Facing Reality

I am approaching the end of my service term and have reached a crossroads. What to do next weighs on my mind, since I am attempting to move in what I perceive as opposite directions: starting a family or pursuing my career transformation (since I gave up my therapy profession when I relocated). These tasks are enormous. I have more control over the development of the latter than the former. So for my peace of mind, lately I’ve begun to ponder a serious job search for another position in the non-profit sector.

And yet, the other goal pulls my attention away. I hesitate to search if I am only to give it up again in order to become a parent. It’s a huge undertaking — pregnancy and birth and mothering — and at this point in my life I do not see myself powering through all that and a full-time job. Not with my middle-aged body.

I’ve also been doing some research on that goal of getting pregnant. What I am finding confirms my body’s intuition. Each month my body is telling me that it is changing; my cycles are varied, the length of periods are shorter. I wake up in a sweat more often and I experience insomnia more often as well. My sense is that I am entering perimenopause, and the door is shutting, has been shutting, on the possibility of bearing children for some time now. There is grief in this, and this grief is intensified over the fact that my husband holds out hope. He wants to keep trying. He asks me to think positively. Yet all the positive thoughts I summon can’t outfox biological reality.

For my own future reference, I’ve posted some statistical information about pregnancy after 40 that, by reading and re-reading, forces me to confront the probable reality. I’ve emphasized text I think especially pertinent. (Also, for the record: adoption is a possibility, yes. But there remains a valid sadness in recognizing that certain opportunities can be lost by waiting too long, and this is where I am at the moment.)

From Babycenter.com.

The biggest downside to putting off pregnancy until your 40s is significant: It’s harder to get pregnant the longer you wait. The principle reason: as early as 15 years before a woman goes through menopause, the number of her eggs begins to decline, and the eggs that are produced are more likely to have chromosomal problems that raise the risk for miscarriage and birth defects.

There’s a big difference in egg viability between the early 40s and the mid- to late 40s. “There’s a steep drop in fertility in the 40s,” says Julia Johnson, a professor of obstetrics and gynecology at the University of Vermont. “Your odds of getting pregnant at 41 are much better than they are at 43.”

A recent study in the medical journal Fertility and Sterility confirms Johnson’s point. Researchers found that 40-year-old women treated for infertility had a 25 percent chance of achieving pregnancy using their own eggs. By age 43 that number dropped to 10 percent, and by 44 it had plummeted still further, to 1.6 percent. Among women who did get pregnant, the miscarriage rate was 24 percent for 40-year-olds, 38 percent for 43-year-olds, and 54 percent for 44-year-olds.

Fertility expert James Goldfarb says that in his 30 years on the job, he has never seen a woman get pregnant with her own eggs after age 46. “It’s like buying a lottery ticket,” he says. “Yes, someone wins every once in a while, but you shouldn’t bank on it.”

Using a donor egg boosts the odds of getting pregnant considerably, and according to Goldfarb, that’s how most of the older celebrity moms are doing it — whether they admit it or not. “The fact that they don’t talk about it openly does a real disservice to other women,” he says. “We get at least one patient a month who comes in with the false hope that she can get pregnant using her own eggs.”

Pregnancy complications are another concern. In your 40s you’re far more likely to develop problems like high blood pressure and diabetes during pregnancy, as well as placental problems and birth complications. Women over 40 have a higher risk of delivering a low-birth-weight or preterm baby. Stillbirth rates are also higher, and studies show that children born to older mothers are themselves at increased risk of type 1 diabetes and high blood pressure.

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Two-thirds of women over 40 have fertility problems according to the American Society for Reproductive Medicine (ASRM). Once you pass 40, time is pitiless. You have about a 5 percent chance of getting pregnant in any single ovulation cycle, according to leading fertility specialist Sherman Silber, director of the Infertility Center of St. Louis at St. Luke’s Hospital in Missouri and author of four best-selling fertility books, including How to Get Pregnant. At 40 your chance of conceiving within a year of beginning to try is about 40 to 50 percent, compared to a woman in her mid-30s, who has a 75 percent chance. By age 43, a woman’s chance of pregnancy plummets to 1 or 2 percent.

Why the steep drop-off? Silber says it’s all about the eggs. From the time you reach puberty, with your eggs numbering between 300,000 and 400,000, you’ll lose about 13,000 eggs a year. Over the years this steady drop in egg supply will leave you with about 25,000 eggs by age 37. At 37 comes a precipitous drop in fertility. “By age 43, you’re really at the end of your egg supply,” Silber says, “and your chances of pregnancy are slim.”

Miscarriage rates begin to skyrocket in your 40s as well. From age 40 to 44, the rate is 34 percent, and it rises to 53 percent for women 45 and older (compared to 10 percent at age 20 and 12 percent at age 30). After age 40, the risk of pregnancy complications, such as high blood pressure and diabetes is twice as high as it is for a woman in her 20s. The odds of genetic problems also jump as you get older: At 40, your chance of having a child with Down syndrome is one in 106; at 45 it’s one in 30. Since risks of genetic problems increase in this age group experts routinely recommend detailed fetal screening such as amniocentesis or chorionic villus sampling during pregnancy for women this age.

First-time mothers over 40 also have a 43 percent chance of having a cesarean (versus 14 percent for first-time mothers in their 20s) as a result of delivery complications. Incidents of low-birth-weight and stillborn babies are higher as well.

