromosomal abnormalities at any age result in spontaneous miscarriage in the first trimester," says Eric Widra, M.D., medical director of the Shady Grove Fertility Center, a leading fertility center in the United States, and director of the division of reproductive endocrinology and infertility at Georgetown University.
Younger women might still have some bad habits left over from their high school or college days that can sabotage fertility. They may still subsist on a diet composed of a lot of fast food and alcohol, or they may not have lost the "Freshman 15." The good news is that women in their 20s can still take steps to optimize their odds of getting pregnant. For instance, weight plays an important role in conception, but many young women tend to be very underweight or overweight, explains Raupp. "Maintaining a normal BMI and adopting a pre-conception plan of eating a nutrient-dense diet, limiting alcohol and caffeine, and avoiding cigarettes helps a woman achieve her most optimal health prior to conception," she says. "That way, she can more likely conceive with ease, have a healthy pregnancy, and bring a child into a healthy home."
Traditionally, women in their 20s have been advised to seek help from a fertility specialist after trying to get pregnant for a full year, but some experts suggest you should see a doctor even sooner. "I recommend getting help after six months of trying, even sooner if you suspect something is wrong, such as having irregular periods," says Dr. Paulson. In fact, if you aren't getting your period at all or if your cycles are longer than every 35 days, seek help immediately, says Dr. Widra. Talk to your doctor if you have a family history of early menopause or a known history of pelvic abnormalities, sexual dysfunction, or any other medical conditions that might affect fertility, including your partner's medical problems, which may affect his sperm count.
The treatment options don't vary much based on age -- they just vary in their effectiveness. For instance, there's ovulation induction through the use of oral medication and intrauterine inseminations. "In vitro fertilization [IVF] is the most effective treatment for most forms of infertility," says Dr. Widra. For women under 35, the success rate of IVF is 41 to 43 percent, according to the American Pregnancy Association. Along with age, however, factors that can affect whether or not IVF works include a woman's reproductive history, her particular diagnosis, and her partner's sperm count.
Don't discount the male's role in fertility. "Male factors are present in 30 to 50 percent of couples seeking care for infertility," says Dr. Widra. "Semen analyses are, as I tell my patients, pain-free, risk-free, and inexpensive. This is a critical step in evaluation."
Odds of Getting Pregnant
On average, a woman in her 30s has a 15 to 20 percent chance of getting pregnant each month. Fertility gradually declines throughout the decade, especially after age 35.
Women in their 30s still have the stamina to handle middle-of-the-night feedings and basic baby care, and they have more financial security than when they were younger. "A woman in her 30s is more settled in her own skin, and since her peer group is more likely to have children around the same age, she has that support network," adds Raupp. Though fertility is dipping a bit, it's not necessarily in the danger zone, especially for women in their early 30s.
According to the American Society for Reproductive Medicine, as a woman reaches her mid- to late 30s, she's less likely to become pregnant and more like to have miscarriages because the quality and quantity of her eggs are dwindling.
Women at this age might feel tremendous anxiety when it comes to having children. "Women in their 30s are trying to keep up with their friends who are starting a family, and their doctors and family members often pressure them to get pregnant immediately for fear of fertility challenges due to advancing maternal age," says Raupp. "I often see a lot of emotional stress surrounding conception for these women."
Along with making sure their weight falls in a normal BMI range and that they are following a preconception plan, women in their 30s should consider the birth control they've been using. "If they've been on the pill for over five years, they should plan to stop it before trying to conceive," says Raupp. "The body may need time to reestablish a regular ovulatory cycle." Although some women may have delays in resuming their menstruation cycle, plenty of women will still be able to get pregnant right away. In fact, "the vast majority of women will revert to their historical cycle pattern and fertility as soon as they stop," says Dr. Widra. So you don't have to stop taking birth control too far in advance of trying to conceive, but always consult your gynecologist about the best plan for you.
Women in their early 30s should get help after trying for six months to a year; those between 35 and 39 should definitely seek assistance after six months. If you have any of the risk factors mentioned for women in their 20s, talk to your doctor about possibly seeing a specialist sooner.
A woman in her 30s has the same options as women in their 20s, but the course of action might vary by the diagnosis, the specific age of a patient, and other factors, says Dr. Widra. If you're going to seek treatment for infertility, it's best to do it sooner than later, especially if you want to get pregnant without the use of donor eggs. "The real issue with aging is that the opportunity to help couples declines rapidly with age, and time becomes a more valuable commodity," says Dr. Widra.
Odds of Getting Pregnant
By age 40, a woman's odds of getting pregnant is less than 5 percent each month. For women ages 45 to 49, those odds dip as low as 1 percent.
Many women who have children in their 40s feel very prepared for motherhood, even though they know the odds are lower when it comes to fertility. "Women in their 40s often seem at peace around the potential obstacles when it comes to conceiving," adds Raupp. "That's not to say that many of them aren't dealing with the same stressors of younger women, but they seem more at ease in their own skin, more confident mentally and financially, and more willing to follow a plan to optimize their health and fertility."
But all obstetrical risks (such as gestational diabetes, hypertension, miscarriage, delivery complications, the need for a Cesarean, prolonged labor, and giving birth to a child with a genetic disorder) increase as a woman gets older. And the quantity and quality of a woman's eggs -- the key to fertility -- are both rapidly declining. "In the world of reproduction, nothing gets better with age," says Dr. Paulson.
The risk of Down syndrome is 1/90 at age 40 and 1/30 at age 45. Risks of any chromosomal abnormality is 1/66 and 1/21, respectively.
Along with the healthy lifestyle changes that women in their 20s and 30s should adopt, it helps greatly to put things in perspective. "Age shouldn't always be taken as a guarantee of fertility," says Raupp. "When one optimizes health -- mentally, physically, and nutritionally -- then fertility may optimize as well. My biggest message to all women who are trying to conceive is to have faith in your body, treat it like the palace that it is, and do what you can to achieve emotional peace." This includes making sure you get plenty of sleep each night and that you do what you can to limit stress. Some experts recommend yoga, acupuncture, exercise, or meditation accomplish that, but always talk to your doctor about what's right for you.
The jury's out on when women in their 40s should seek help from a fertility specialist: some say after three months of trying to get pregnant naturally; others say six. But there's nothing wrong with being preemptive. "For women in their 40s whose time is very precious, it's perfectly okay to go in for basic testing even prior to trying," says Dr. Paulson.
Women in their 40s have the same treatment options as do those in their 20s and 30s, though success rates are drastically lower. For instance, by age 44, a woman's odds of becoming pregnant through IVF are less than10 percent. Keep in mind, however, that while it's true to say that fertility declines with age, it's more precise to say that it declines with the age of a woman's eggs. That's why older women might want to (or need to) consider egg donation as a means of getting pregnant. "Women in their 40s who are recipients of eggs donated by younger women get pregnant at the same rate as the women who donate those eggs," explains Dr. Paulson. "That is why egg donation is so effective in circumventing the biological clock -- it's all about the egg!"
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