These questions whisper inside my patients’ secret fears, the questions that haunt them when they can’t sleep in the middle of the night.
How old is too old? You might be surprised.
Sometimes that fear of age based infertility plays out in strange, unexpected ways.
When Nadia (names and details have been changed to protect my patients’ privacy) walked into my office, I couldn’t believe the information on her chart. According to the background information she had supplied, she was almost 45 years old. But the woman sitting across from me in the consultation room looked like a college student.
“I have good genes,” she replied, when I asked her to confirm if the birthdate on her chart was correct. “My grandmother never seemed to age, when she was eighty people still mistook her for a lady in her middle age.”
Nadia was here because she wanted a baby, and now that she was finally married to the love of her life she was ready to look into the possibility. It never occurred to her that, however youthful she looked and felt, Nadia’s ovaries were also 45 years old.
We discussed her history, completed the physical exam. And we arranged for a series of tests called OVARIAN RESERVE TESTING.
Even I was surprised when we got the results. Nadia’s ovaries were no longer producing viable eggs on their own. She was in pre-menopause. If we were lucky we would be able to stimulate the production of a healthy egg through hormone treatment; if not, Nadia was a good candidate for egg donation.
Nadia had a very hard time accepting the results of the Reserve Testing. “I feel like I’m still 25,” she said, her voice choked with tears. “How could I be infertile due to age?”
For many of my patients, this is their first and worst nightmare. Sometimes, people delay seeking treatment because they are afraid of a scenario just like this one.
But I want you to know…
I get these kinds of questions all the time:
“Doctor— am I too old to get pregnant?”
“Is my clock still ticking or has the window of opportunity closed for me?”
“Did I wait too long to start trying?”
“Didn’t Cheryl Tiegs get pregnant at 52? Geena Davis was 48, and Holly Hunter was 47. I’m sure they were just healthy…”
These are some of the most common questions I hear from patients every day. In some way or another every woman feels the pressure of time when she’s having trouble getting pregnant. And running out of time is one of those fears that keep women awake at night…worrying…and avoiding seeing a specialist. Keeping away because no one wants to ever hear it is too late.
The impact of age on fertility is a bigger issue in 2013 than ever before. Especially in New York and on Long Island it is a major issue for my patients. Why? Because approximately 20% of women wait until after age 35 to begin their families.
I remember a story my mother once told me about my grandmother. Decades ago she was in her mid 30′s and thought she might be pregnant. She was in shock…She told my mother what would she do? What would the neighbors and her friends think if an old woman of 35 like her was pregnant!? This was a different time. In the early 1900′s women married in their teens and had their first pregnancy by 20. The world is a very different place in New York in 2013.
The best information on the changing trends comes from the Centers for Disease Control (CDC). The average age of first-time moms is ever increasing over the past decades – rising from an average age of 21 in 1970 to 25 years in 2008. They also found that back in 1970 only 1 in 100 women had their first baby after age 35 but by 2006 that number had risen almost 10-fold to 1 in 12.
The news is full of mixed messages about women, age and fertility. I think the media does a lot to confuse women about age and fertility. On the one hand, if you look at celebrities it seems there is no limit to the age where someone can get pregnant. I’ve been fortunate to help women even in their 50′s achieve a safe pregnancy but like the celebrities you see on TV, fertility treatments were almost always used.
Often young women get the message that they can “have it all,” and that they can delay having children indefinitely while they pursue their career and look for their perfect mate. Often, people use the existence of fertility treatments themselves as evidence that they can just get a little help when the time is perfect to have a child.
A major study recently showed this “false-fertility security net” lets many women think they can wait indefinitely and just let science take care of it when the time is right. But it’s not always that simple. What’s worse the smartest career women I see who get all the right information often first start to worry about their age-fertility connection when its already far too late.
On the other hand, women often get the message that they are not “perfect.” The physical standards that women are expected to meet are so unrealistic and so punishing, that often women starve and exercise themselves into infertility. Ironically, they look fitter and even younger sometimes because they are so muscular and thin. But too rigorous a physical regimen, and too nutrient and calorie lacking a diet, and women who look young may be experiencing infertility as a result of societal pressure!
Like elite athletes I have cared for, triathletes, ballet dancers, and professional sports celebrities—extreme exercise and diet frequently forces the reproductive system to shut down. It’s the body’s way of responding to extreme physical stress. Any living creature fleeing for its life or starving would be unsafe to be pregnant.
Despite these mixed messages implying that age itself doesn’t matter when it comes to having children, women are very afraid about the impact of their age on their fertility. It’s in the top five fears of the patients I’ve seen. I’ve seen many women who are so scared about the answer that they avoid getting the help they need to get pregnant. They know the fertility clock keeps ticking, but they are paralyzed by the fear that they’ve already waited too long to get help and now it’s too late.
The irony is, age is sometimes not even a factor in a woman’s infertility at all.
Some are overjoyed when they find out age wasn’t even their cause of not getting pregnant! Worse yet are those couples who have a nagging feeling that their clock is ticking but those around them, especially their general ob-gyn and well-meaning friends and parents, keep telling them to just relax, plenty of people their age get pregnant.
So how can you tell if age is a factor or not?
What really matters when it comes to age and fertility is not the statistics, but YOU. You need to figure out how age is impacting your fertility (or not) and what to do about it.
Before we can talk about you, though, you need to get a basic background.
Why is Age a Bigger Issue for Fertility Than Ever before?
* contraception is readily available
* more women are in the work force
* women get married at much later ages
* the divorce rate remains high
* married couples are delaying pregnancy until they are more financially secure
* The rates of sexually transmitted diseases, obesity, smoking, and other factors that impair fertility has also skyrocketed
In fact extensive interviews with women who voluntarily delayed pregnancy only to find they were staring down the barrel of infertility found purposeful delays were often due to the woman’s uncertainty about her personal or financial relationships.