Explore posts in the same categories: Journal, Nature, Pregnancy

9 Comments on “Facing Reality”

  1. William Sackinger Says:

    The statistics do not necessarily apply to your specific case. Remember that I was born when my mother was 44 1/2. And I also should mention that my spouse and I have had six children, all by Caesarian section. Do not be afraid of that part of it.
    You would find that raising a child (even twins, twice as good) would bring forth all of the skills that you have learned during your adult years, and concentrate them in the children, who would feed them back to you for the rest of your life, as closest relatives do…and they will pass them forward to their own descendents as well. Your genetics are of very high rank and deserve to live on, as the human race moves into the new millenium.
    No one can guarantee the absence of random birth defects, such as you have discussed. But, most of them can somehow be accomodated. I think that you and your spouse are on the right track to maximize the possibility of conception, and you can also contact a good fertility clinic to maximize your biological factors. Good luck!
    Bill

  2. M Sinclair Stevens Says:

    I disagree completely with Mr. Sackinger above. Do not let either guilt or regret make you feel pressured to have a baby.

    My brother was born with birth defects that left him unable to walk, talk, or feed himself. He was in diapers for the 46 years that my parents cared for him until his death. By the time my parents were in their 70s caring for my brother was a physically daunting task. (Fortunately other family lived nearby to help.)

    I’m not just trying to scare you–despite the love we have for all children regardless of their mental and physical health–spending the rest of one’s life taking care of a child born with birth defects probably does not fulfill one’s fantasy of child rearing. I do not know what your dreams for having a child entail but try those dreams out on a child with MS or Down Syndrome or ever one with autism. Is it the same?

    Your body is beautifully designed to produce children. The fact that it shuts down production as the chances of producing a healthy child decrease is not accidental. That we’ve developed technology to subvert nature does not mean we should use it

    Children are not some magic form of validation as Mr. Sackinger suggests. You raise them, you worry about them, they leave. They do not sit adoringly at your feet and tell you what a great parent you’ve been. They do not take all the lessons you’ve taught them and pass them on to their children. You do not have, as he chides, a duty to humanity to pass on your superior genes.

    You might think I’m down on parenting–and I’m not. I’m down on people trying to make you feel guilty for looking at the probabilities and making the choice that’s right for you.

    Whichever you decide, I wish you the best.

  3. Liora Says:

    At 38, I’m thinking about these same things and feeling the same pressure. However, I want to prepare myself for the fact that I may not become a mother. I don’t want to have a complete crisis if that happens. I comfort myself with the fact that there are many women who actually choose not to become mothers. When I analyze what appeals about having a child, some of it is wanting to pass along something, wanting to have a part of me that survives after I’m gone. A legacy. This is when I think things like, If I don’t have children, I will create books that will be my legacy. I will pour that energy into nurturing and creating such books that they will be my children as much as populating the earth with more humans could ever be.

  4. Liora Says:

    “You do not have, as he chides, a duty to humanity to pass on your superior genes.”

    I agree. This statement bothered me when I read it. There’s no duty there. The only duty to humanity is to live fully and pass on something. That’s my belief.

  5. gerry rosser Says:

    My perspective is that of a childless man. I certainly have no inkling (other than common humanity) how the urge to reproduce affects a woman (meaning I think it’s programmed in the genes, while being subject to intellectual and emotional tides). Four years ago my stepdaughter was lucky enough to have a child via in vitro, it was not an easy or inexpensive process. We all love this kid to pieces. I really appreciate this chance to relate to a child (well, “appreciate” is a pretty weak word in this context, I love it and her). I don’t have “regrets” about being without children, I don’t fancy my genes will be missed in the human pool, but I guess I’ll always wonder. Anyway, I hope it all resolves in a way which leaves you going forward happy. As a short-term reader of your web page, I think you’ve added a lot to the world already.

  6. Bonnie Says:

    I am a grandmother who raised three children, and lost one when he was 22 years old due to a car wreck. There are no guarantees anywhere along the way. Live your life as if each day is the most important one . If the job/career/endeavor that will be your life’s work is something you enjoy and receive satisfaction from, then pursue it. If you conceive in the middle of that, then make your choices based on your options. Give up the work temporarily and go back to it later or not. You just can’t plan your future….you can only live your present.

  7. Bonnie Says:

    I am a grandmother who raised three children, and lost one when he was 22 years old due to a car wreck. There are no guarantees anywhere along the way. Live your life as if each day is the most important one . If the job/career/endeavor that will be your life’s work is something you enjoy and receive satisfaction from, then pursue it. If you conceive in the middle of that, then make your choices based on your options. Give up the work temporarily and go back to it later or not. You just can’t plan your future with certainty.

  8. shirl Says:

    as you know, I have no children. There are regrets, but you learn to live with them. Just today, I was getting a haircut at a new place. The gal asked if I had children. So sad, she said. It is, but it isn’t.

    Love to you, Kathryn.

  9. lisa Says:

    hello I am a very lucky woman! I have a teenager and a new baby. I enjoy them both. I want another baby at 40yoa and we will go into it being educated about our choice. Yes you have the chance of birth defects and miscarriage. You just need to know that from the start and go appropriately. life is worth it. at this point in life you know what you want and go after it. you have your careers established and it is all good. i am so thankful for our newest son. we hope for a girl next. good luck and live your life…. smiles