They wanted to wait for “right time in their life” when they felt stable enough. What’s more they wanted a chance to experience all the excitement and opportunities of life and to reach the heights of their careers. They also needed to secure their financial well-being and face the uncertainties of relationships in times of high divorce.
Hollywood and celebrities have us convinced that anyone can get pregnant into their 50′s. After all Cosmo keeps telling my patients “40 is the new 30.” Maybe for Cosmo yes but for your ovaries…No.
“But Doctor– I’m healthy, I work out every day, have 4% body fat, can run a marathon, and at peak health. I am younger than my birthdate says I am…”
Remember my patient Nadia? How you look and your fitness can’t tell you about your fertility!
At birth a woman has about 3 million eggs in her body. Boy that sounds like a safe huge number! But by the time of puberty at her first cycle only 300,000 are left! What happened to the rest? Even though a woman only ovulates a single egg each month she actually loses THOUSANDS of eggs each and every month. Ultimately only about 300 will ever make it to be released and have a chance of pregnancy and all the rest simply are lost.
Here’s some data from a landmark study about age and fertility
20 – 24 years old. 7% of women will be infertile
25 – 29 years old 9% of women will be infertile
30 – 34 years old 15% of women will be infertile
35 – 39 years old 22% of women will be infertile
40 – 44 years old 29%of women will be infertile
This is the double whammy of age and fertility. Not only does the number decline with age but the quality of the eggs plummets as well. What’s egg quality? I’ve been asked “are my eggs spoiled?” Eggs contain precious chromosomes which have the genetic DNA in them.
Research by many, including my group when I was at Yale University, showed the two most shocking age-fertility time bombs. The best eggs a woman has are released early in her life and as she gets older many of the remaining eggs were already damaged before birth!
The second time bomb is, over time those precious sleeping eggs accumulate new damage. The end result is by age 35 about half the eggs no longer can work and by age 40 only 1 on 5 eggs works (can create a healthy baby). That means the average 40 year old really only has 2 chances a year of success without treatment!
That’s why older eggs also raises the risk for miscarriage and genetic abnormalities like Down’s syndrome.
In a 20 year old only about 10% of pregnancies miscarry. In a 35 year old the number has doubled to almost 20%. In a 40 year old the risk jumps to 35% and over age 45 more than half of all pregnancies will miscarry due to damaged eggs.
Now realize these are average numbers only to help you get educated to make your own best decisions. YOUR exact age number may be better or worse than these averages. Like I tell the couples I help – you are more than just your birthday – that number is a starting point.
But how can you tell if age is a factor? I’ll give you the secret…your True Ovarian AgeTM.
To find out how age affects your fertility, you will need to get some tests to determine your personal ovarian reserve and function.
You need to discover your True Ovarian AgeTM. At Gold Coast, we have a muti-faceted 5-part system for analyzing your ovarian function and overall fertility, and assessing the impact that age is having, or not having, on your fertility.
My next article here at Get Pregnant Now will talk about these tests and what we do to determine your True Ovarian AgeTM. But you can take action this minute and get the information you need.
I know how hard it is to pick up the phone and take that next step of getting the information you need to move forward. So many patients have told me how they believed it was already too late.
It’s not too late. Today virtually all women who want to be pregnant and are facing age issues can have a successful pregnancy with the amazing advances in fertility treatments.
To help, we have a free, confidential 800 number that provides education to people who are still learning about their personal situation. This free recorded message is available 24 hours a day, seven days a week.
Call in and get important information about how to stop those voices of fear and start on the journey to parenthood, now.
All the best,
Steven F. Palter, MD
Gold Coast IVF
PS My office number is (516) 682-8900 – if you are ready, please feel free to call me directly.
But if you are still learning about your options, the recorded information hotline is at 800-799-HOPE
Fertility and Sterility’s November, 2011 feature article author interview. Video and New media editor Steven Palter interviews Dominique deZiegler on the potential benefits and controversies about growth hormone use for IVF poor responders. Does it improve egg quality or quantity or have no benefit at all. Review of published scientific data further analyzed by the cause of the patient’s poor response.
Women’s reproductive disorder responsible for more than 10 hours lost productivity per week and quality of life impairment equal to that of some cancers. There was an average 7 years delay in treatment even after women presented with symptoms and the delay was worse in public funded health systems than in private. landmark study was conducted in 10 countries and included diverse populations of women . Interview with authors of featured video article of August 2011 edition of Fertility and Sterility
Are the Rules for Diagnosing Ectopics Wrong?
ASRM Fertility & Sterility January 2012 Feature Article Author Interview with Dr Kurt Barnhart by New Media Editor Dr Steven Palter. Discussion of hCG levels in Ectopic Pregnancies–Exceptions to the Rules. Author Provides New Recommendations on interpreting hCG levels to diagnose ectopic from viable normal pregnancies based on new research.
Medical research teaching has remained essentially unchanged for over 150 years….until now. Dr. Steven Palter has been named the first ever Editor for video and New Media for the world’s leading fertility journal Fertility & Sterility. F&S is the official publication of the American Society for reproductive Medicine (ASRM). Dr. Palter was honored to be hand selected to lead the society and the journal into the 21st century. Internationally recognized as a leading innovator in fertility and the “visionary of our specialty” Dr. Palter has begun a series of initiatives to transform how fertility and medical research in general is published shared and taught.
See the exciting new developments in multimedia interactivity in Fertility & Sterility and how they can help you keep up
with the explosive volume of new developments. Author interview videos, original video articles, discussion forums, and more!